Patient information and consent form

Purpose of the Activity:

You are being invited to participate in the Reliever Reliance Test (RRT), a short assessment designed to help you understand your use of reliever inhalers and your level of asthma control. This is not a treatment and does not replace medical advice from your doctor.

Nature of Participation:

You will be asked a few simple questions about your asthma symptoms and reliever inhaler use. There is no medication, no medical procedure and no physical intervention involved.

Voluntary Participation:

Your participation is completely voluntary. You may choose not to participate or may withdraw at any time without affecting your medical care.

Confidentiality & Data Use:

Your responses will be kept strictly confidential.
No personal information (name, address, phone number) will be collected or shared.
Your anonymized data may be combined with other patients’ responses to better understand reliever usage patterns and to support publications, presentations at conferences and patient education initiatives.
No information that can identify you will ever be published or disclosed.

Risks & Benefits:

The test involves no physical or medical risk as this is just a questionnaire-based test.
You may benefit from a better understanding of your asthma medications and control and may discuss the results with your doctor to improve your management.

Your Rights:

• You may refuse to answer any question without giving any reasons.
• You may stop the test at any time.
• You may request that your responses not be used, even after participation.
• Participation will not affect your treatment, doctor’s advice or access to care.

Consent Statement: