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Asthma Review

Asthma Review Adults (Over 12 years old)

If you are a person aged 4 -11 years old, please USE THIS ASTHMA REVIEW QUESTIONNAIRE INSTEAD

Please answer all questions to help us understand how we can help you and your asthma.

Please note: once received it can take up to 1 month to review your answers, if you are in need of urgent advice/treatment, please complete a KLINK form, or call us 020 3474 6730 or call 111 or 999 in life threatening situation.

On reviewing your submission, a nurse may want to speak to you, so we will arrange a telephone call for you to discuss your asthma management in more details, so please ensure we have the correct contact number for you.

Personal Details
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Asthma Questions

Asthma Questions

The following test can help people with asthma assess their asthma control.  Please chose the appropriate score for each question.  There are five questions in total.  Calculate your total Asthma Control Test score by adding up the numbers for each of your responses.  Please answer the questions as honestly as possible.

Question 1

Question 2

Question 3

Question 4

Question 5

out of 25



Score: 25 - WELL DONE

Your asthma appears to have been UNDER CONTROL over the past 4 weeks.   However, if you are experiencing any problems with your asthma, you should book an appointment with a nurse or GP as soon as possible.

Score 20 - 24 - ON TARGET

Your asthma appears to have been REASONABLY WELL CONTROLLED during the past 4 weeks.   However, if you are experiencing any problems with your asthma, you should book an appointment with a nurse or GP as soon as possible.

Score less than 20 - OFF TARGET

Your asthma may NOT HAVE BEEN CONTROLLED during the past 4 weeks.   Your doctor or nurse can recommend an asthma action plan to help improve your asthma control. If you have symptoms, please book an appointment with a nurse or doctor as soon as possible, or alternative visit a pharmacist for further advice, call 111, or 999 in life threatening situation.


Please note: an exacerbation (flare up) is classed as an episode where your asthma symptoms have worsened and you have had further treatment prescribed by a doctor or nurse (such as steroid tablets). Please remember that this will include the times you have had to attend A&E/hospital or contacted the GP practice about worsening asthma.

Asthma Action Plan

What is an asthma action plan?

Everyone with asthma can benefit from using an asthma action plan.

It tells you, and anyone with you:

  • which medicines you take every day to prevent symptoms and cut your risk of an asthma attack
  • what to do if your asthma symptoms are getting worse  
  • the emergency action to take if you’re having an asthma attack and when to call 999.

You fill it in with your GP or asthma nurse, so it’s personal to you and your asthma.

Then take it along to all your asthma appointments, including any out of hours appointments or A&E, so your doctor or asthma nurse can help you keep it up to date.

“Experts recommend asthma action plans to look after your asthma well and cut your risk of an asthma attack,” says Dr Andy Whittamore, Asthma UK’s in-house GP.

Info taken from ASTHMA UK 15/03/2021

Further information about Asthma Action Plan can be found here

A nurse will review your submission, and will send you a basic asthma action plan for your attention. If you like a more detailed version, based on your peak flow reading, please let us know your latest/best peak flow reading below and we can include that upon your asthma plan.

if you are not sure, state the colour of the inhaler, please including how many puffs you take a day, and how often you take these
Inhaler Technique

Inhaler Technique

Taken from Asthma UK correct as of 15/03/2021


How does good inhaler technique help you manage your asthma?

If you’re using your preventer inhaler as prescribed, and using the right inhaler technique, it can help you:

  • cut your risk of an asthma attack
  • feel less breathless climbing stairs
  • cope better with your usual asthma triggers
  • get a good night’s sleep
  • have less time off work
  • take part in exercise and family activities.

Good inhaler technique can really make a difference to how well you manage your asthma. It could also mean you’ll be able to manage your asthma symptoms without needing to be prescribed higher doses. 

Visit ASTHMA UK - Using your Inhalers webpage for more information

Visit ASTHMA UK - to see videos on how to use your inhaler correctly


If you are not sure if you are using it correctly, you can book an appointment to come in and see a practice nurse or a GP, or visit any Pharmacist and they too can help with your technique.

Asthma Attack

What to do in an asthma attack (from Asthma UK)

Smoking Status
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Would you like support to quit?

Visit SMOKE FREE LEWISHAM to get further support, or call 0800 0820 388 or email to book your first appointment

They offer free, friendly, practical support and advice on medications to support you while you stop smoking.

The support is free and all medications are available on prescription.

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Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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