• Asthma Control Test for teens 12 years and older.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • If your teen is 12 years or older have him/her take the test now and discuss the results with your provider.

    Step 1. Mark the circle that best describes your answer.

    Step 2. Submit the test when completed, or if unable download it and bring with you to your next appointment to discuss with your provider.

    What does it mean if my child scores 19 or less?

    • If your child's score is 19 or less, it may be a sign that your child's asthma is not under control.
    • Make an appointment to discuss your child's asthma score with their provider. Ask if you should change your child's asthma treatment plan.
    • Ask your child's provider about daily long-term medications that can help control airway inflammation and constriction, the two main causes of asthma symptoms.  Many children may need to treat both of these on a daily basis for the best asthma control.
  • 1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
  • 2. During the past 4 weeks, how often have you had shortness of breath?
  • 3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) wake you up at night or earlier than usual in the morning?
  • 4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as Albuterol)?
  • 5. How would you rate your asthma control during the past 4 weeks?
  • Should be Empty: