COPD review

Section

Part 1

These questions help us to grade how your COPD is affecting your breathing.

Please tick the statement that most applies to how your breathing feels most of the time: *

I am not troubled by breathlessness except on strenuous exercises

I am short of breath when hurrying on a level or when walking up a slight hill

I walk slower than most people on level ground because of breathlessness or I have to stop for breath when walking at my own pace

I stop for breath after walking around 100m or after a few minutes on level ground

I am too breathless to leave the house or I feel breathless when dressing or undressing

Part 2

In the last 12 months, how many times have you had a flare-up of your COPD? (A ‘flare-up’ includes when your COPD symptoms become particularly severe and you have needed steroid tablets and/or antibiotics or emergency treatment) *

0

1 – 2

3 or more

Is there anything else you would like us to be aware of about your COPD and COPD management?

*

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Section

Part 1

Part 2