Questionnaire is applicable to all.

Check whether you have asthma or not?

You or your child or any other person, if they are suffering with frequent cough and cold you should get serious doubt that whether it is allergy or asthma. Go through the following questions (If your answer is yes for more than 5 questions, you may be suffering with asthma). Check it even for yourself or for your child or for your friends or relatives and inform them about what they have to do.

	During the last 2 years, has your child had  repeated episodes of any of following health conditions?
	A. Asthma B. Cough C. Trouble Breathing D. Chest Tightness E. Dust  Allergy/Sneezing
	During the last 2 Years, has your child been treated in an emergency room or hospital for episodes of cough, chest tightness trouble breathing or wheezing?
	A. Never B. One time C. Two times D. Three times E. Four or more times
	How often does your child miss school because of cough, chest tightness, trouble breathing or wheezing?
	A. Never B. Less than 5 days for year C. 5 to 10 days per year D. More than 10 days per year
	Does your child have episodes of cough, chest tightness, trouble breathing or wheezing when they play or exercise?
	A. Never B. Rarely C. Sometimes D. Often E. Most of the time
	In the past one month, how often has your child used a medicine (a syrup, an inhaler or a breathing machine) to treat episode of cough, chest tightness, trouble breathing or wheezing?
	A. Never B. Less than two days a week C. Two or more days a week but not everyday D. Every day E. More than once a day on most days
	In the past one month, how often has your child had episodes of cough. Chest tightness, trouble breathing or wheezing in the morning or during the daytime?
	A. Never B. Less than two days a week C. Two or more days a week but not everyday D. Every day E. More than once a day on most days
	During the past one month, how often has your child had cough, chest tightness, trouble breathing, or wheezing at night or while sleeping?
	A. Never B. Less than one night  a week C. One night a week or more but not every night D. Every night
	Past academic performance (Select all answer that apply)
	A. Average B. Good C. Discontinued studies in the middle D. Poor performance in studies & games because of frequent Health problems E. Can improve in studies further if no such problems
	What type of problems the parents faced because of these illnesses?
	A. No problems at all B. Frequent Visits to Hospitals C. Frequent change of doctors since no response to treatment D. Loss of mental peace in the family E. Cause Economic burden to the family
	Is any body suffering with similar problems in the family?
	A. None B. Father or grand parents C. Mother or Grand Parents D. Some of the Close blood relative suffered with similar symptos E. We don’t know

If you are already taking treatment…
Is your asthma under control With the medicines you are using now?

	Do you experience asthma symptoms more than 3 days a week?
	Yes / No
	Is your sleep disturbed due to asthma symptoms for one or more nights per week?
	Yes / No
	Does your asthma stop you from doing certain physical activities?
	Yes / No
	Do you need to use Asthalin (Salbutamol) inhaler more than three times a week for your asthma symptoms?
	Yes / No
	Have you missed work or school because of your asthma?
	Yes / No
	After all are you feeling better with your present treatment?
	Yes / No
If you have answered YES to 1 or more of the above questions, your asthma is NOT optimally controlled.

You need to:

	Discuss with your doctor.
	You may need a preventer medication, if you already aren't using one.
	Avoid triggers (like pollen, dust, smoke, etc.)
	If you are already using a preventer inhaler (as advised by your doctor)
	Check whether you are using the inhaler CORRECTLY. Check whether you are using it REGULARLY. Check with your doctor whether you need to have ADDITIONAL Preventer medicine / INCREASE dose of the existing preventer.

Be regular for follow-up. Keep the appointment with your doctor.