How often do you need to use your reliever inhaler?

• Never
• 1-2 times a month
• 1-2 times a week
• 1-2 times a day
• 2+ times a day

Do you feel that your asthma symptoms and management are well controlled at the moment?

• Well controlled - No review needed
• Not Controlled - I need a review with a practice nurse

Please select the following with regards to your smoking status

• never smoked
• ex-smoker
• light smoker (1-9 cigarettes a day)
• moderate smoker (10-19 cigarettes a day)
• heavy smoker (20-39 cigarettes a day)
• very heavy smoker (more than 40 cigarettes per day)
• user of electronic cigarette
• I do not wish to give this information

If you currently smoke, are you interested in trying to quit or reduce your smoking

• Yes- we will send you advice / information and contact details on the best ways and treatment to quit smoking
• no- I do not want to stop smoking
• not applicable

How many units of alcohol do you consume per day?

• I do not drink alcohol
• I only ever drink occasionally
• light drinker (1-2 units per day)
• moderate drinker (3-6 units per day)
• heavy drinker (7-9) units per day
• I do not want to give this information