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Enter Name Today s Date: Enter Address Patient s Name: Enter City/State/Zip FOR PATIENTS: Take the Asthma Control TestTM (ACT) for people 12 yrs and older. Know your score. Share your results with.

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The scores range from 5 (poor control of asthma) to 25 (complete control of asthma), with higher scores reflecting greater asthma control. An ACT score >19 indicates well-controlled asthma.

The first is the Asthma Control Test (ACT ), which is a short quiz for patients 12 years of age and older. It provides a numerical score to help you and your asthma specialist determine if your asthma symptoms are well controlled.

Mild episodes may last only a few minutes; more severe ones can last from hours to days. Mild attacks can resolve spontaneously or may require medication, typically a quick-acting inhaler. More severe asthma attacks can be shortened with appropriate treatment.

When your asthma is well-controlled, you experience very few symptoms throughout the day and night and you can perform daily activities without shortness of breath, chest tightness, coughing or wheezing. It is recommended that people with asthma monitor their symptoms daily.

A patient self-administred tool for identifying those with poorly controlled asthma. The scores range from 5 (poor control of asthma) to 25 (complete control of asthma), with higher scores reflecting greater asthma control. An ACT score >19 indicates well-controlled asthma.

They are also asked to rate their asthma control. Each questionnaire with an ACT score 20 indicates controlled asthma, while 16 to 19 indicates partly controlled asthma and 15 characterizes poorly controlled asthma.

Daily symptoms, such as chest tightness, shortness of breath, coughing and wheezing, are signs of uncontrolled asthma and may require the use of quick-relief medication a few times a week or even daily. In addition, you may commonly experience nighttime flare-ups and may even have to visit the emergency room.

A simple questionnaire to measure the adequacy of asthma control and change in asthma control which occurs either spontaneously or as a result of treatment. Scores range between 0 (totally controlled) and 6 (severely uncontrolled).

When your asthma is well-controlled, you experience very few symptoms throughout the day and night and you can perform daily activities without shortness of breath, chest tightness, coughing or wheezing. It is recommended that people with asthma monitor their symptoms daily.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232