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Total # of Questions: 18

PROMIS parent proxy item bank - asthma impact - version 2.0 [91426-7]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

In the past 7 days - My child's asthma bothered him/her [91422-6]

In the past 7 days - My child had trouble breathing because of his/her asthma [91416-8]

In the past 7 days - My child felt wheezy because of his/her asthma [91413-5]

In the past 7 days - It was hard for my child to take a deep breath because of asthma [91410-1]

In the past 7 days - My child was bothered by the amount of time he/she spent wheezing [91421-8]

In the past 7 days - My child had asthma attacks [91415-0]

In the past 7 days - My child's chest felt tight because of asthma [91424-2]

In the past 7 days - My child's body felt bad when he/she was out of breath [91423-4]

In the past 7 days - My child had trouble sleeping at night because of asthma [91417-6]

In the past 7 days - My child was bothered by asthma when he/she was with friends [91420-0]

In the past 7 days - My child coughed because of his/her asthma [91411-9]

In the past 7 days - My child got tired easily because of his/her asthma [91414-3]

In the past 7 days - It was hard for my child to play sports or exercise because of asthma [91408-5]

In the past 7 days - My child had trouble walking because of asthma [91418-4]

In the past 7 days - My child felt scared that he/she might have trouble breathing because of asthma [91412-7]

In the past 7 days - My child missed school because of asthma [91419-2]

In the past 7 days - It was hard for my child to play with pets because of asthma [91409-3]

PROMIS parent proxy asthma impact - version 2.0 T-score [91425-9]

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