Asthma Review

For patients who are due an annual asthma review. 

Please would you answer the questions on the form below and submit it to us. 

If your symptoms are deteriorating or you have any concerns, please make an appointment with the respiratory nurse or a doctor as well.

Please complete the Asthma Annual Review Questionnaire.

Asthma Annual Review Questionnaire
Address *


5. In the last month has your asthma interfered with your usual activities (e.g. housework, work, school etc)?
6. Have you ever had your peak flow measured at the surgery?
7. Are you happy with your inhaler technique?
8. Have you ever smoked?
If ‘Yes’, please answer the following: Do you smoke now?
There are plenty of options available to help you quit. Is this something you would like us to contact you about?