Asthma control test questionnaire

This page explains the content and coding for the Asthma control test questionnaire.

On this page:

1. Questionnaire content
2. SNOMED coding
3. How to give feedback

Questionnaire content

Text message

Dear <patient first name>,

<Practice name> would like to ask a few questions about your asthma.

Your answers will help your GP give you advice and let you know when to get help.

It should take about 2 minutes, and your answers are private.

Select the link to get started <link>

Introduction Screen

A few questions about your asthma

Dear <patient name>,

<Practice name> would like to ask a few questions about your asthma.

Your answers will help your GP give you advice and let you know when to get help.

It should take about 2 minutes, and your answers are private

Thank you,
<Practice name>

Questions and answers

1. In the last 4 weeks, how much has your asthma kept you from doing as much as you’d like at work, school or home?

All of the time  

Most of the time  

Some of the time  

A little of the time 

None of the time  

 

2. In the last 4 weeks, how often have you had shortness of breath?

More than once a day  

Once a day  

3 to 6 times a week 

Once or twice a week 

Not at all 

 

3. In the last 4 weeks, how often have your asthma symptoms made you wake up at night or earlier than usual in the morning?

Symptoms include wheezing, coughing, shortness of breath, pain or tightness in chest.

4 or more nights a week  

2 to 3 nights a week

Once a week 

Once or Twice 

Not at all

 

4. In the last 4 weeks, how often have you used your reliever inhaler (usually the blue one) or nebuliser medication, such as Salbutamol?

• 3 or more times per day  
• Once or twice per day 
• 2 or 3 times per week  
• Once a week or less 
• Not at all 

 

5. How would you rate your asthma control in the last 4 weeks?

• Not Controlled at all  
• Poorly Controlled  
• Somewhat Controlled 
• Well Controlled  
• Completely Controlled 

 

6. In the last year, have you had time off work or school because of your asthma?

• Yes
• No

7. Is there anything else you’d like us to know about your asthma?

For example, if you’re not getting on with your medication, or you want to tell us more about any of your answers.

(Blank text field)

8. Do you have a personalised asthma action plan?

• Yes
• No
• I don't know

9. Do you smoke, or have you ever smoked regularly?

• I smoke (if patient selects this one, go to question 10)
• I used to smoke regularly (if patient selects this one, and is under 19, go to question 11. If they select this and they are over 19, go to outcome screen 2)
• I have never smoked (if patient selects this one, and is under 19, go to question 11. If they select this and they are over 19, go to outcome screen 3)

10. How many cigarettes do you smoke a day?

If you roll your own cigarettes or smoke other tobacco products, think of the equivalent amount.

• Less than 1
• 1 to 9
• 10 to 19
• 20 to 39
• 40 or over

(Go to outcome screen 1)

11. Does anyone else in your household smoke?

• Yes
• No

Results

Outcome 1

We've sent your answers to your GP

Thank you.

To stay on top of things, Asthma and Lung has tips to improve your inhaler technique.

Get help to stop smoking

For free local services and tips, take a look at the NHS advice on how to quit smoking.

 

 

Outcome 2

We've sent your answers to your GP

Thank you.

To stay on top of things, Asthma and Lung has tips to improve your inhaler technique.

If you’re tempted to smoke again

The NHS Smokefree helpline has trained advisers to help you stay off cigarettes.
Call free on 0300 123 1044.

 

Score of 21–25

We've sent your answers to your GP

Thank you.

To stay on top of things, Asthma and Lung has tips to improve your inhaler technique.

MJOG inbox

Inbox subject line

Asthma Control Test (version 1)

Inbox body copy

Questionnaire Asthma Control Test (version 1)

ACT score: 5-25 / 25

5 ACT questions 5 scores of 1 - 5

Time off from work or school: Yes/No

Is there anything else you’d like us to know: Free text

Personalised asthma action plan: Yes/No/Don’t know

Do you smoke: [answer]

How many cigarettes do you smoke a day: [N/A / answer]

Anyone is household smoke: [N/A / Yes/No]

Coding

Asthma specific codes

[When the SMS invite is sent to the patient]

[When the patient completes the questionnaire]

If the patient answers yes whether anyone in their household smokes

Codes for smoking status within the asthma questionnaire

Do you smoke, or have you ever smoked regularly? 

How many cigarettes a day do you smoke? (average - where smoking roll ups, please give your best approximation)

How to give feedback

As always, we’d love to hear your feedback about our questionnaires.

To request a new questionnaire or suggest changes, please fill in our request form.