Please answer Questions 1–6.
Circle the number of the response that best describes how you have been during the past week.
1. On average, during the past week, how oen were you woken by your asthma during the night?
0 Never 4 Many times
1 Hardly ever 5 A great many times
2 A few times 6 Unable to sleep because of asthma
3 Several times
2. On average, during the past week, how bad were your asthma symptoms when you woke up in the morning?
0 No symptoms 4 Quite severe symptoms
1 Very mild symptoms 5 Severe symptoms
2 Mild symptoms 6 Very severe symptoms
3 Moderate symptoms
3. In general, during the past week, how limited were you in your activities because of your asthma?
0 Not limited at all 4 Very limited
1 Very slightly limited 5 Extremely limited
2 Slightly limited 6 Totally limited
3 Moderately limited
4. In general, during the past week, how much shortness of breath did you experience because of your asthma?
0 None 4 Quite a lot
1 A very little 5 A great deal
2 A little 6 A very great deal
3 A moderate amount
5. In general, during the past week, how much of the time did you wheeze?
0 Not at all 4 A lot of the time
1 Hardly any of the time 5 Most of the time
2 A little of the time 6 All the time
3 A moderate amount of the time
6. On average, during the past week, how many pus of short-acting bronchodilator have you used each day?
0 None 4 9–12 pus most days
1 1–2 pus most days 5 13–16 pus most days
2 3–4 pus most days 6 More than 16 pus most days
3 5–8 pus most days
To be completed by a member of the clinic sta:
7. FEV
1
prebronchodilator:
0 > 95% predicted FEV
1
% predicted:
1 95–90% 4 69–60%
FEV
1
% predicted: 5 59–50%
2 89–80% 6 < 50% predicted
3 79–70%
(Record actual values on the dotted lines and score the FEV
1
% in the next column)
Juniper EF, O’Byrne PM, Guyatt GH, et al. Eur Respir J. 1999;14:902-907.
Asthma Control Questionnaire
