COPD review

Section

Which surgery are you registered at?

Smoking

Smoking status: *

Smoker

What do you mainly smoke?
How many cigarettes do you smoke in a day? *
How many cigars do you smoke in a day? *
Would you like to give up smoking? *

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex smoker

What did you mainly smoke?
How many cigarettes did you smoke in a day? *
How many cigars did you smoke in a day? *

Assessment

How often do you cough?
On a scale of 0 being “I never cough” and 5 being “I cough all the time”
How much phlegm do you have in your chest?
On a scale of 0 being “I have no phlegm in my chest at all” and 5 being “My chest is full of phlegm”
How tight does your chest feel?
On a scale of 0 being “My chest does not feel tight at all” and 5 being “My chest feels very tight”
How breathless are you walking up a hill or flight of stairs?
On a scale of 0 being “I am not breathless” and 5 being “I am very breathless”
How much are your activities at home limited by your lung condition?
On a scale of 0 being “I am not limited” and 5 being “I am very limited”
How confident are you leaving your home despite your lung condition?
On a scale of 0 being “I am confident” and 5 being “I am not at all confident”
How soundly do you sleep?
On a scale of 0 being “I sleep soundly” and 5 being “I don’t sleep soundly because of my lung condition”
How much energy do you have?
On a scale of 0 being “I have lots of energy” and 5 being “I have no energy at all”

Breathlessness

How would you rate your level of breathlessness? *

It has been found to be beneficial for patients with COPD to undertake Pulmonary Rehabilitation programmes. You may already have done so. It consists of education about the disease and assistance with exercise.

Please select an option relating to the Pulmonary Rehabilitation programme:
Terms and conditions