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Asthma

Is Your Asthma Controlled?

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Question 1 of 5

In the past 4 weeks, how much of the time did your asthma stop you from getting much done at work, at school or at home?

  • ANone of the time
  • BA little of the time
  • CSome of the time
  • DMost of the time
  • EAll of the time

Question 2 of 5

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

  • ANot at all
  • BOnce or twice a week
  • C3 to 6 times a week
  • DOnce a day
  • EMore than once a day

Question 3 of 5

During the past 4 weeks, how often have you used your bronchodilator (which is sometimes called a "rescue inhaler") or a nebulizer?

  • ANot at all
  • BOnce a week or less
  • C2 or 3 times a week
  • D1 or 2 times per day
  • E3 or more times a day

Question 4 of 5

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

  • ACompletely controlled
  • BWell controlled
  • CSomewhat controlled
  • DPoorly controlled
  • ECompletely uncontrolled

Question 5 of 5

During the past 4 weeks, how often did your asthma symptoms wake you up at night or earlier than usual in the morning?

  • ANot at all
  • BOnce or twice
  • COnce a week
  • D2 to 3 nights a week
  • E4 or more nights a week
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