ASTHMA CONTROL TEST (ACT)

<script><!-- [et_pb_line_break_holder] -->function CalculateScore() {<!-- [et_pb_line_break_holder] -->var i=0;<!-- [et_pb_line_break_holder] -->var score = 0;<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->for( i = 0; i < document.quizform.Q1.length; i++ ) {<!-- [et_pb_line_break_holder] -->if(document.quizform.Q1[i].checked)<!-- [et_pb_line_break_holder] --> { score += parseInt(document.quizform.Q1[i].value); }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->for( i = 0; i < document.quizform.Q2.length; i++ ) {<!-- [et_pb_line_break_holder] -->if(document.quizform.Q2[i].checked)<!-- [et_pb_line_break_holder] --> { score += parseInt(document.quizform.Q2[i].value); }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->for( i = 0; i < document.quizform.Q3.length; i++ ) {<!-- [et_pb_line_break_holder] -->if(document.quizform.Q3[i].checked)<!-- [et_pb_line_break_holder] --> { score += parseInt(document.quizform.Q3[i].value); }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->for( i = 0; i < document.quizform.Q4.length; i++ ) {<!-- [et_pb_line_break_holder] -->if(document.quizform.Q4[i].checked)<!-- [et_pb_line_break_holder] --> { score += parseInt(document.quizform.Q4[i].value); }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->for( i = 0; i < document.quizform.Q5.length; i++ ) {<!-- [et_pb_line_break_holder] -->if(document.quizform.Q5[i].checked)<!-- [et_pb_line_break_holder] --> { score += parseInt(document.quizform.Q5[i].value); }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->document.quizform.totalscore.value = score;<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --><style type="text/css"><!-- [et_pb_line_break_holder] -->label {<!-- [et_pb_line_break_holder] -->width:180px;<!-- [et_pb_line_break_holder] -->display:block;<!-- [et_pb_line_break_holder] -->float:right;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->#question {<!-- [et_pb_line_break_holder] -->width:220px;<!-- [et_pb_line_break_holder] -->font-family:Segoe UI,Tahoma,Verdana,Arial;<!-- [et_pb_line_break_holder] -->color:#000000;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->#testform p.soam {<!-- [et_pb_line_break_holder] --> font-weight: bold;<!-- [et_pb_line_break_holder] --> font-family: Segoe UI,Tahoma,Verdana,Arial;<!-- [et_pb_line_break_holder] --> width:520px;<!-- [et_pb_line_break_holder] --> color:#09357A;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->.myInput {<!-- [et_pb_line_break_holder] -->-moz-border-radius:6px 6px 6px 6px;<!-- [et_pb_line_break_holder] -->background:url("http://www.clinicalresearchcenter.com/images/inputbg.png") repeat-y scroll 0 0 transparent;<!-- [et_pb_line_break_holder] -->border:1px solid #09357A;<!-- [et_pb_line_break_holder] -->color:#09357A;<!-- [et_pb_line_break_holder] -->font-family:Segoe UI,Tahoma,Verdana,Arial;<!-- [et_pb_line_break_holder] -->font-size:22px;<!-- [et_pb_line_break_holder] -->margin:2px auto 10px;<!-- [et_pb_line_break_holder] -->padding:5px;<!-- [et_pb_line_break_holder] -->width:60px;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->fieldset.general {<!-- [et_pb_line_break_holder] -->-moz-border-radius:15px 15px 15px 15px;<!-- [et_pb_line_break_holder] -->background:url("https://www.clinicalresearchcenter.com/images/accept.png") no-repeat scroll right top #F1F1F1;<!-- [et_pb_line_break_holder] -->border:5px solid #CCCCCC;<!-- [et_pb_line_break_holder] -->font-family:Georgia;<!-- [et_pb_line_break_holder] -->font-size:14px;<!-- [et_pb_line_break_holder] -->margin-bottom:10px;<!-- [et_pb_line_break_holder] -->padding:10px;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->legend {<!-- [et_pb_line_break_holder] --> font-family:Segoe UI,Tahoma,Verdana,Arial;<!-- [et_pb_line_break_holder] --> font-size:23px;<!-- [et_pb_line_break_holder] --> font-weight:bold;<!-- [et_pb_line_break_holder] --> color:#09357A;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->#assub {<!-- [et_pb_line_break_holder] -->background:url("http://www.clinicalresearchcenter.com/images/submit.png") no-repeat scroll 0 0 transparent;<!-- [et_pb_line_break_holder] -->border:medium none;<!-- [et_pb_line_break_holder] -->cursor:pointer;<!-- [et_pb_line_break_holder] -->display:block;<!-- [et_pb_line_break_holder] -->height:50px;<!-- [et_pb_line_break_holder] -->width:308px;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --></style><!-- [et_pb_line_break_holder] --><fieldset class="general"><!