| Question: |
Answer: |
Score |
| Age |
Years |
|
|
Have you ever lived or worked in an environment
with poor air quality, such as exposure to
smoke, secondhand smoke, dust, or
pollution?
|
|
|
|
Do you generally cough up phlegm when you are
not sick?
|
|
|
|
Have you ever experienced shortness of breath
at rest or while climbing
stairs?
|
|
|
|
Have you ever been prescribed or used any
inhalers for asthma or any other lung condition
except for viral infection?
|
|
|
| Highest PEFR Reading |
|
|
| Total Calculated Score |
|
