Patient Assessment Tool

Asthma Control
Test (ACT)

A validated 5-question survey to measure how well your asthma has been controlled over the past 4 weeks.

ACT
5-Question
Assessment

Instructions: For each question, choose the one answer that best describes how your asthma has affected you during the past 4 weeks. There are no right or wrong answers. Be as honest as possible — your score helps your doctor make the best treatment decisions for you.

0 of 5 questions answered 0%
1
In the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school, or at home?
2
During the past 4 weeks, how often have you had shortness of breath?
3
During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
4
During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
Do not count medicines you take every day to prevent symptoms.
5
How would you rate your asthma control during the past 4 weeks?

⚠ Please answer all 5 questions before calculating your score.

Your ACT Score
🫁
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out of 25
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5 — Very Poorly Controlled 25 — Completely Controlled

📋 What Your Score Means

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📊 Your Answer Breakdown

Here is a summary of your responses and the points assigned to each question.

★ Recommended Next Steps

Bring This Score to Your Next Visit

    ? ACT Score Reference Guide

    The ACT is a validated tool developed and licensed by QualityMetric. Scores range from 5 (no control) to 25 (complete control). Use the guide below to understand what different score ranges mean.

    5–15
    🔴 Very Poorly Controlled
    Your asthma is having a significant impact on your daily life. A treatment change is very likely needed. Contact your doctor soon — and call 911 or go to the ER if breathing is difficult right now.
    16–19
    🟠 Not Well Controlled
    Your asthma symptoms are interfering with your daily activities. Talk to your doctor about adjusting your treatment plan at your next visit — or sooner if symptoms are bothering you.
    20–24
    🟡 Well Controlled
    Your asthma is generally well managed. Continue your current treatment and discuss any remaining symptoms with your doctor at your routine visit. There may still be room for improvement.
    25
    🟢 Completely Controlled
    Your asthma appears to be completely controlled. Keep up with your prescribed medications and routine check-ups. If anything changes, retake the ACT and share results with your doctor.
    This tool is for educational purposes only and does not replace a clinical evaluation by your healthcare provider.
    Provided by:      Date:  
    For more information:
    www.aaaai.org  |  www.acaai.org
    www.nhlbi.nih.gov/asthma