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Child asthma review (up to 12 years old)

Child Asthma Review

Section

Asthma Control Score

Questions for Child

How is your asthma today? *
How much of a problem is your asthma when you run, exercise or play sports? *
Do you cough because of your asthma? *
Do you wake up during the night because of your asthma? *

Questions for Parent or Gurdian

During the last 4 weeks, how many days did your child have any daytime asthma symptoms? *
During the last 4 weeks, how many days did your child wheeze during the day because of asthma? *
During the last 4 weeks, how many days did your child wake up during the night because of asthma? *

Inhaler Technique

Please select the types of inhalers that you use:

Please watch these short video(s) on how to use your inhalers

Please let us know that you have watched and understood the video(s): *

Asthma Care Plan

Do you have a care plan?

Additional Questions

Do you smoke?
How many cigarettes do you smoke in a day?
Would you like to be seen by our smoking cessation adviser?
Are you exposed to tobacco smoke at home/in public places?