Asthma Relief

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Questionnaire for Children & Teens (5–17 years old*)

Using a fast-acting inhaler to get relief from asthma attacks does not
necessarily mean your child’s asthma is under control. Answer
the questions below and discuss them with your child’s doctor.

Instructions

  • Click on the answer that best describes your child’s situation.
  • The score will be automatically tallied.
  • Print this page and give it to your child’s doctor at your next visit.


(This will be printed with your questionnaire results.)

Question 1

In the past 4 weeks, did your child:
a.
Have wheezing or difficulty breathing when exercising?
b.
Have wheezing during the day when not exercising?
c.
Wake up at night with wheezing or difficult breathing?
d.
Miss days of school because of his/her asthma?
e.
Miss any daily activities (such as playing, going to a friend’s
house, or any family activity) because of asthma?

Question 2

Does your child use an inhaler or a nebulizer for
quick relief from asthma symptoms?
If yes, in the past 4 weeks, what was the greatest number
of times in 1 day your child used this inhaler/nebulizer?

Question 3

Do you believe that your child’s asthma was
well controlled in the past 4 weeks?
View Results

* The ATAQ Questionnaire for Children & Teens has been scientifically validated for 5- to 17-year-olds. For children under 5, please speak with your doctor.

The control domain is 1 domain of the ATAQ instrument. Other disease management domains are included in the complete instrument.

† These numbers reflect a lower threshold than was used in the ATAQ validation studies. To identify potential control problems, this modification was designed to encourage patients and providers to discuss how asthma medications are being used.

This version conforms to the updated version of the ATAQ questionnaire.

20850275(5)-07/08-SNG