Asthma Care Competency Form
Assess your knowledge and practical skills in asthma care. Please complete all sections of the Asthma Care Competency Form.
Full Name
*
First Name
Last Name
Current Role or Training Status
*
Please Select
Healthcare Professional
Student/Intern
Caregiver
Other
How would you rate your overall knowledge of asthma care?
*
1
2
3
4
5
Which of the following are common asthma triggers? (Select all that apply)
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Dust mites
Pollen
Pet dander
Cold air
Exercise
Other
Select the correct steps for using an inhaler with a spacer.
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Rows
Step is correct
Step is incorrect
Shake the inhaler before use
1
2
Insert inhaler into spacer
3
4
Breathe in quickly and forcefully
5
6
Hold breath for 10 seconds
7
8
Exhale immediately after inhalation
9
10
List three common symptoms of an asthma attack.
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If a person’s asthma symptoms worsen, what is the first action you should take?
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Administer quick-relief medication
Call emergency services immediately
Monitor and wait for improvement
Other
How often should maintenance (controller) asthma medication be taken?
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Only when symptoms appear
Daily as prescribed
Only before exercise
Other
Describe one strategy to improve medication adherence in asthma care.
*
How confident are you in your ability to provide asthma care?
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Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
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