Asthma Annual Review Questionnaire

Contact Details
1. When was your asthma diagnosed?
2. In the last month, have you had any difficulty sleeping because of your asthma symptoms (including cough)?
Details of sleeping difficulties:
3. In the last month, have you had your usual asthma symptoms during the day? (cough, wheeze, chest tightness or breathlessness)?
Details of symptoms during the day:
4. How often do you use your blue inhaler?
Details of inhaler use:
5. In the last month has your asthma interfered with your usual activities (e.g. housework, work, school etc)?
6. If you  have a peak flow metre, please put in most recent measurement.
7. Are you happy with your inhaler technique?
8. Are you a smoker ? No Yes
9. Would you like smoking cessation advice?     No Yes
Auchtermuchty Health Centre recommends that giving up smoking is the best thing you can do to improve your own health and can offer you personalised smoking cessation advice and treatment.
If you are not, did you know there is an online demonstration on the Asthma UK website or pop in and see our practice respiratory nurse for more advice.