Childhood ACT

Copyright 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated.

Questions to be completed by child.

Copyright 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated.

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?

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 OK

It’s not a problem

Do you cough because of your asthma?

Yes, all 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 asthma?

Yes, all the time

Yes, most of the time

Yes, some of the time

No, none of the time

Questions to be completed by parent/carer.

Copyright 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated.

During the past 4 weeks, how many days did your child have any daytime asthma symptoms?

not at all

1-3 days

4-10 days

11-18 days

19-24 days

Everyday

During the last 4 weeks, how many days did your child wheeze during the day because of asthma?

not at all

1-3 days

4-10 days

11-18 days

19-24 days

Everyday

During the last 4 weeks, how many days did your child wake up during the night because of asthma?

not at all

1-3 days

4-10 days

11-18 days

19-24 days

Everyday

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