Questionnaire relating to asmtha

1. Please answer the following questions.

 

1. What type of inhalers are you currently using? Tick where appropriate. *

 

2. What type of asthma equipment do you use? Tick where appropriate.
*

 

3. Do you use any other medication other than inhalers? Tick where appropriate. *

 

4. How often have you use your Reliever inhaler (usually blue) during the past 4 weeks? *

 

5. At what time of day do you take your inhalers/and or other medication? Tick where appropriate. *

 

6. When was your last asthma attack? *

 

7. What medication did you use to relieve your symptoms? *

 

8. Could you access your Reliever inhaler easily?

 

9. How often do you wake up in the night due to your asthma (including coughing symptoms) within the past 4 weeks? *

 

10. When doing any form of exercise, how wheezy and breathless are you? *

 

11. How would you describe your current storage for your medication? *

 

12. Where do you store your spare inhalers/and or other medication?
*

 

13. Where do your store you inhalers at night when you need to use them? *

 

14. When travelling outside your house, how do you transport your inhalers? *

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