Do you need to use your rescue inhaler (also known as a reliever bronchodilator) four or more times a week? YesNo Do you wake up because of asthma symptoms (e.g., coughing, wheezing, chest tightness, etc.) one or more nights a week? YesNo Does your asthma prevent you from exercising? YesNo Have you ever had to stay home (e.g., from school, daycare, etc.) due to your asthma? YesNo Do you experience asthma symptoms (e.g., coughing, wheezing, chest tightness, etc.) four or more days a week? YesNo If you use a peak flow meter, are your peak flow readings or breathing test results outside normal levels as specified by your doctor? YesNo / Do Not Use In the last year, have you gone to the emergency room or made an unscheduled visit to your doctor because of an asthma episode? YesNo Does your asthma get worse when you have a respiratory tract infection (e.g., a cold or the flu)? YesNo Does your asthma get worse at certain times of the year (e.g., spring, summer, fall or winter)? YesNo Submit
