Questions to Ask Asthma Patients
For nurses, pharmacists, primary care doctors and students taking a history from, or reviewing, a patient with asthma. The questions follow the order the conversation usually takes: how the breathing is today and over the past month, what sets it off, how the inhalers are really used, past attacks and the action plan, with a last group for a child and their parent. Each has a note on what a reassuring or a worrying answer sounds like and what to do with it; thresholds and treatment steps differ between guidelines, so check the one your service follows.
The questions
Each question, and why to ask it
Symptoms
How is your breathing today compared with a normal day for you?
Why ask it
This tells you whether you are doing a routine review or meeting someone who is getting worse. Watch as they answer: whether they finish a sentence in one breath says as much as the words. If today is clearly worse than usual, the history can wait and your setting's process for an acute assessment comes first.
In the past four weeks, how often have you had wheeze, cough, a tight chest or shortness of breath during the day?
Why ask it
A fixed window turns 'it's fine' into a number you can compare at the next visit. Control questionnaires each use their own window and cut-offs, so match the one your service works from. An answer like 'only when I do anything' describes a limit on their life, and should not go down as good control.
How many nights in the past four weeks has your asthma woken you, or had you coughing in the early hours?
Why ask it
People stop counting night waking as asthma once it has gone on for years, so it rarely comes up unasked. If a partner or parent is in the room, ask them too: they often hear a cough the patient sleeps through. The common control questionnaires all ask about nights, so write the number down even when the daytime answer sounded good.
Is there anything you have stopped doing, or do less of, because of your breathing?
Why ask it
Many patients report no symptoms because they have quietly arranged their life to avoid them: the elevator every time, no more weekend soccer, walking behind the group. A named activity gives you a goal to check at the next review. If the answer is 'I just don't exercise', ask when that started and why.
How many days of work or school have you missed because of your asthma in the past year?
Why ask it
Missed days are easy to count and hard to play down. Zero is the answer you hope for. A handful of days, or a job changed in order to cope, belongs in the notes as a measure of what the asthma is costing them, whatever the symptom count says.
What is the first thing you notice when your asthma is starting to get worse?
Why ask it
Each person has an early sign of their own: a tickly cough, a tight chest on the stairs, reaching for the reliever before lunch. Write it down in their words, because that is the cue their action plan should start from. Someone who says there is no warning at all needs the plan talked through with extra care.
Is your cough dry, or are you bringing anything up, and is that different from usual?
Why ask it
You are listening for change. A cough that has turned chesty, comes with a fever, or is new in someone whose asthma never involved coughing may not be the asthma, so it goes to whoever examines the chest that day. Record the color and the amount in the patient's words and leave the interpreting to the examination.
When were you first told you had asthma, and what tests were done to confirm it?
Why ask it
Asthma from childhood that went quiet and came back is a different story from asthma that began in adult life, and the second should send you to the question about work under Triggers. Plenty of people carry the label from one wheezy winter with no breathing test on record. 'Nobody ever tested me' is worth writing down as said, because an unconfirmed diagnosis is one explanation for inhalers that never seem to help.
Triggers
What sets your asthma off?
Why ask it
Leave it open before you offer a list: the first thing they name is usually the one that matters most to them. Then work through the specific questions that follow, since few people have connected all of theirs. 'Nothing, it just happens' is common, and a reason to keep going.
What happens to your breathing when you exercise, laugh hard or go out into cold air?
Why ask it
All three are easy to avoid without noticing you are doing it. Find out whether symptoms come during the effort or a few minutes after stopping, and whether they take the reliever beforehand. 'I gave up running' is a symptom, so record it as one.
When you catch a cold, does it go to your chest, and how long does it take to clear?
Why ask it
The answer tells you what winter is like for them. Listen for 'every cold ends in steroid tablets' or a cough that hangs on for weeks afterward. It also sets up a later question: what do they change, if anything, on the first day of a cold?
Do you get hay fever, eczema or food allergies, and is your nose often blocked or runny?
Why ask it
Asthma often travels with other allergic conditions, and a nose that is never clear can make the chest harder to settle. Ask what they take for it and whether it works. A past severe reaction to a food should be recorded prominently and checked against what the record already says.
Does anyone in your close family have asthma, eczema or hay fever?
Why ask it
Parents, brothers, sisters and children are the ones that count here. A family full of allergies fits the picture, while a clear 'nobody' proves nothing, so do not lean on it either way. Listen for how the relative's asthma went: a parent who died in an attack, or one who 'never bothered with inhalers', shapes how this patient treats their own.
