Asthma Reviews

Asthma reviews are offered on a regular basis to those patients who have been diagnosed with the condition. It is recommended that patients with asthma attend a review every 12 months.

The purpose of a regular review is to help patients manage their asthma as well as possible.

For patients who are due an annual asthma review:

To assist your clinician with managing your asthma it’s recommended that you complete the following questions and submit the form to us.

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

Asthma Review Form

Asthma Review

If you are human, leave this field blank.

First Names: *

Last Names: *

Date of Birth:

Email Address: *

Mobile telephone number: *

In the last month, have you had any difficulty sleeping because of your asthma symptoms (including cough)?

No

Yes. Everyday

Yes. 1-2 times a week

Yes. 1-2 times a month

Yes. 1-2 times a year

Yes. See details I have added below

Asthma sleeping difficulty details:

In the last month, have you had your usual asthma symptoms during the day? (cough, wheeze,chest tightness, or breathlessness)

No

Yes. 1-2 times a week

Yes. 1-2 times a month

Yes. 1-2 times a year

Yes. See details I have added below

Details of symptoms during the day:

In the last month has your asthma interfered with your usual activities (e.g housework, work, school, etc,.)?

Yes

No

Are you happy with your inhaler technique? If not, did you know there is an on-line demonstration on the Asthma UK website. Follow link at the bottom of this form if required.

Yes

No

What is your current smoking status?

Smoker

Non-smoker

Ex-smoker

If you’re a current smoker, we strongly recommend you take advantage of our Smoking Cessation Clinic.
More information about asthma and how to manage the condition can be found on the Asthma UK website.

Related Clinics and Services

If you have been diagnosed with COPD, we recommend that you receive a Seasonal Flu Vaccination every year. You should receive an invitation for this in the winter. You will also be offered a one-off pneumococcal (PPV) vaccination to protect against pneumococcal Infection, if you have never received one before.

Also, if you are a current smoker, we strongly recommend you take advantage of our Smoking Cessation Clinic.