Individual patient needs survey*

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree
I know what asthma is and can recognize the signs and symptoms of asthma.	1	2	3	4	5
I understand how each of my asthma medications works to improve my condition.	1	2	3	4	5
I know what my asthma "triggers" are and how I can avoid them or reduce exposure to them.	1	2	3	4	5
I am confident I can prevent asthma symptoms from occurring in most situations.	1	2	3	4	5
I am confident I can manage asthma symptoms when they occur.	1	2	3	4	5
I know how to monitor my airways with a peak flow meter to detect potential asthma episodes before they occur.	1	2	3	4	5
Having asthma does not prevent me from doing activities that I would do if I did not have it.	1	2	3	4	5
People around me (family, friends, co-workers, school personnel) are familiar with my asthma self-management plan.	1	2	3	4	5

Asthma_patient_needs_survey.htm

* As used by the author and his staff.

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