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Island City Practice > Forms > Health Review Forms > Asthma Control Test > Asthma Control Test for Children aged 4-11

Asthma Control Test for Children aged 4-11

Let your child respond to the first four questions. If your child needs help in reading or understanding the question, you may help, but let your child select the response.

Complete the remaining three questions on your own and without letting your child’s responses influence your answers. There are no right or wrong answers.

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

Asthma Control Questions for the Child

Let your child respond to the first four questions. If your child needs help in reading or understanding the question, you may help, but let your child select the response.
How is your asthma today?
How much of a problem is your asthma when you run, exercise or play sports?
Does your asthma make you cough?
Does your asthma make you wake up during the night?

Asthma Control Questions for the Parent/Guardian

Complete the remaining three questions on your own and without letting your child’s responses influence your answers. There are no right or wrong answers.
During the last 4 weeks, how many days did your child have any daytime asthma symptoms?
During the last 4 weeks, how many days did your child wheeze during the day because of asthma?
During the last 4 weeks, how many days did your child wake up during the night because of asthma?