Asthma Control Questionaire - ACQ-5

Date*

Birthday*

1. On average, during the past week, how often were you woken by your asthma during the night?*

2. On average, during the past week, how bad were your asthma symptoms when you woke up in the morning?*

3. In general, during the past week, how limited were you in your activities because of your asthma?*

4. In general, during the past week, how much shortness of breath did you experience because of your asthma?*

5. In general, during the past week, how much of the time did you wheeze?