What is your home like: any damp or mold, pets, carpets, or a gas stove or wood burner?
Why ask it
What has changed matters as much as what is there: a move, a new kitten, building work. Symptoms that ease when they stay somewhere else point at the home. A tenant with mold on the bedroom wall may need a letter or a referral more than a new inhaler, and what you can offer there depends on where you work.
What is your job, and is your breathing any better on days off or on vacation?
Why ask it
Improvement away from work is the pattern to listen for, especially in asthma that began in adult life. Ask what they breathe in during a shift: flour, wood dust, paint spray, cleaning products, animals, fumes. Write the job and the exposure beside a yes, and learn how suspected work-related asthma is investigated and reported where you practice before you tell the patient what happens next.
Do you smoke or vape, and does anyone you live with?
Why ask it
Say it flatly and take the answer without comment, or the next figure you are given will be smaller. Include cannabis and hookah, and for those who quit, when. For a smoker, one more question is enough for today: would they like help to stop? Have the local stop-smoking offer ready in case the answer is yes.
Have aspirin, ibuprofen or similar painkillers ever made your chest worse, and has any medicine been started or changed recently?
Why ask it
Some people with asthma react to this group of painkillers, and many have never been asked. Record what happened and how soon after the dose. List any new tablets or eye drops for blood pressure, the heart or glaucoma by name: a few of them can affect the airways, and a pharmacist or prescriber will know which.
Do you get heartburn, or acid coming up into your throat, especially at night or after a big meal?
Why ask it
Reflux and asthma are often found in the same person, and a cough at 2 a.m. can belong to either. Ask what they take for it, and whether the chest is worse on the nights the heartburn is. Record it as a problem of its own for the review, and do not promise that treating it will settle the breathing.
Is there a time of year, or a kind of weather, when your asthma is reliably worse?
Why ask it
Spring and summer suggest pollen, fall and winter suggest viruses and cold air, and some people name thunderstorms or days of poor air quality. A dependable bad season means the review can be booked before it starts. Ask how that season went last year.
Do stress, strong emotion or a run of bad sleep make your breathing worse?
Why ask it
Patients sometimes hold this back for fear of being told it is all in their head, so say plainly that you are asking about a trigger like any other. A yes opens a gentle question about what is going on at home or at work. Skip it if a relative is answering for the patient, and come back when you can ask them directly.
Inhalers
Which inhalers do you have, and what do you understand each one is for?
Why ask it
Have every device put on the table, old ones included. Patients tend to go by color, and colors differ between brands and countries, so read the label yourself. Check the prescription before correcting anyone: some regimens use a single inhaler for both daily treatment and relief.
How many times a week do you reach for your reliever?
Why ask it
Get days and puffs, and count doses taken before exercise separately. 'Only when I need it' is not a number, so try 'how many times yesterday?' Guidelines read frequent reliever use as a sign of poor control, each with its own threshold, and a count that has climbed since the last visit matters even when it sits under that line.
When did you last pick up a new preventer, and when a new reliever?
Why ask it
This is the pharmacist's question, and the dispensing record can answer it when memory cannot. The pattern to raise is many relievers collected and few preventers. Bring it up as something you noticed in the record, with curiosity, and ask what makes the reliever the one they turn to.
In an ordinary week, how many doses of your preventer get missed?
Why ask it
Asking how many, not whether, makes it safe to say 'most of them'. The reason matters more than the count: forgetting, feeling well, cost, a fear of steroids, or never having been told it is meant for every day. Each has a different fix, and only the first is solved by a reminder on a phone.
Will you show me how you take your inhaler, exactly as you would at home?
Why ask it
Watch the whole thing in silence before you teach anything. The correct steps depend on the device, so have its checklist or instruction sheet in front of you: a slow, gentle breath suits some inhalers and a fast, deep one suits others. Correct one or two things, then ask them to do it again.
Do you use a spacer with your inhaler, and how do you look after it?
Why ask it
A spacer only goes with a spray (metered-dose) inhaler, so check which device they have before you ask. Plenty of adults were handed one once and think of it as something for children. If it lives in a closet, find out what put them off: the size, the embarrassment, nobody showing them how. For washing and replacing it, go by the leaflet for that model.
How do you tell when an inhaler is running out?
