Ladywell Medical Centre West

NHS Scotland

Asthma Control Test (ACT)

Asthma Control Test
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Please use format day/month/year e.g. 12/05/1979

Your Asthma Review

In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home? *
During the past 4 weeks, how often have you had shortness of breath? *
During the past 4 weeks, 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? *
During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)? *
How would you rate your asthma control during the past 4 weeks? *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Ladywell Medical Centre West

10 Ladywell Road
Edinburgh
EH12 7TB

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