Sample Survey


Asthma Survey : October 1993

Hello, my name is Griffin Weber. Thank you for participating in my Asthma and Weather science project. I've noticed that weather conditions certainly seem to affect my asthma and I am trying to gather data to see if this is true for other people. Each night for the month of October, please rate your condition on how you have been for the day on a scale of 0 - 10 where 0 = needed serious emergency treatment, 5 = typical or usual condition, 10 = as if I never had asthma. If one day you are feeling a little worse than typical, you might want to rate it a 4, if you feel much worse the next day then that might be a 2. Typical or usual means different things to each asthma patient depending on the seriousness of your condition. It might be that your typical is that everything sort of seems OK, while for me, typical is that my chest feels tight and I am thankful that I did not have an attack, while for someone else, typical might be self medication for an attack. Just fill in the appropriate rating in each daily box in the calendar.


Do you think that weather (temperature, humidity, wind, rain, barometric pressure, etc.) affects your asthma? If yes, how?


Do you think that airborne irritants (pollen, mold, pollution, etc.) affects your asthma? If yes, which ones?


On a scale of 1 - 5 where 1 = very bad, 3 = average, 5 = very good, give a general overall rating of the severity of your asthma symptoms for each of the four seasons:

Winter:Spring:Summer:Fall:

Either mail me the completed survey or return it to the person from whom you received it. If you want my updated final report along with a statistical analysis of how weather affects your asthma, please write your name and address and I will mail you a copy. If you want to remain anonymous, leave this space blank. Thanks again for your help!!!