Question 1/10

Have you been diagnosed with asthma?

Yes
No

Question 2/10

How often do you use an inhaler?

Daily
Weekly
Rarely
Never

Question 3/10

Do you experience shortness of breath during physical activity?

Always
Sometimes
Rarely
Never

Question 4/10

Are your asthma symptoms triggered by allergens or environmental factors?

Yes
No
Unsure

Question 5/10

How would you rate your asthma management?

Excellent
Good
Fair
Poor

Question 6/10

Have you visited the ER for asthma symptoms in the past year?

Yes
No

Question 7/10

Do you have a written asthma action plan?

Yes
No

Question 8/10

How often do you experience nighttime asthma symptoms?

Weekly
Monthly
Rarely
Never

Question 9/10

Do you use long-term asthma control medications?

Yes
No

Question 10/10

Have you had an asthma checkup in the past six months?

Yes
No