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Name_________________________
Date of birth__________________
Asthma Control Test Score for People 12 years and Older
Step 1: Write the number of each answer in the score box provided.
Step 2: Add the score boxes for your total.
Step 3: Take the test to your doctor to talk about your score.
1. In the past 4 weeks, how much of the time did you asthma keep you from getting as much done
at work, school or home?
2. During the past 4 weeks, how often have you had shortness of breath?
3. During the last 4 weeks, how often did your asthma symptoms wake you up at
night or earlier than usual?
4 During the last 4 weeks, how often have you used your reliever medication?
5 How would you rate your asthma control during the past 4 weeks?
If your score is 19 or less, your asthma may not be as controlled as
it could be. Talk to your doctor to see if things can be improved.
... it
Score
Total Score
19