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Allergy and Asthma Self Assessment Questionnaires 2

The following questionnaire was developed by the American College Allergy, Asthma, and Immunology for further assessment of asthma sufferers:

Activities

  1. When I walk or do simple chores, I have trouble breathing or I cough.
    Yes

    No
  2. When I perform heavier work, such as walking up hills and stairs or doing chores that involve lifting, I have trouble breathing or I cough.
    Yes

    No
  3. Sometimes I avoid exercising or taking part in sports like jogging, swimming, tennis, or aerobics because I have trouble breathing or I cough.
    Yes

    No
  4. I have been unable to sleep through the night without coughing attacks or shortness of breath.
    Yes

    No

Symptoms

  1. Sometimes I can’t catch a good, deep breath.
    Yes

    No
  2. Sometimes I make wheezing sounds in my chest.
    Yes

    No
  3. Sometimes my chest feels tight.
    Yes

    No
  4. Sometime I cough a lot.
    Yes

    No

Triggers

  1. Dust, pollen, and pets make my asthma cough or trouble breathing worse.
    Yes

    No
  2. My asthma gets worse in cold weather.
    Yes

    No
  3. My asthma gets worse when I’m around tobacco smoke, fumes, or strong orders.
    Yes

    No
  4. When I catch a cold it often goes to my chest.
    Yes

    No

Hospital visits

  1. I made one or more emergency room visits because of asthma or breathing problems in the last year.
    Yes

    No
  2. I had one or more overnight hospitalizations because of asthma or breathing problems in the last year.
    Yes

    No

Medication problems

  1. I feel like I use my asthma inhaler too often.
    Yes

    No
  2. Sometimes I don’t like the way asthma medicines make me feel.
    Yes

    No
  3. My asthma medicine doesn’t control my asthma.
    Yes

    No

Anxieties

  1. My breathing problem or asthma controls my life more than I would like.
    Yes

    No
  2. I feel tension or stress because of my breathing problem or asthma.
    Yes

    No
  3. I worry that my breathing problem or asthma affections my health or may even shorten my life.
    Yes

    No

For more information on how to treat bronchial asthma and protect your loved ones to suffer bronchial asthma again. Please go to The Asthma Relief Report.

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