Step 1: Let your child
respond to the first four
questions (1 to 4). If
your child needs help
in reading or understanding
the question, you may
help, but let your child
select the response.
Complete the remaining
three questions (5 to 7)
 on your own and without
letting your child's
responses influence your
answers. There are no
right or wrong answers.

Step 2: Click an answer
button for each question.
You will see a number
score populate the
column to the right.

Step 3: When all seven
questions have been
answered, press the "SEE
YOUR SCORE" button to
view your score.

Step 4: Take a printout
of the test results to the
doctor to talk about your
child's total score.

Have your child complete these questions.
1. How is your asthma today? Score
Very Bad
Bad
Good
Very Good
2. How much of a problem is your asthma when you run, exercise or play sports?
It's a big problem, I can't do what I want to do.
It's a problem and I don't like it.
It's a
little problem
but it's okay.
It's not a
problem.

3. Do you cough because of your asthma?
Yes, all of
the time.
Yes, most of
the time.
Yes, some of
the time.
No, none of
the time.

4. Do you wake up during the night because of your asthma?
Yes, all of
the time.
Yes, most of
the time.
Yes, some of
the time.
No, none of
the time.



Please complete these questions on your own.

5. During the last 4 weeks, how many days did your child have any
    daytime asthma symptoms?
Not at all
1-3 days
4-10 days
11-18 days
19-24 days
Everyday

6. During the last 4 weeks, how many days did your child wheeze during
    the day because of asthma?
Not at all
1-3 days
4-10 days
11-18 days
19-24 days
Everyday

7. During the last 4 weeks, how many days did your child wake up during
    the night because of asthma?
Not at all
1-3 days
4-10 days
11-18 days
19-24 days
Everyday
Please enter your ZIP code:        Why my ZIP code?
Reset Form


This Web site is brought to you by GlaxoSmithKline. GlaxoSmithKline is a research-based pharmaceutical company and
a world leader in respiratory care.
This website is funded and developed by GlaxoSmithKline.
This site is intended for US residents only.
© 1997-2010 GlaxoSmithKline. All Rights Reserved.
Legal Notices | Privacy Statement | Medicine Savings | Contact Us