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Please fill out the questions below. 

Personal Details 

How much has your asthma kept you from getting things done at work/school/home?

Asthma Control Test

How often have you been short of breath?

How often have asthma symptoms woken you at night or early in the morning?

How often have you used your reliever inhaler or rescue medication e.g. Salbutamol?

How would you rate your asthma control?

Additional Questions

How many times in the last year have you experienced exacerbations in your asthma?

What is your current smoking status?

Are you happy with your Asthma management?

If you would like a review and want to read some information beforehand, please refer to the Asthma UK website for information about managing your asthma and plans you can follow to help keep your symptoms in check:

Are there any other details you would like to add?

Please complete all necessary fields.

Please complete all necessary fields.

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