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. Author manuscript; available in PMC: 2006 Oct 20.
Published in final edited form as: Pediatrics. 2004 Oct;114(4):e459–e468. doi: 10.1542/peds.2004-0455

TABLE 1.

Five-Item Questionnaire Used in the UAB Asthma Case-Detection Procedure

1. Has your child ever had wheezing or a whistling sound in the chest? Yes □ No □
 1a. If yes, has this been in the past 12 months? Yes □ No □
2. Has your child ever had breathing problems (coughing, wheezing, whistling in the chest, shortness of breath, chest tightness) when he/she first woke up in the morning? Yes □ No □
 2a. If yes, has this been in the past 12 months? Yes □ No □
3. Has your child ever had breathing problems (coughing, wheezing, whistling in the chest, shortness of breath, chest tightness) that woke him/her up at night? Yes □ No □
 3a. If yes, has this been in the past 12 months? Yes □ No □
4. Has a doctor ever said your child has asthma? Yes □ No □
 4a. If yes, has this been in the past 12 months? Yes □ No □
5. Has your child ever taken asthma medicine (pills, inhaler, or puffers) prescribed by a doctor? Yes □ No □
 5a. If yes, has this been in the past 12 months? Yes □ No □

Probable asthma, yes to questions 4 and 5a; possible asthma, yes to ≥1 question; negative for asthma, no to all questions.