Why ask it
Some devices have a dose counter and some do not, and a patient who shakes the canister to judge is guessing. The worrying answer is 'when it stops working', because that tends to be found out in the middle of an attack. Check the counter and the expiry date on the ones they brought.
Where is your reliever right now?
Why ask it
A good answer is a pocket or a bag within reach. 'At home', 'in the car' or 'I think my sister has it' tells you what would happen if an attack started in your waiting room. Follow with where the spare lives, and whether work, the gym bag and the bedside are covered.
Have you noticed a sore mouth, a hoarse voice or anything else you put down to your inhalers?
Why ask it
Side effects are a quiet reason for stopping, and people rarely volunteer them. Ask whether they rinse their mouth after the preventer and whether anyone ever suggested it. For a teacher or a singer a hoarse voice is reason enough to give up the inhaler, so note what it costs them and raise it with the prescriber before they do.
Is there anything about your inhalers that worries you, or that you have read or been told?
Why ask it
The usual worries are steroids, becoming dependent, the medicine wearing off with use, and safety in pregnancy. Hear the whole worry before you respond, and do not reassure beyond what you know. A patient who is pregnant or planning to be and thinking of stopping needs the prescriber's answer soon, so arrange that conversation before they decide alone.
Is the cost of your inhalers, or getting the prescription filled, ever the reason you go without?
Why ask it
People ration inhalers and are ashamed to say so, so ask it as a practical matter in an even voice. Listen for skipped doses near payday or a preventer made to last twice as long. What help exists depends entirely on the country, the insurer or the health service, so find out what your workplace can offer before you ask.
What else do you take for your chest or your allergies, including anything bought without a prescription?
Why ask it
Antihistamines, nasal sprays, cough mixtures, a relative's inhaler, herbal remedies and nebulizers bought online all come up here. None of it is a confession, and saying so gets a fuller list. A borrowed inhaler or a home nebulizer is the item to ask more about: how often, and what they do when it does not work.
Past attacks
Tell me about the worst asthma attack you have ever had: what happened, and how was it treated?
Why ask it
Let them tell it as a story, then fill in the gaps: how fast it came on, who treated it and where, how long recovery took. The worst episode shows what this person's asthma is capable of. A patient who cannot recall a bad attack is giving you good news, though check they are not counting only the ones that ended in the hospital.
In the past twelve months, how many times have you needed steroid tablets, an urgent appointment or the emergency department for your asthma?
Why ask it
Take the three one at a time, since people forget the urgent appointment that ended with a short course of tablets. Compare the count with the record. Guidelines use attacks in the past year to judge the risk of another, so a number above zero shapes the review even when the patient feels well today.
Have you ever been admitted to the hospital with asthma, and did you ever need intensive care or help from a breathing machine?
Why ask it
This is the answer to put where nobody can miss it. Guidelines list a past stay in intensive care among the markers of risk for a dangerous attack, however well the patient seems now and however long ago it was. Get the year and the hospital so the discharge summary can be found.
When was your most recent attack, and what do you think brought it on?
Why ask it
Their theory is often right and always useful: a cold, a cat, a missed week of preventer, a hard month. Ask whether anyone looked at their treatment afterward. An attack that was treated and never talked about again is a gap, and this visit may be the first chance anyone has had to close it.
Do your attacks build over a few days, or come on within minutes?
Why ask it
A slow build leaves time for an action plan to work, and you can ask which day they usually act on. Attacks that arrive with almost no warning change what the plan has to say and who needs to know about it. Put the pattern in the notes in their words: 'three days of cough first', or 'fine at lunch, in the ambulance by two'.
In the last bad episode, what did you do first, and at what point did you ask for help?
Why ask it
You are listening for delay. 'I waited to see if it would pass', 'I didn't want to bother anyone' and 'I kept taking the blue one all night' are the replies that should worry you. Go through it without blame, then return to it when you reach the action plan.
Action plan
Do you have a written asthma action plan, and where do you keep it?
Why ask it
A photo on the phone or a copy on the fridge is a good answer; 'somewhere in a drawer' means it will not be found at 3 a.m. Ask to see it, and check the date and that it names the inhalers they have today. If there is none, find out who writes them in your service and how the patient gets one.
If your reliever was not helping as it normally does, what would you do next?
Why ask it
Have them say the steps aloud without looking at the plan. Compare what you hear with what is written, and send any mismatch to the clinician who wrote it; do not improvise doses yourself. 'Keep taking it and hope' tells you the plan has not landed.
What would make you call an ambulance or go to the emergency department?
