Asthma Control Questionnaire16–18
1. On average, during the past week, how often were you woken by your asthma during the night? | 0 Never 1 Hardly ever 2 A few times 3 Several times 4 Many times 5 A great many times 6 Unable to sleep because of asthma |
2. On average, during the past week, how bad were your asthma symptoms when you woke up in the morning? | 0 No symptoms 1 Very mild symptoms 2 Mild symptoms 3 Moderate symptoms 4 Quite severe symptoms 5 Severe symptoms 6 Very severe symptoms |
3. In general, during the past week, how limited were you in your activities because of your asthma? | 0 Not limited at all 1 Very slightly limited 2 Slightly limited 3 Moderately limited 4 Very limited 5 Extremely limited 6 Totally limited |
4. In general, during the past week, how much shortness of breath did you experience because of your asthma? | 0 None 1 A very little 2 A little 3 A moderate amount 4 Quite a lot 5 A great deal 6 A very great deal |
5. In general, during the past week, how much of the time did you wheeze? | 0 Never 1 Hardly any of the time 2 A little of the time 3 A moderate amount of the time 4 A lot of the time 5 Most of the time 6 All the time |
6. On average, during the past week, how many puffs/inhalations of short-acting bronchodilator (eg, Ventolin, Bricanyl) have you used each day? (If you are not sure how to answer this question, please ask for help.) | 0 None 1 1–2 puffs/inhalations most days 2 3–4 puffs/inhalations most days 3 5–8 puffs/inhalations most days 4 9–12 puffs/inhalations most days 5 13–16 puffs/inhalations most days 6 More than 16 puffs/inhalations most days |