Asthma Review

 
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Asthma Review

Asthma Review 

What is an Asthma Review?

  • It is intended to measure and assess well you are managing your condition.

What does it involve?

  • There are 5 questions relating to different situations.
  • Once you have scored each question the values are added together to give an indication of how you are managing.
  • On reviewing your submission, a nurse may want to speak to you or arrange an appointment, please ensure we have the correct contact number for you so we can contact you as required.

Once received it can take up to 1 month to review your answers

  • If you are in need of urgent advice/treatment call the surgery or call 111
  • Call 999 in life threatening situations
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All questions marked with a * are mandatory

Patient Details
Please double check you've entered the correct email address
May be used to identify you

Children must be aged 4 or over to take the Asthma Control Test.

This form is not suitable for those under 4 years so you cannot continue: *
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Asthma Questions

During the past 4 weeks

How often did your asthma prevent you from getting as much done at work, school or home?: *
How often have you had wheeze or shortness of breath?: *
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?: *
How often have you used your rescue/reliever inhaler (such as salbutamol or MART): *
How would you rate your asthma control during the past 4 weeks?: *

Have your child answer these questions

How is your asthma today?
  • Very Bad
  • Bad
  • Good
  • Very Good
How much of a problem is your asthma when you run, exercise or play sports?
  • Very It's a big problem, I can't do what I want to do
  • It's a problem and I don't like it
  • It's a little problem but it's okay
  • It's not a problem
Do you cough because of your asthma?
  • Yes, all of the time
  • Yes, most of the time
  • Yes, some of the time
  • No, none of the time
Do you wake up during the night because of your asthma?
  • Yes, all of the time
  • Yes, most of the time
  • Yes, some of the time
  • No, none of the time

Please complete the following questions on your own

During the past 4 weeks

How many days did your child have any daytime asthma symptoms?: *
How many days did you child wheeze during the day because of asthma?: *
How many days did your child wake up during the night because of asthma?:
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Well Done

, your score is 

Your asthma appears to have been under control over the past 4 weeks.

If you are experiencing any problems with your asthma

  • Book an appointment with a nurse or GP as soon as possible

On Target

, your score is 

Your asthma appears to have been reasonably well controlled during the past 4 weeks.

If you are experiencing any problems with your asthma

  • Book an appointment with a nurse or GP as soon as possible

Off Target

, you have a score of 

Your asthma may not have been controlled during the past 4 weeks.

Your doctor or nurse can recommend an asthma action plan to help improve your asthma control.

  • If you have symptoms, please book an appointment with a nurse or doctor as soon as possible or call 111
  • Alternative visit a pharmacist for further advice
  • Call 999 in life threatening situation.

Your Child's Score: 

  • If your child’s score is 19 or less, it may be a sign that your child’s asthma is not controlled as well as it could be.
  • No matter what the score, please continue to complete this form.
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Additional Questions
Exacerbation means your asthma has become worse and you required antibiotic and / or oral steroid treatment
Since the last review, was there a need for a course of steroid tablets to get asthma under control?: *
Is there an action plan?: *

Please read "What is as Action Plan"

An asthma action plan is very useful particularly when your asthma is not well controlled. The practice will contact you for review if this is required and the nurse will fill this form out with you

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Inhaler Technique

If you would like more information on inhaler technique or have any concerns you are not using your inhaler(s) properly please look at the following links for further information and helpful videos.

Guides about using your inhalers

Guides about using inhalers

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Asthma Attack

Having an Asthma Attack

What to do when you are having an Asthma Attack

Find our what to do in an Asthma Attack

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Lifestyle
Smoking Status
Please choose from one of the following options: *
Stop Smoking

Steps to quit smoking

Stopping smoking lets you breathe more easily. People breathe more easily and cough less when they give up smoking because their lung capacity improves by up to 10% within 9 months.

  NHS Stop Smoking Services

  Take steps now to stop smoking

  10 self-help tips to stop smoking

Interested in further advice and support on how to quit?: *
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Dalhousie Medical Practice
Bonnyrigg Health Centre
109-111 High Street
Bonnyrigg
EH19 2ET

Telephone: 0131 370 3999

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