YES

NO

1.

Have you ever in the last 12 months experience a high or rough noisy breathing?

2.

Have you ever experience breathlessness?

3.

Does breathlessness happens only when you have cold or catarrh?

4.

Have you ever in the last 12 months waked up in the middle of the night with chest tightness?

5.

Have you ever in the last 12 months waked up with coughing?

6.

Have you in the last 12 months had asthma attacks?

7.

Do you at present use asthma medication, for example, inhaler, franol, Ventolin drugs e.t.c?

8.

Have you ever, even when not having a cold or flu had sneezing or nose itching?