6
When was the last time you had an asthma review at your GP surgery? *
Asthma check-ups involve
- Measuring peak Flow
- Checking inhaler technique
- Listening to breathing
- Going through spacer technique
- Determining how often you are needing to use
- your inhaler
- Determining whether symptoms disturb sleep or affect you during the day
Please provide the month and year
7
Do you understand that this service is not suitable for treating urgent asthma symptoms? *
If you are struggling to breathe, having an asthma attack, or are experiencing any chest pains or discomfort, please call 999 and seek urgent medical attention
10
What is the reason you are requesting treatment today? *
11
Do you understand that the following symptoms require immediate medical assistance: *
Asthma check-ups involve:
- Your reliever inhaler (usually blue), is not helping your symptoms as much as it usually does, or it is not helping you at all
- You need to use your inhaler more than four times a day
- You are experiencing severe breathlessness or wheezing, especially at night or in the early morning
- You are having to strain your chest muscles to breathe
- You are breathing faster
- You have a fast heartbeat
- You are experiencing drowsiness, confusion, exhaustion or dizziness
- You have blue lips or fingers
- You are fainting
12
During the last 4 weeks, how much of the time has your asthma kept you from getting as much done at work, university or home? *
13
During the last 4 weeks, how often have you had a shortness of breath? *
14
During the last 4 weeks, how often have your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) woken you up at night, or earlier than usual in the morning? *
15
During the last 4 weeks, how often have you used your reliever inhaler (usually the blue inhaler)? *
16
How would you rate your asthma control during the last 4 weeks? *
20
Are you pregnant, breastfeeding, planning pregnancy, or at risk of pregnancy whilst taking Ventolin? *
Pregnancy risk may be defined as late period or unprotected sexual intercourse which may have taken place since your last normal period.
27
Are you currently registered with a UK GP practice? *
