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Take the Asthma Control Test (ACT)

Know your score.
The Asthma Control Test provides a numerical score to help you and your healthcare provider determine if your asthma symptoms are well controlled.

Add up the score for each of the first 5 questions. 
If your score is 19 or less, your asthma symptoms may not be as well controlled as they could be.
If your score is 15 or less, your asthma may be very poorly controlled. Please contact the surgery right away. There may be more you and your healthcare provider could do to help control your asthma symptoms.

Please find a link to an asthma management plan, which can be a useful tool for managing your asthma day to day. The following link will open in a new window. After reading it, please return to this page to finish this questionnaire.
Asthma Management Plan

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* 1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?

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* 2. During the past 4 weeks, how often have you had shortness of breath?

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* 3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?

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* 4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)

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* 5. How would you rate your asthma control during the past 4 weeks?

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* 6. How many exacerbations have you had in the last year (when your asthma was much worse than normal)?

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* 7. Please let us know your name

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* 8. and your date of birth

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* 9. If you would like to add any additional information please write in the Comment box below:

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* 10. What is your smoking status

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