-- [et_pb_line_break_holder] --><form name="quizform" method="post" id="testform"><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p class="soam">1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school, or at home? </p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div id="question"><!-- [et_pb_line_break_holder] --><p><label>All of the time</label><input type="radio" name="Q1" value="1"></p><!-- [et_pb_line_break_holder] --><p><label>Most of the time</label><input type="radio" name="Q1" value="2"></p><!-- [et_pb_line_break_holder] --><p><label>Some of the time</label><input type="radio" name="Q1" value="3"></p><!-- [et_pb_line_break_holder] --><p><label>Very little</label><input type="radio" name="Q1" value="4"></p><!-- [et_pb_line_break_holder] --><p><label>Not at all</label><input type="radio" name="Q1" value="5"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p class="soam">2. During the past 4 weeks, how often have you had shortness of breath?</p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div id="question"><!-- [et_pb_line_break_holder] --><p><label>More than once a day</label><input type="radio" name="Q2" value="1"></p><!-- [et_pb_line_break_holder] --><p><label>Once a day</label><input type="radio" name="Q2" value="2"></p><!-- [et_pb_line_break_holder] --><p><label>3 to 6 times a week</label><input type="radio" name="Q2" value="3"></p><!-- [et_pb_line_break_holder] --><p><label>Once or twice a week</label><input type="radio" name="Q2" value="4"></p><!-- [et_pb_line_break_holder] --><p><label>Not at all</label><input type="radio" name="Q2" value="5"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p class="soam">3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) wake you up at night or earlier than usual in the morning? </p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div id="question"><!-- [et_pb_line_break_holder] --><p><label>4 or more nights a week</label><input type="radio" name="Q3" value="1"></p><!-- [et_pb_line_break_holder] --><p><label>2 or 3 nights a week</label><input type="radio" name="Q3" value="2"></p><!-- [et_pb_line_break_holder] --><p><label>Once a week</label><input type="radio" name="Q3" value="3"></p><!-- [et_pb_line_break_holder] --><p><label>Once or twice</label><input type="radio" name="Q3" value="4"></p><!-- [et_pb_line_break_holder] --><p><label>Not at all</label><input type="radio" name="Q3" value="5"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p class="soam">4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)? </p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div id="question"><!-- [et_pb_line_break_holder] --><p><label>3 or more times per day</label><input type="radio" name="Q4" value="1"></p><!-- [et_pb_line_break_holder] --><p><label>1 or 2 times per day</label><input type="radio" name="Q4" value="2"></p><!-- [et_pb_line_break_holder] --><p><label>2 or 3 times per week</label><input type="radio" name="Q4" value="3"></p><!-- [et_pb_line_break_holder] --><p><label>Once a week or less</label><input type="radio" name="Q4" value="4"></p><!-- [et_pb_line_break_holder] --><p><label>Not at all</label><input type="radio" name="Q4" value="5"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p class="soam">5. How would you rate your asthma control during the past 4 weeks? </p><!-- [et_pb_line_break_holder] --><p></p><!-- [et_pb_line_break_holder] --><p><!-- [et_pb_line_break_holder] --><div id="question"><!-- [et_pb_line_break_holder] --><p><label>Not controlled at all</label><input type="radio" name="Q5" value="1"></p><!-- [et_pb_line_break_holder] --><p><label>Poorly controlled</label><input type="radio" name="Q5" value="2"></p><!-- [et_pb_line_break_holder] --><p><label>Somewhat controlled</label><input type="radio" name="Q5" value="3"></p><!-- [et_pb_line_break_holder] --><p><label>Well controlled</label><input type="radio" name="Q5" value="4"></p><!-- [et_pb_line_break_holder] --><p><label>Completely controlled</label><input type="radio" name="Q5" value="5"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><div><!-- [et_pb_line_break_holder] --><br><!-- [et_pb_line_break_holder] --><input type="button" id="assub" value="" onClick="CalculateScore()"><!-- [et_pb_line_break_holder] --><br><p class="soam"><label style="float: left; margin-top: 13px; font-size: 23px; color: #09357A;text-decoration: underline;">Total Score</label><input type="text" class="myInput" name="totalscore" size="4"></p><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><br><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --></fieldset>