Transcription of Asthma Control Test (ACT) is
1 All ofthe time2 More thanonce a day24 or morenights a week23 or moretimes per day2 Not controlled at all11111 Most ofthe timeOnce a day 2 or 3 nightsa week1 or 2 timesper dayPoorlycontrolled2 Some ofthe time3 to 6 timesa weekOnce a week2 or 3 timesper weekSomewhatcontrolled33333A little ofthe timeOnce or twicea weekOnce or twiceOnce a weekor less Wellcontrolled44444 None of the timeNot at allNot at allNot at allCompletelycontrolledTOTALSCORE555552. During the past 4 weeks, how often have you had shortness of breath?3. During the past 4 weeks, how often did your Asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?5. How would you rate your Asthma Control during the past 4 weeks?1. In the past 4 weeks, how much of the time did your Asthma keep you from getting as much done at work, school or at home?
2 If your score is 19 or less, your Asthma may not be under Control . 2008 The GlaxoSmithKline Group of Companies All Rights Reserved. Printed in USA. AD4254R0 March 2008A quick test that provides a numerical score to assess Asthma by the National Institutes of Health (NIH) in its 2007 Asthma validated against spirometry and specialist Control Test (ACT) is:HEALTHCARE PROVIDER:Include the ACT score in your patient s chart to track Asthma : Department of Health and Human Services, National Institutes of Health, National Heart, Lung and Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis andManagement of Asthma (EPR-3 2007).NIH Item No. 08-4051. Accessed September 10, 2007. RA et al. J Allergy ;113:59-65. PATIENTS:1. Answer each question and write the answer number in the box to the right of each Add your answers and write your total score in the TOTAL box shown Discuss your results with your d a y s D a t e :Patient s Name:Copyright 2002, by QualityMetric Incorporated.
3 Asthma Control Test is a trademark of QualityMetric Asthma Control Test is for people with Asthma 12 years and older.
