Questionaire–Englishversion–notvalidated.docVIP

Questionaire – English version – not validated Questions about asthma and breathing problems Have you ever had wheezing or whistling in the chest at any time in the past? Yes ( No ( If you answered “No” please skip to question 5 In the last 12 months have you had wheezing or whistling in the chest? Yes ( No ( If you answered “No” please skip to question 5 3. In the last 12 months how many attacks of wheezing have you had? None ( 1- 3 times ( 4 -12 times ( More than 12 times ( In the last 12 months have your chest sounded wheezy during or after exercise? Yes ( No ( In the last 12 months have you had dry cough at night apart from a cough associated with a cold or a chest infection? Yes ( No ( In the last 12 months have you had wheezing or whistling in the chest without having a cold? Yes ( No ( Do you feel short of breath, have whistling in the chest or severe cough? When exercising ( In cold weather ( In damp/foggy weather ( When exposed to cigarette/tobacco smoke ( In dusty environment ( Exposed to car exhaust/urban environment ( Exposed to strong scents(perfume, spicy fragrances, cleaning agents, printing ink ( During pollen season ( In contact with fur animals ( At psychic stress ( Have you by a physician been diagnosed as having asthma? Yes ( No ( Answer Question 9-11 if you in the last 12 months have had breathing problems /asthma in other words answered yes to any of the questions 2-7. In the last 12 months have you been home from school or work due to your asthma? Yes ( No ( In the last 12 months have you made any emergency visits to hospital or primary care unit due to breathing problems or asthma? Yes ( No ( If yes how many times? ……………. In the last 12 months how often have you had to use asthma medication? Never ( Sometimes ( Often/periodically ( Every day ( In the last 12 months what asthma medication have you used and how