Childhood Asthma Control Test

If your child (aged 4-11) has asthma, please submit this form.

Your healthcare provider can help you take appropriate action to better manage your asthma.

Childhood (4-11) Asthma Control Test

Section

How to answer the childhood asthma control form

Let your child answer the first 4 questions. You may help your child understand the question but let them select the response.

Complete the remaining 3 questions on your own without letting your child's response influence your answers.

Your score will automatically calculate and go through to the surgery for review. If your child's score is less than 19, it may be a sign that their asthma is not as controlled as it could be.

Asthma Control

Ask your child to complete these questions:

Please complete the following questions on your own:

Additional Questions

Do you have a personalised asthma action plan?
Since your child's last review, have they needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of their asthma?
Since your child's last review, have they needed a course of steroid tablets to get their asthma under control?

Inhalers

Please select the types of inhalers that you use:

Please watch these short video(s) on how to use your inhalers

Please let us know that you have watched and understood the video(s): *