Why ask it
You want their threshold in their own words. If it is 'when my lips go blue' or 'if I collapsed', it is set far too late, and the danger signs on their plan need going over again. Make sure they know the emergency number where they live, and that nobody will think an asthma attack was a wasted call.
Do you check your peak flow at home, and what is your best reading when you are well?
Why ask it
Plenty of plans are built on symptoms alone, so 'no' is not a failing. For those who do measure, the personal best is the number every other reading is judged against, so ask to see the diary or the app. A patient with a meter and no idea of their best was given a tool with no instructions.
Who around you knows you have asthma and would know what to do in an attack?
Why ask it
Think of the people present when it is most likely to happen: a partner at night, coworkers, a coach, a roommate. Someone who lives alone, or who says 'nobody, I don't like a fuss', has a plan with one point of failure. Suggest they show one person where the reliever is kept and what the plan says.
When was your last asthma review, and do you know when the next one is due?
Why ask it
A patient seen only during attacks has never had the conversation you are having now. How often reviews happen, and who runs them, differs between services, so learn the local arrangement before you promise anything. If they have dropped off the list, book it or tell them exactly how to.
Have you had this season's flu vaccine, and do you know which other vaccines are offered to you because of your asthma?
Why ask it
Chest infections are a common route to an attack, which is why this belongs in an asthma review. Which vaccines are offered, at what age and at whose cost depends on the country's schedule and sometimes on the treatment they take. Check the current local advice before answering, and record a refusal with the reason given.
What is the one thing about your asthma you would most like to be different by the next time we meet?
Why ask it
It closes the review on their terms: sleeping through, a full game of basketball, fewer inhalers to carry. Put the goal in the notes word for word and open the next visit with it. Someone who wants nothing changed may be well controlled, or may have stopped expecting better.
Children
Can you tell me what your chest feels like when you need your inhaler?
Why ask it
This one is for the child, before the parent answers for them, and it needs you to wait through the silence. Children say 'my tummy hurts', 'my chest is itchy' or 'it feels squeezy', and those are the words the parent and the teacher should be listening for. A child who cannot say when they need the inhaler is relying on an adult to notice.
Does your child cough or wheeze at night, and how often does it wake them or you?
Why ask it
Parents count broken nights better than they count symptoms, so ask about their own sleep too. A cough that only shows up at night or after running around is easy to wave off as 'just a cough'. Ask for a number of nights in the past month, and whether anyone has recorded the sound on a phone for the clinician to hear.
Can your child keep up with friends when they run around, or do they stop, cough or sit out?
Why ask it
Young children do not say they are breathless; they just stop playing. A parent may describe a child who 'isn't athletic' or who always asks to be carried. Ask what a teacher or coach has noticed, since they see the child beside a whole class of others the same age.
Who gives the inhalers at home, and how much does your child do for themselves?
Why ask it
The answer shows where doses get lost: between two households, on the morning a grandparent does the school drop-off, or with a ten-year-old trusted to remember alone. Older children and teenagers often take over before they are ready. Ask who checks, and how.
Can you and your child show me how the inhaler is given at home, spacer and mask included?
Why ask it
Watch the two of them do it as they really do, wriggling and all. Look at whether the mask seals on the face and how many breaths the child takes from the spacer, then compare with the instructions for that device. Praise what went right before you change anything.
Does the school or daycare have a reliever, a spacer and a copy of the plan, and do the staff know when to use them?
Why ask it
A good answer names the person and the cabinet. Rules on who may hold or give medicine at school differ by country, state and district, so ask the parent to find out what theirs requires and which forms you may have to complete. Ask about field trips, sports days and the bus as well.
Does your child spend nights in another home, and is there an inhaler and a spacer there?
Why ask it
Grandparents, the other parent and sleepovers are where the preventer gets skipped and the reliever gets left behind. Ask whether the adults there have seen the plan, and whether anyone smokes indoors or keeps pets. One set of inhalers traveling in a backpack is a fragile arrangement, so ask whether a second set for the other house has ever been requested.
What worries you most about your child's asthma?
Why ask it
Common answers are steroids and growth, an attack in the night, and whether sports are safe. Whatever the fear is, it is probably shaping how the inhalers are given, so hear it out before you answer. Take questions about a medicine's effects to the prescriber, and tell the parent you are doing so.
