Skip to content
Tel: 0161 789 3029
Out of hours: 111
Log in to Online Services
My NHS Account
Menu
Menu
Home
About Us
Contact and opening hours
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Practice Policies
At the Practice
Data
Patient Record
The National Care Record Service (NCRS)
Patient Rights
Website
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Care Coordinator
Travel Clinic & Holiday Vaccinations
Online Services
Patient Record
Learn My Way
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
Cancer
Diabetes
Find the NHS Service You Need
Mental Health
Pharmacy First
Pregnancy Guide
Social Care and Support Guide
COVID-19 Support
Help & Support Organisations
Who Do I See?
Menopause
News
Menu
Home
About Us
Contact and opening hours
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Practice Policies
At the Practice
Data
Patient Record
The National Care Record Service (NCRS)
Patient Rights
Website
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Care Coordinator
Travel Clinic & Holiday Vaccinations
Online Services
Patient Record
Learn My Way
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
Cancer
Diabetes
Find the NHS Service You Need
Mental Health
Pharmacy First
Pregnancy Guide
Social Care and Support Guide
COVID-19 Support
Help & Support Organisations
Who Do I See?
Menopause
News
Need help with a non-urgent medical or admin request? Contact us online.
Submit a new request
Orient Road Medical Practice
>
Forms
>
Health Review Forms
>
Asthma Control Test
>
Adult Control Test for Adult 12+ years
Adult Control Test for Adult 12+ years
Asthma Control Test – Adult
First Name
*
Last Name
*
Email
*
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Control Test Questions
During the last 4 weeks, how much of the time has your asthma kept you from getting as much done at work, school or home?
*
All of the time – 1
Most of the time – 2
Some of the time – 3
A little of the time – 4
None of the time – 5
During the last 4 weeks, how often have you had shortness of breath?
*
More than once a day – 1
Once a day – 2
3-6 times a week – 3
1-2 times a week – 4
Not at all – 5
During the last 4 weeks, how often have your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) woken you up at night or earlier than usual in the morning?
*
4 or more times a week – 1
2-3 nights a week – 2
Once a week – 3
Once or twice – 4
Not at all – 5
During the last 4 weeks, how often have you used your rescue inhaler or nebuliser medication?
*
3 or more times a day – 1
1-2 times a day – 2
2-3 times a week – 3
Once a week or less – 4
Not at all – 5
How would you rate your asthma control during the last 4 weeks?
*
Not controlled – 1
Poorly controlled – 2
Somewhat controlled – 3
Well controlled – 4
Completely controlled – 5
If you are human, leave this field blank.
View Your Score
Close
Home
About Us
Contact and opening hours
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Practice Policies
At the Practice
Data
Patient Record
The National Care Record Service (NCRS)
Patient Rights
Website
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Care Coordinator
Travel Clinic & Holiday Vaccinations
Online Services
Patient Record
Learn My Way
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
Cancer
Diabetes
Find the NHS Service You Need
Mental Health
Pharmacy First
Pregnancy Guide
Social Care and Support Guide
COVID-19 Support
Help & Support Organisations
Who Do I See?
Menopause
News