Asthma Review (CDM)

Asthma Review
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Please complete this form so that we can review your Asthma.

We would highly recommend reading the Asthma UK website. It is full of helpful information telling you about your asthma and how to better manage it.

On submission of this form:

  • We will contact you for a review if you asthma control is poor or you have indicated you would like to speak to a clinician.
  • We will continue your current treatment if your control is good and you have indicated that you would not like to speak to a clinician.

Inhaler Use

How often do you use your RELIEVER? (blue inhaler)
If you have one, how often do you use your PREVENTER? (regular daily inhaler)

Asthma Control

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?
During the last 4 weeks, how often have you had shortness of breath?
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?
During the last 4 weeks, how often have you used your reliever inhaler?
How would you rate your asthma control during the last 4 weeks?

Score < 20
Your asthma does not seem well controlled.
It would probably help to have your treatment reviewed and increased. This will be discussed at your review.

Score of 20-24
Your asthma seems reasonably well controlled.
It would be reasonable for you to stay on your current treatment or possibly review and increase your treatment.
This will be discussed at your review if you like.

Score of 25
Your asthma appears to be VERY WELL CONTROLLED.
We would recommend considering reducing your current treatment and reviewing it again in a few months. It would also be reasonable to simply continue your current treatment if you are happy.