GINA asthma symptom control: what the four questions cover and how to read your 0 to 4 result

At an asthma review your doctor often asks how the last four weeks went, and the answer easily becomes a rough guess. The Global Initiative for Asthma (GINA) turns those weeks into four yes-or-no questions. You can answer them on paper, or in Sam's asthma diary, which asks about the same four topics once a month and keeps each result with its date.

This guide explains what the questions cover and how the 0 to 4 count works. It also shows what the result leaves out and how Sam asks it. How your asthma is doing is something you and your doctor work out together.

What does the GINA symptom control check ask?

GINA publishes a strategy report for health professionals every year. Its 2026 Summary Guide rates asthma symptom control from four questions about the past four weeks. They sit in Table 2A of the guide.

Two questions are about how often. One asks about asthma symptoms during the day, the other about needing your reliever for symptoms. For both, GINA draws the line at more than twice a week. The other two questions count any occurrence at all: a night when asthma woke you, and any time asthma held you back from an activity.

Sam's check-in covers the same four topics in its own words. Each question names the four-week window. Where GINA says more than twice a week, Sam's questions say more than a couple of days or times a week. The wording is not GINA's text.

How is the 0 to 4 result scored?

You count your yes answers. The total runs from 0 to 4, and a lower count means fewer symptoms. GINA sorts the count into three levels, and Sam uses the same boundaries:

• 0 yes answers: well controlled.
• 1 or 2 yes answers: partly controlled.
• 3 or 4 yes answers: uncontrolled.

There is no weighting. A night woken counts as much as a week of daytime symptoms.

The levels are GINA's own. The question wording in Sam is product-authored and has not been validated as a questionnaire of its own. That sets it apart from named questionnaires validated in their original version, such as MIDAS for migraine. Sam's hay fever check-in is product-authored in the same way.

Want to try the four questions on their own first? The asthma symptom control tool on this site walks you through them.

What does the result not tell you?

GINA looks at asthma control from two sides. One is symptom control, which these four questions cover. The other is risk: what raises your chance of an attack, of losing lung function or of side effects from medication. GINA lists these in a separate table, and your doctor assesses them. Examples are a severe attack in the past year, poor lung function or smoking.

So a count of 0 does not rule out risk. GINA lists factors that raise the risk of attacks even in people with few symptoms. An expert group of the American Thoracic Society and the European Respiratory Society made the same point in 2009. No single measure captures asthma control on its own.

Lung function is separate too. GINA asks doctors to measure it with spirometry before an inhaled steroid is started, 3 to 6 months later and then at least every one to two years.

Severity is another thing again. GINA defines it by how much medication it takes to control symptoms and prevent attacks. That can only be judged after several months. One check-in does not say how severe your asthma is. What "not controlled" means in daily life, and what to bring to your doctor, is covered in asthma not well controlled.

How is this different from the Asthma Control Test?

The Asthma Control Test (ACT), a trademark of QualityMetric, is a separate questionnaire. The Asthma Control Questionnaire (ACQ) is another one. Both have their own questions and scores. Their numbers do not convert into GINA levels.

A Spanish study compared GINA levels with ACQ scores in 1,363 people with stable asthma. By GINA criteria, 13.6 percent were controlled, 34.2 percent partly controlled and 52.3 percent uncontrolled. Agreement between the two methods reached a kappa of 0.62. In plain words, they often agreed, but not always. The study used the GINA criteria of 2006.

If you filled in an ACT or ACQ elsewhere, tell your doctor which one it was. Do not put its number next to your Sam result as if they were the same scale.

What counts as reliever use?

A dose taken before exercise does not count. GINA leaves it out, and so does the question in Sam.

There is a second detail. GINA applies the reliever question only to a short-acting reliever (SABA). For a reliever that combines a steroid with formoterol (ICS-formoterol), GINA does not use this count. Sam's question counts every reliever use for symptoms, whatever the inhaler. If a combination inhaler is your reliever, tell your doctor. Your doctor knows your inhalers and reads your answer with that in mind.

Twice a week is not an allowed amount. It is the line in one question. How you use your inhalers is set in the plan you agree with your doctor. How to keep a day-by-day record of each use is explained in logging reliever puffs.

How does Sam ask the check-in and keep your results?

In Sam the check-in belongs to the asthma program, which is its own diary with a doctor report as a PDF and a monthly questionnaire. The program assumes a doctor has confirmed your asthma. You answer the check-in once when you start, as your baseline. After that it comes up every 30 days, and Sam reminds you when it is due.

After each check-in, Sam shows your count and its level. It compares the result with your last check-in and with your baseline. When the count moves into another level, or changes by two or more, the screen says so. When the count rises, it adds that one month is a data point, not a verdict.

The doctor report from the program shows your latest result with its level and the trend for the period you choose. It names the source as well: a check modeled on GINA's framework, with wording written for Sam. If asthma is still new to you, read your first weeks with asthma first.

How do you read your results over several months?

One check-in looks back four weeks. A cold, pollen season or a stretch of poor sleep can push a single month up. A run of check-ins shows whether that was a bump or a change.

Before your appointment, three questions help:

• Has your count stayed in the same level for three months or more?
• Did a worse month line up with a cold, pollen or a change in medication?
• Is the count still raised after the trigger has passed?

GINA asks doctors to assess symptom control at every opportunity and to review asthma at least once a year. Your record gives that conversation dates instead of memories. GINA also names uncontrolled symptoms as an important risk factor for attacks. A high count is worth raising with your doctor soon.

What if it cannot wait?

The check-in looks back four weeks. It says nothing about how you are right now. This section is general information, not an instruction from Sam.

The NHS says to call the emergency number during an asthma attack if you feel worse at any time. The same applies if your reliever does not help, or if you have no inhaler with you. Use your local emergency number (112 in the EU, 999 in the UK, 911 in the US). Do not wait for your next check-in. What counts as getting worse for you belongs in your written action plan, which you agree with your doctor.

Answer the asthma check-in in Sam and take the trend to your appointment

You bring months of check-ins to your asthma review instead of a guess about the last four weeks.

• Instead of a paper sheet: the check-in comes up every 30 days, and each result stays with its date and level.
• Instead of memory: Sam compares every result with your last check-in and your baseline.
• Instead of loose notes: the doctor report as a PDF puts the trend next to your reliever days, nights woken and attacks.

The check-in is part of the program for asthma, with its own diary and doctor report; it assumes a doctor has confirmed your asthma. Sam records your answers, and your doctor assesses risk and lung function.

Try Sam for free

Sam 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.

Related reading

• Asthma not well controlled? What the term means
• Inhaler tracker: logging reliever puffs
• Hay fever symptom check-in in Sam
• MIDAS: the migraine disability questionnaire

Sources

Updated: October 2026

• Global Initiative for Asthma: 2026 GINA Summary Guide and the PDF, Table 2 (assessment of asthma control) and the sections on lung function and severity. Copyright GINA; the questions are described here, not reproduced.
• Reddel HK, Taylor DR, Bateman ED et al.: An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations. Am J Respir Crit Care Med 2009;180(1):59-99, PubMed 19535666
• Olaguibel JM, Quirce S, Julia B et al., MAGIC Study Group: Measurement of asthma control according to Global Initiative for Asthma guidelines: a comparison with the Asthma Control Questionnaire. Respir Res 2012;13:50, PubMed 22726416
• Asthma Control Test: asthmacontroltest.com (trademark of QualityMetric, site copyright GSK group)
• NHS: Asthma attacks (last reviewed 7 April 2025)