Over 12s ACT
Copyright 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated.
In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or home?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
In the past 4 weeks, how often have you had shortness of breath?
More than once a day
Once a day
3 to 6 times a week
Once or twice a week
Not at all
In the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning?
4 or more nights a week
2 to 3 nights a week
Once a week
Once or twice
Not at all
In the past 4 weeks, how often have you used your reliever inhaler (usually blue)?
3 or more times per day
1 to 2 times per day
2 to 3 times per week
Once a week or less
Not at all
How would you rate your asthma control during the past 4 weeks?
Not controlled at all
Poorly controlled
Somewhat controlled
Well controlled
Completely controlled
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