Severe Asthma Clinical Trial
  • *What is the age of the person with asthma?
  • *What is their sex?
  • *What is their current weight?
  • *When were they diagnosed with asthma (year)?
  • *How many times have they had a severe asthma attack (also know as an exacerbation) in the past year? A severe asthma attack is one that required an emergency room visit, hospitalization, or treatment with steroids.
  • *Are they currently taking any inhaled medications (check all that apply)?
  • *Have they smoked cigarettes in the past?
  • *Do they have any of the following conditions?
  • *In the past 5 years, have they been treated for any of the following cancers?
  • *Study visits will need to take place between the hours of 6 am and 10 am. Can they attend these visits during this time frame? If you would like additional information on this study first, please select "I don't know".
  • It appears that they may be eligible for this trial!

    Please enter the following contact information and we will get in touch with you.

    • *
      Your First Name
    • *
      Your Last Name
    • *
      Patient's name
    • *
    • *
      Zip Code
    • *
    • *
    • *

That's all, folks!

* End page and disqualification logic can only be seen in the live survey