Description of the 10-item ad hoc questionnaire to assess the impact of asthma on daily living activities completed by patients and physicians
| Items | Scores (from 0=no impact to 10=severe impact) | ||||||||||
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
| 1. Having independence in self-care (personal hygiene/grooming, dressing/undressing, eating, etc) | |||||||||||
| 2. Doing housework (cleaning including floors, making beds, etc) | |||||||||||
| 3. Performing other normal daily activities (regular commitments, going out, hobbies, exercise, etc) | |||||||||||
| 4. Performing sporadic leisure time activities (travelling, cinema/theatre, sports, other hobbies, etc) | |||||||||||
| 5. Carrying out usual work tasks | |||||||||||
| 6. Maintaining normal social relationships | |||||||||||
| 7. Maintaining normal family relationships | |||||||||||
| 8. Having an active sexual life (frequency of relations and satisfaction) | |||||||||||
| 9. Economic burden of the disease on the family | |||||||||||
| 10. Health-related quality of life | |||||||||||