Asthma not well controlled? What the term means and what to record for your doctor
What does uncontrolled asthma mean? The four GINA questions, how they differ from the ACT, and what to record about reliever use and nights.
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How well your asthma is controlled is something your doctor rates from the last four weeks. You can record your days with reliever use and your nights woken in Sam, where sleep and overnight respiratory rate from Apple Health sit next to your entries.
What does "not controlled" mean for asthma?
Asthma is not well controlled when it limits you despite your current treatment: by day, at night or in daily life. The time span is the last four weeks. The Global Initiative for Asthma (GINA) rates symptom control with four questions.
Online you find "uncontrolled asthma", "asthma got worse" and "poorly managed asthma". Usually the same thing is meant: it is not going well right now.
GINA sees control from two sides: how much asthma affects you on your current treatment, and your risk of problems in future. The four questions cover the first side only.
"Not controlled" describes a time span. It is not a verdict on you. Your doctor rates your case.
What are the four questions, and how do I score them?
GINA asks whether any of this applied in the past four weeks:
- Daytime symptoms more than twice a week.
- Any night waking because of asthma.
- Reliever needed for symptoms more than twice a week.
- Any activity limitation because of asthma.
No yes answers means well controlled. One or two means partly controlled. Three or four means not controlled. Risk factors and lung function are assessed separately by your doctor.
The reliever question applies to a short-acting reliever (SABA). Do not count a puff taken before exercise. For a reliever that combines formoterol with a steroid (ICS-formoterol), this counting rule does not apply, says GINA. The packaging or your plan says which inhaler you have. If unsure, ask your doctor. "Twice a week" is not an allowed amount. It is a threshold in one GINA question.
You can go through the four questions in our asthma symptom control tool. It is not a GINA product.
What is the difference between the Asthma Control Test and the GINA questions?
If you search for "asthma control test", you probably mean the ACT. It is a trademarked questionnaire owned by QualityMetric, and the copyright notice on the official site belongs to the GSK group. Its questions are not reproduced here.
The four questions come from GINA. The ACT and GINA each have their own questions and scoring. An ACT score and a GINA rating are two different statements. Do not treat them as equal. Tell your doctor which test you took and bring the result.
How do I record reliever use: days, not just puffs?
People who search "how often can I use my asthma inhaler" often want an allowed number. This text gives none. How you use your inhaler is set in the plan you agree with your doctor. What you can contribute is an honest record:
- Write down each use on the same day: date, time, reason.
- Count days, not just puffs. Several puffs on one day count as one day with reliever. Note the puffs next to it.
- Note whether it helped: yes, a bit or no.
- Give any use before exercise, if your plan says so, its own line.
- Mark the nights asthma woke you.
In Sam each reliever use is its own entry with date, puffs and reason. Uses before exercise are counted separately. You enter an attack as its own entry, with strength, whether the reliever helped and a switch for waking at night.
Do not set yourself a target for the number of reliever days. Writing less to look better distorts exactly what your doctor needs to read. An extra day in the record is a more accurate number, not a defeat.
What do I bring and ask?
One page is enough, for the last four weeks or since your last visit:
- Days with reliever, split into symptoms and exercise.
- Nights woken, and whether the reliever helped.
- Attacks, with the date and how bad they felt.
- Steroid tablet courses, with dates.
- Help beyond the reliever: GP, out-of-hours service, emergency department.
- How you take your preventer, including the gaps. In Sam you can tick off doses and set reminders.
- Triggers you noticed, such as pollen, cold air, a cold or dust.
- All your inhalers, so your doctor can check your technique.
GINA says that when asthma is not well controlled, doctors check adherence, inhaler technique, risk factors and other conditions first, before stepping up treatment. That is why honest gaps and your real device matter.
Questions you can ask:
- How do you rate my asthma from my notes?
- Is my inhaler technique still right?
- Do I have a written action plan, and is it up to date?
- Do I need an appointment before my next regular one?
- Who do I contact out of hours?
The NHS says annual asthma reviews check your inhaler technique and whether your treatment works. If you are newly diagnosed, start with asthma diagnosis: what now. The peak flow calculator helps if you measure peak flow, and our checklist for a doctor visit with a chronic condition adds a general list.
What if I have a severe asthma attack?
