Childhood Asthma Control Test: Monitor Asthma Management

Step 1 of 5

Complete the Childhood Asthma Control Test with your parent/carer and patient over the phone and guide them through the questions.

There are two parts to this test.

PART 1 - To be completed by yourself and the child

PART 2 - To be completed by just yourself and the parent/carer

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PART 1 - TO BE COMPLETED BY THE CHILD WITH YOUR ASSISTANCE
Let the child respond to the first four questions (1 to 4). If the child needs help in reading or understanding the question, you may help, but let the child select the response by clicking on the appropriate image.
Q1. How is your asthma today?*

Very bad

Bad

Good

Very good
Q2. How much of a problem is your asthma when you run, exercise or play sports?*

It's a big problem, I can't do what I want to do

It's a problem and I don't like it

It's a little problem but it's okay

It's not a problem
Q3. Do you cough because of your asthma?*

Yes, all of the time

Yes, most of the time

Yes, some of the time

No, none of the time
Q4. Do you wake up during the night because of your asthma?*

Yes, all of the time

Yes, most of the time

Yes, some of the time

No, none of the time

PART 2 - ADULT PARENT, CAREGIVER ONLY
Complete the remaining three questions (5 to 7) with the parent/carer and without letting the child's responses influence the answers. There are no right or wrong answers.
Q5. During the last 4 weeks, how many days did your child have any daytime asthma symptoms?*

Not at all

1 to 3 days

4 to 10 days

11 to 18 days

19 to 24 days

Everyday
Q6. During the last 4 weeks, how many days did your child wheeze during the day because of asthma?*

Not at all

1 to 3 days

4 to 10 days

11 to 18 days

19 to 24 days

Everyday
Q7. During the last 4 weeks, how many days did your child wake up during the night because of asthma?*

Not at all

1 to 3 days

4 to 10 days

11 to 18 days

19 to 24 days

Everyday

Asthma Score*
Score Category 1
Score Category 2
Score Category 3
SCORE CATEGORIES

- If the child’s score is less than or equal to 12, his or her asthma may be very poorly controlled.
- If score is greater than 12 or less than or equal to 20, they are not well Controlled
- If the score is greater than 20, the child's asthma is well controlled.
Regardless of your child's score, continue to talk to your healthcare provider.
There may be more you and your child's healthcare provider could do to help control your child's asthma symptoms.

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About you (Adult parent, caregiver or guardian)
First Name*
Last Name*
If no email, enter phone and noemail.com*

Relationship to child*
State*
Postcode*
Are you of Aboriginal/Torres Strait Islander Origin?*
About the child
First Name*
Last Name
Year of Birth*

Childhood Asthma Control Test (C-ACT) – Asthma Educator Version

C-ACT Asthma Educator Version

PART 1 - TO BE COMPLETED BY THE CHILD WITH YOUR ASSISTANCE

PART 2 - ADULT PARENT, CAREGIVER ONLY

About you (Adult parent, caregiver or guardian)

About the child