Childhood Asthma Control Test for Children aged 4 to 11 Years Old

This test will provide a score that may help your doctor determine if your child’s asthma treatment plan is working or if it might be time for a change.

Let your child respond to the first four questions (1 to 4). If your child needs help 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 response influence your answers. There are no right or wrong answers.

Childhood Asthma Control Form

Section

Please use date format DD/MM/YYYY

Asthma Control - Have your child complete these questions

How is your asthma today? *
How much of a problem is your asthma when you run, exercise or play sports? *
Do you cough because of your asthma? *
Do you wake up during the night because of your asthma? *

Asthma Control - Please complete the following questions on your own

During the last 4 weeks, how may days did your child have any daytime asthma symptoms? *
During the last 4 weeks, how may days did your child wheeze during the day because of asthma? *
During the last 4 weeks, how may days did your child wake up during the night because of asthma? *