Test for Respiratory and Asthma Control in Kids (TRACK* - adapted) - FOR CHILDREN UNDER 5 YEARS OF AGE

This survey has been adapted from the TRACK^(c)questionnaire, which is used to help assess respiratory and asthma control in patients between the ages of 12 months and 5 years old. In the context of the Breathe Better with Sparky^TM Project, it is being used to establish a baseline of respiratory and asthma contol for children who enter into the Project. The information is anonymous so we do not see the individual results for your child.
*TRACK - copyright AstraZeneca

Question Title

* 1. During the past 4 weeks, how often was your child bothered by breathing problems, such as wheezing, coughing, or shortness of breath

Not at all

Once or twice

Once every week

2 or 3 times a week

4 or more times a week

Question Title

* 2. During the past 4 weeks, how often did your child's breathing problems (wheezing, coughing, shortness of breath) wake him or her up at night?

Not at all

Once or twice

Once every week

2 or 3 times a week

4 or more times a week

Question Title

* 3. During the past 4 weeks, to what extent did your child's breathing problems, such as wheezing, coughing, or shortness of breath, interfere with his or her ability to play, go to school, or engage in usual activities that a child should be doing at his or her age?

Not at all

Slightly

Moderately

Quite a lot

Extremely

Question Title

* 4. Has your child's physician or nurse practitioner prescribed a quick-relief medication for your child?

Yes

Question Title

* 5. During the past 3 months, how often did you need to treat your child's breathing problems (wheezing, coughing, shortness of breath) with quick-relief medications (eg. albuterol, salbutamol, pirbuterol, levalbuterol, epinephrine mist)

Not at all

Once or twice

Once every week

2 or 3 times a week

4 or more times a week

Question Title

* 6. During the past 12 months, how often did your child need to take oral corticosteroids (prednisone, prednisolone, dexamethasone) for breathing problems not controlled by other medications?

Never

Once

Twice

3 times

4 or more times

Question Title

* 7. During the past 12 months, how often was your child admitted to the Emergency Department or Hospital for breathing problems?

Never

Once

Twice

3 times

4 or more times

With the exception of questions 4 and 7, the remaining 5 questions are used to establish a TRACK^(c) score which some healthcare providers may use to assess your child. We only see pooled information, but if you would like a copy of the original TRACK^(c) test that you can use with your child's healthcare provider, please send an email to info@lung-games.com and we will send you a pdf version.

Question Title

* 8. Is yourchild participating in the Breathe Better with Sparky^TM Project?

Yes

Test for Respiratory and Asthma Control in Kids (TRACK* - adapted) - FOR CHILDREN UNDER 5 YEARS OF AGE

Question Title

* 1. During the past 4 weeks, how often was your child bothered by breathing problems, such as wheezing, coughing, or shortness of breath

Question Title

* 2. During the past 4 weeks, how often did your child's breathing problems (wheezing, coughing, shortness of breath) wake him or her up at night?

Question Title

* 3. During the past 4 weeks, to what extent did your child's breathing problems, such as wheezing, coughing, or shortness of breath, interfere with his or her ability to play, go to school, or engage in usual activities that a child should be doing at his or her age?

Question Title

* 4. Has your child's physician or nurse practitioner prescribed a quick-relief medication for your child?

Question Title

* 5. During the past 3 months, how often did you need to treat your child's breathing problems (wheezing, coughing, shortness of breath) with quick-relief medications (eg. albuterol, salbutamol, pirbuterol, levalbuterol, epinephrine mist)

Question Title

* 6. During the past 12 months, how often did your child need to take oral corticosteroids (prednisone, prednisolone, dexamethasone) for breathing problems not controlled by other medications?

Question Title

* 7. During the past 12 months, how often was your child admitted to the Emergency Department or Hospital for breathing problems?

Question Title

* 8. Is yourchild participating in the Breathe Better with SparkyTM Project?

* 8. Is yourchild participating in the Breathe Better with Sparky^TM Project?