How frequently have you had difficulty sleeping due to your asthma?

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* 1. How frequently have you had difficulty sleeping due to your asthma?

Have you had your usual asthma symptoms during the day

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* 2. Have you had your usual asthma symptoms during the day

How often does your asthma limit your activities or exercise?

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* 3. How often does your asthma limit your activities or exercise?

How often do you need to use your reliever inhaler?

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* 4. How often do you need to use your reliever inhaler?

Since your last review, have you needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of your asthma?

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* 5. Since your last review, have you needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of your asthma?

Since your last review, have you needed a course of steroid tablets to get your asthma under control?

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* 6. Since your last review, have you needed a course of steroid tablets to get your asthma under control?

Do you smoke?

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* 7. Do you smoke?

Please list the inhalers you use daily or on a regular basis (name/strength/how many puffs/how many times a day/via a space device?):

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* 8. Please list the inhalers you use daily or on a regular basis (name/strength/how many puffs/how many times a day/via a space device?):

What is the primary reason you choose not attend an asthma review appointment?

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* 9. What is the primary reason you choose not attend an asthma review appointment?

About You

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* 10. About You

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