Adult Online Asthma Review

Adult Online Asthma Review Questionnaire

Non-urgent advice: Welcome

Welcome to our Online Asthma Review Questionnaire.

Any patient aged 16 and older with a diagnosis of asthma can do this questionnaire.

The purpose of this questionnaire is to review your asthma symptoms and control.

Adult Asthma Annual Review Questionnaire

Current Health Status

In this section we will ask you general questions about your current health.
Please select one of the following with regards to your smoking status.
If you currently smoke, are you interested in trying to quit or reduce your smoking?
How many units of alcohol do you consume per day?
For example – 12st3 or 78kg
For example – 6ft or 1.82m
If you do not know your blood pressure reading, then please call into the surgery and use our free BP machine located in reception. This will also record your height and weight. No appointment is required. Please ask reception for a gold token to use the machine

Asthma Control Questions

In this section we will ask you questions regarding your asthma control and management.
How compliant are you with your inhaler or how would you rate your technique?
During the past 4 weeks, how often did your asthma prevent you from getting as much done as possible at work, school or home?
During the past 4 weeks, how often have you had shortness of breath?
During the past 4 weeks, how often does your asthma symptoms wake you up during the night or early morning?
During the past 4 weeks, how often have you used your reliever inhaler (usually blue)?
During the past 4 weeks, how would you rate your asthma control?

Asthma Review

The last part of the questionnaire, will ask you if you feel your asthma is well controlled and will give you the option to decide if you would like further review from a Practice Nurse.
Do you feel that asthma symptoms and management are well controlled at the moment?