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. 2012 Apr 1;18(4):PH43–PH50. doi: 10.12659/MSM.882609

Table 1.

Main and additional questions used in a study screening questionnaire.

Questionnaire
  1. Have you had wheezing or whistling in your chest at any time in the last 12 months?

    • 1.1. Have you been at all breathless when wheezing noise was present?

    • 1.2. Have you had this wheezing or whistling when you did not have a cold?

  2. Have you been woken up with a feeling of tightness in your chest at any time in the last 12 months?

  3. Have you been woken by an attack of shortness of breath at any time in the last months?

  4. Have you been woken by an attack of coughing at any time in the last 12 months?

  5. Have you had an attack of asthma in the last 12 months?

  6. Are you currently taking any medicine (including inhalers, aerosols, or tablets) for asthma?

  7. Do you have any nasal allergies including hay fever?

  8. Have you ever been admitted to hospital because of asthma?

  9. In the past 12 months, have you missed a school because of asthma?

    • 9.1. In the past 12 months, how many days of a school have you missed because of asthma?

Additional questions
  • 10. How many household members do you have?

  • 11. How many rooms do you have in your house/apartment?

  • 12. Which type of fuel do you use for heating?

  • 13. Do you use gas for cooking?

  • 14. Do you own pets, dog or cat over 12 months?

  • 15. Are you an active smoker?

  • 16. Is somebody in your household an active smoker?