DATA COLLECTION SHEET

ID (case) NO:
A. Particulars of the patient:

Name :

Mother’s name :

Father’s name :
Date of birth :
Date of admission :
Age at admission :
Sex : 1 Boy 2 Girl

:
Address

Mobile no :
Economic status of the parents :
Education status of the parents &patients
B. Patient characteristics at enrollment :

Duration of asthma
Diagnosis at enrollment
Vit D level

Age
Sex
BMI

C:Clinical Features

GINA
1.Intermittent
2.Mild persistent
3.Moderate persistent
4.Severe persistent
Exacerbation n
ICS + SABA
ICS
No n
Low n
Medium n
High n
Leukotriene Receptors Antagonist

Respiratory rate
Wheezing

Emergency department visit

No of in-hospital
stay
H/o atopy
TABLE : STUDY CLINICAL FOLLOW UP SCHEDULE

After 2 months
Asthma severity
Asthma control

ICS dose
Leucotrine use
Asthma
exacerbation
No of hospital visit

RESULT

OUTCOME