Asthma Review

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Please complete the following questions to allow your health care professional to assess your asthma.

This questionnaire is for a routine review of your symptoms. If you are experiencing severe shortness of breath at present, please follow your care plan (if you have one) or ring your GP or 999 immediately.

Personal Details
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Asthma Questions
Inhaler Technique

It is essential to have a good inhaler technique to ensure that your medication gets to the part of your lungs that need it.

Please watch the specific inhaler video below to check that you are using your inhalers correctly


Asthma Control Test Score
Mymhealth Asthma App

Mymhealth Asthma App, a digital app

This app allows you access to a variety of education, interventions and tools which you can use to manage your asthma more effectively.

For example;

  • an asthma action plan
  • inhaler technique training
  • asthma control test and peak flow diary
  • education
  • a range of other self-management tools 
Your Lifestyle – Smoking

Depending upon your answers and your other medical conditions, you will be contacted if you need to be seen in clinic for a further assessment. Should your symptoms change, please seek medical advice and book an appointment if required

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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