This section is not an instruction from Sam. It points you to the right services. The NHS says to call the emergency number if you have an asthma attack and you feel worse at any time, you do not feel better after the maximum dose of your reliever inhaler, or you do not have an inhaler. Use your local emergency number (112 in the EU, 999 in the UK, 911 in the US). After an attack the NHS advises seeing your GP within 2 days.
What counts as getting worse for you is written in your action plan, which you agree with your doctor. If you do not have one, ask for it. If treatment is not helping or you need your inhaler more often, the NHS says to contact your GP. GINA names uncontrolled symptoms an important risk factor for severe attacks.
What can my Apple Watch add?
If your Apple Watch records a respiratory rate while you sleep, it sits in Apple Health. In the asthma program Sam reads it and shows it as a number next to your own average. That is a reading, not a finding. An Apple Watch does not measure lung function, and one number does not say whether your asthma is controlled. Apple states that Vitals app measurements are not intended for medical use.
More in respiratory rate, sleep and asthma with Apple Health.
Log reliever days and nights in Sam and take them to your appointment
You bring one page instead of estimates: the doctor report from the asthma program shows days with reliever and nights woken for the last 28 days, as a PDF.
- Instead of a paper note or notes app: each use is an entry with puffs and reason, uses before exercise count separately, and the report works out the days.
- Instead of Apple Health alone: sleep and respiratory rate of the night sit next to your entries, with your own average.
- Instead of memory: attacks and steroid courses appear in the report with their dates.
Sam has no peak flow entry and no action plan.
Try Sam HealthSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
Sources
Updated: October 2026
- Global Initiative for Asthma: 2026 GINA Summary Guide and the PDF, Table 2 (assessment of asthma control) and the section on uncontrolled asthma
- NHS: Asthma attack, Asthma treatment and Living with asthma (last reviewed 7 April 2025)
- Asthma + Lung UK: Personal asthma action plans (last reviewed 11 January 2026)
- CDC: Living with asthma (last reviewed 28 August 2026)
- Asthma Control Test: asthmacontroltest.com (trademark of QualityMetric, site copyright GSK group)
- Apple Support: Track overnight and daytime vitals with Apple Watch
More on Asthma
Frequently Asked Questions
What does uncontrolled asthma mean?+
In the GINA guidelines, asthma symptom control is rated from four questions about the last four weeks: daytime symptoms more than twice a week, any night waking because of asthma, reliever needed more than twice a week, and any activity limitation. Three or four yes answers mean not controlled. That rates your symptoms, not you. Your doctor makes the assessment for your case.
My asthma has got worse. What should I write down?+
Write down the days you used your reliever, the nights asthma woke you and where it limited you in daily life, each with the date and what happened before. Your doctor can then compare the last weeks with earlier ones instead of relying on how you feel.
Asthma is worse at night. What belongs in my record?+
Every night asthma woke you, with date and time, and whether you used your reliever and whether it helped. Night waking is one of the four GINA questions, and a single time in four weeks counts as yes.
What is the difference between the Asthma Control Test and the GINA questions?+
The Asthma Control Test (ACT) is a trademarked, copyrighted questionnaire owned by QualityMetric, so its questions are not reproduced here. The four questions come from GINA. Each has its own wording and scoring, so an ACT score and a GINA rating are not the same thing. Tell your doctor which one you filled in.
How often is too often to use a reliever inhaler?+
This text does not give an allowed amount. How you use your inhaler is set in the plan you agree with your doctor. Your record should hold every use with date, reason and whether it helped. Counting days and noting the puffs works well. Note uses before exercise on their own line. The NHS says to contact your GP if you need your inhaler more often.
What do I bring if my asthma is poorly controlled?+
One page covering the last weeks: days with reliever, nights woken, attacks and any steroid tablet courses. Bring all your inhalers, and be honest about how you take your preventer. That shows your doctor what you recorded.
Is uncontrolled asthma an emergency?+
The rating covers four weeks, not the moment. GINA does call uncontrolled symptoms an important risk factor for severe attacks, so talk to your doctor soon instead of waiting for a routine visit. A severe attack is different: the NHS says to call the emergency number if you feel worse, or your reliever does not help. What counts as worse for you belongs in your written action plan.
Can an Apple Watch show that my asthma is getting worse?+
It is not made for that. Apple states that Vitals app measurements are not intended for medical use. If the watch records a respiratory rate in sleep, that number sits in Apple Health. It is a reading, not a finding, and the watch does not measure lung function.