Perception of Asthma Control in Bermuda
Thank you for taking our ‘Perception of Asthma Control in Bermuda’ Survey, this should take less than 5 minutes to complete.
Whom are you representing doing this survey? *
Do you consider your asthma is ...? *
Age *
Gender *
Race *
Employment Status *
Health Insurance *
Was your asthma diagnosed by a doctor? *
Have you had asthma since childhood? *
When you have asthma do you ...? *
(tick all that apply)
In the past week have you ...? *
(tick all that apply)
Have you had a review of your asthma with your Doctor in the past year? *
Do you have an Asthma Action Plan? *
Do you use a spacer device? *
Have you had your inhaler technique checked by a health professional in the past year? *
Do you have a peak flow meter? *
Have you ever had one-on-one asthma education with an asthma nurse? *
Which treatment do you take for asthma? and how often?
More than twice a week
Only occasionally
Only when I have a cold /virus
Only when I have asthma symptoms
Rescue/reliever only (Ventolin or Airomir)
Single drug preventer (Beclomethazone, Becotide, Qvar, Flixotide)
Combination inhaler (Symbicort, Seretide / Advair, Dulera)
If you do not use prevention daily - Why?
(tick all that apply)
How many times have you been to Emergency (or the Lamb Foggo Acute Care facility) for asthma in the past year? *
How many times have you been admitted to the hospital for asthma in the past year? *
How much time off work/school have you taken due to asthma this past year? (approximately) *
Where do you seek information about asthma? *
(tick all that apply)
Optional EMAIL ADDRESS - if provided we will forward YOUR results and applicable information regarding control.
Your answer
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