Asthma Review

If you have been advised by the surgery to submit an annual review of your asthma symptoms please use this form. If your symptoms are deteriorating or you are having any concerns please make an appointment with our Nurse.

Asthma Review

About You

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Asthma Review

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

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

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 videos below to check that you are using your inhalers correctly:

Please watch these short video(s) on how to use your inhalers

Lifestyle - Alcohol

Lifestyle - Smoking

For further information, please see: www.nhs.uk/smokefree

Asthma Control Test Score