Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)
Asthma Review

Asthma Review (for CHILDREN 4-11 years old only)

If you are a person aged 12 or above, PLEASE CLICK HERE AND USE THIS ASTHMA REVIEW QUESTIONNAIRE INSTEAD

This form needs to be completed by an adult together with the child.

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

Please note: once received it can take up to 1 month to review the answers, if your child is in need of urgent advice/treatment, please download the ASKNHS app, or complete an eConsult, or call us 020 3474 6709 or 020 3474 6730 or call 111 or 999 in life threatening situation.

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

Personal Details of the Child
 
Please double check you've entered the correct email address
UK mobile only
Who is completing this form?
 
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 seven questions in total.  Calculate your child's total Asthma Control Test score by adding up the numbers for each of your responses.  Please answer the questions as honestly as possible.

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. 

Question 1

Question 2

Question 3

Question 4

Step 2: Adult, please complete the following questions on your own.

Question 5

Question 6

Question 7

out of 27

Scoring:

 

Score: 20 - 27 - May be Well Controlled Asthma

This score shows that your child's asthma may be well controlled. If your child is experiencing any problems with their asthma, call and book an appointment as soon as possible with a nurse or doctor 020 3474 6709 or 020 3474 6730, or alternative visit a pharmacist for further advice, call 111, or 999 in life threatening situation.

Score 13 - 19 - Poorly Controlled Asthma

This score shows signs that your child's asthma is poorly controlled. If your child is experiencing any problems with their asthma, call and book an appointment as soon as possible with a nurse or doctor 020 3474 6709 or 020 3474 6730, or alternative visit a pharmacist for further advice, call 111, or 999 in life threatening situation.

Score 12 or less - Very Poorly Controlled Asthma

This score shows signs that your child's asthma is very poorly controlled. Please book an appointment with a nurse or doctor as soon as possible 020 3474 6709 or 020 3474 6730, or alternative call 111, or 999 in life threatening situation.

Exacerbation

Exacerbation means your child's asthma has become worse and they required antibiotic and / or oral steroid treatment

Asthma Action Plan

What is an asthma action plan?

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

It tells you, your child, and anyone with you:

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

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

Then take it along to all their asthma appointments, including any out of hours appointments or A&E, so their 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 03/06/2021

Further information about Asthma Action Plan can be found here

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

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

Inhaler Technique

Taken from Asthma UK correct as of 03/06/2021

 

How does good inhaler technique help your child and you manage their asthma?

If your child is using a preventer inhaler as prescribed, and using the right inhaler technique, it can help them:

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

Good inhaler technique can really make a difference to how well your child manages their asthma. It could also mean your child will be able to manage their 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 or your child is 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 you and their technique.

Asthma Attack

Smoking Status

We understand that you may be confused about this question, but we have to ask anyone regardless of age when they have asthma. In this way we can assess if their asthma is affected by smoke, so we can provide the right treatment and advice for you and your child.

Please select one

Would your child like support to quit?

Please book an appointment with a GP or Practice Nurse for more information and support for your child.

Advice for anyone in the household who smokes - would you like support to quit?

Visit SMOKE FREE LEWISHAM to get further support, or call 0800 0820 388 or email quit@smokefreelewisham.co.uk 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.

Observations
if known
if known

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.

 
Processing

Page you are trying to access does not exist.