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ACQ5 Get Started

Home > ACQ5 Get Started

ACQ - Symptoms Only (Health Professional Version)

Step 1 of 9

11%

Asthma Control Questionnaire (ACQ) (Symptoms Only)

Click the 'Next' button below to get started.

English version for Australia

TM

©The Asthma Control Questionnaire (ACQ) is copyrighted and all rights are reserved. No part of this questionnaire may be sold, modified or reproduced in any form without the express permission of Elizabeth Juniper on behalf of QOL Technologies Limited.

Please answer questions 1 - 5.
Select the response that best describes how you have been in the last week.


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

1. On average, in the last week, how often were you woken by your asthma during the night?(Required)

2. On average, in the last week, how were your asthma symptoms when you woke up in the morning?

2. On average, in the last week, how were your asthma symptoms when you woke up in the morning?(Required)

3. In general, in the last week, how limited were you in your day-to-day activities because of your asthma?

3. In general, in the last week, how limited were you in your day-to-day activities because of your asthma?(Required)

4. In general, in the last week, how much shortness of breath did you experience because of your asthma?

4. In general, in the last week, how much shortness of breath did you experience because of your asthma?(Required)

5. In general, in the last week, how often did you wheeze?

5. In general, in the last week, how often did you wheeze?(Required)
This field is hidden when viewing the form
YYYY slash MM slash DD
Well Controlled (<= 0.75), Partially Controlled (>0.75, <=1.5), Not Well Controlled (>1.5)
Well Controlled (<= 0.75), Partially Controlled (>0.75, <=1.5), Not Well Controlled (>1.5)
Well Controlled (<= 0.75), Partially Controlled (>0.75, <=1.5), Not Well Controlled (>1.5)
For details on Asthma Scores and Categories click here

If your patient would like a copy of their Asthma Score and Asthma Control Questionnaire responses, enter their details below.

This field is for validation purposes and should be left unchanged.
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