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©2013 UpToDate ® Print Email 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 * As used by the author and his staff.