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To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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Asthma reviews will include checking that you are able to measure your peak flow


- You are using your salbutamol (Ventolin) inhaler 3 times per week or more.


- You are experiencing symptoms of asthma 3 times per week or more.


- You are waking up at night due to the symptoms of asthma 1 night per week or more.


- You have developed symptoms such as night cough or shortness of breath.


- You have had an acute asthma attack within the last 2 years.



If yes, please provide the information on what inhalers or tablets you are taking.





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If you do, kindly explain them below



- Heart conditions (a history of heart problems such as an irregular or fast heartbeat or angina)


- Hypokalaemia (Low potassium level in body)


- An overactive thyroid gland.


- High blood pressure



- Xanthine derivatives (such as theophylline) or steroids to treat asthma.


- Water tablets (diuretics) to treat high blood pressure or a heart condition




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Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.


- The treatment is solely for your own use.


- You have answered truthfully to all the questions and you are aware that any incorrect information you provided can present a potential danger to your health.


- You will read the patient information leaflet supplied with the medicine specifically the side effects and dosages. 


- You will inform your doctor about any unusaul side effects.


- Your breathing is getting worse.


- Your asthma does not improve within 1 hour of using your inhaler.


- You start getting a tight chest


- You have daytime asthma symptoms, you wake up during the night with asthma or your asthma is interfering with your usual activities;