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If you or a family member answer "yes" to three or more of these questions,
discuss the results with your doctor or pediatrician. | 1. Do you cough or clear your throat frequently? | Yes | No |
| 2. Do you have bouts of wheezing or coughing? | Yes | No |
| 3. Is it hard to take a deep breath? | Yes | No |
4. Has your doctor ever told you that you have
allergies? | Yes | No |
5. Do you have cold symptoms more than 3
months during the year? | Yes | No |
| 6. Do you wake up at night unable to breathe? | Yes | No |
7. When you exercise, do you have wheezing or
difficulty breathing? | Yes | No |
8. Do other family members have breathing
problems, asthma or allergies? | Yes | No |
9. Did you have frequent colds or ear infections
as a child? | Yes | No |
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