How to take an asthma history and run a review
Practical guidance for the conversation itself
Before you ask anything
Look at the patient first
Before the first question, notice how they walked in, whether they can finish a sentence, and whether you can hear the breathing from across the room. A person who is struggling is not a person to take a full history from. Know your setting's process for someone who is acutely unwell and who you call, and use it. The list on this page is for the patient who is well enough to talk.
Have the record and the inhalers on the table
Ask patients to bring every inhaler and the spacer to the appointment, including the ones they have stopped using. Before they sit down, look at what has been prescribed and what has been collected over the past year, the date of the last review, and any paperwork from an emergency visit. The questions under Inhalers and Past attacks go further when you can set the answer beside the record.
Learn the words used where you work
Reliever and preventer are also called rescue and controller or maintenance inhalers, and patients say puffer, pump or simply the blue one. Colors are not standard across brands or countries. Use the patient's own word once you know which device they mean, and write the drug name in the notes.
Know which guideline your service follows
What counts as good control, how often is too often for a reliever, and which treatment comes next are set by national and international guidelines that do not all agree and are revised regularly. The same goes for the control questionnaire. Ask a senior colleague or your supervisor which ones apply, and measure answers against those, not against a number you remember from a lecture.
Asking so that you hear the real answer
Follow the order of the groups
The groups run the way a review usually does: how things are now, what sets it off, how the inhalers are really used, what has gone wrong before, and what the patient would do next time. When time is short, start with today's breathing, day and night symptoms, the reliever count, the technique check and the action plan. The Children group adds what to ask a child and their parent or caregiver; most of the adult questions also work for a parent once 'you' becomes 'your child'.
Ask for a number in a set window
'How is your asthma?' gets 'fine' from almost everyone, including people who wake most nights. 'How many nights in the past four weeks?' gets a figure. Keep the same window at each visit so the numbers can be compared, and write them down.
Make the honest answer the easy one
Ask how many doses get missed, not whether any do, and keep your face and voice level when the answer comes. A patient who is told off for skipping the preventer learns to say they take it. The treatment may then be increased for the wrong reason, when the real problem was never the dose.
Watch before you teach
For inhaler technique, ask for a demonstration and say nothing until it is finished. Use the checklist for that exact device, fix the one or two errors that matter most, and ask for a second demonstration. Technique drifts, so repeat the check at every review, including for the patient who has had the same inhaler for twenty years.
What to do with the answers
Answers to pass on the same day
Some replies should not wait for the next routine appointment: breathing that is worse today than usual, a past admission to intensive care, a recent attack that nobody followed up, relievers used up quickly with little or no preventer, or no reliever to hand. What you do next depends on your role and your setting. Find out in advance who you tell and how fast, and let the patient know you are passing it on.
Stay inside your role
A student, a nurse, a pharmacist and a doctor can each ask every question here. Who may change a dose, write an action plan or issue a prescription differs by country, profession and employer. When a patient asks whether to stop or change a medicine, the safe reply is that you will get the answer from the person who can give it. Ask your supervisor where your own limits sit.
Record words and numbers
Write down the count of night wakings, the reliever puffs per week, the missed days and the patient's own goal as they were said. A note that reads 'asthma stable' cannot be compared with anything. Next time, open with the same questions and put the two sets of numbers side by side.
Close with a teach-back
Before the patient leaves, ask them to tell you what changes today and what they would do if the reliever stopped helping. If their version differs from the plan, the explanation needs another go, in fewer words. Agree on one change they will make, and note it.
When the patient is a child
Ask the child as well as the parent
Even a four-year-old can point to where it feels tight or tell you what happens in gym class. Put one or two questions to the child first, in plain words, then turn to the parent for the counts and the dates. A child who has been spoken to is usually more willing to do the inhaler demonstration.
Map every place the child sleeps and plays
Home, a second household, grandparents, daycare, school, the sports club. For each one, ask who is in charge, whether a reliever and spacer are kept there, and whether that adult has seen the plan. The gaps tend to sit at the handovers between places.
Schools have their own rules
Whether a child may carry an inhaler, whether staff may give it, whether the school can hold a spare, and what forms are needed are set by national, state or district policy. Do not guess. Ask the parent to get the school's requirements in writing, and find out which forms your service is expected to complete.
Teenagers
Older children often manage their own inhalers long before anyone has checked that they can, and they skip doses for reasons they will not give in front of a parent. Whether and when to see a young person alone for part of the visit is a matter for your service's policy and the local law on consent and confidentiality. Ask how it is done where you work, and put the adult questions to the teenager directly.