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COPD review

COPD

Form summary

COPD questions

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”
Since your last review, have you had any COPD exacerbations?
An exacerbation is where your COPD symptoms get gradually or suddenly worse and you need medical attention
For example, how many exacerbations you have had and what happened each time

Breathlessness

How would you rate your level of breathlessness? *
Have you taken part in a pulmonary rehabilitation programme in the last 12 months?
Pulmonary rehabilitation is an exercise and education programme for people with lung disease who have symptoms of breathlessness

Smoking status

What is your smoking status? *

Smoker

What type of tobacco or other product do you use mostly? *
How many cigarettes do you smoke on an average day? *
How many cigars do you smoke on an average day? *

When you quit smoking, good things start to happen. You can begin to see almost immediate improvements to your health.

It’s never too late to quit and it’s easier to stop smoking with the right support.

Get help with NHS Quit Smoking (opens in new tab)

Would you like to give up smoking? *

Ex-smoker

What type of tobacco or other product did you use mostly? *
How many cigarettes did you smoke on an average day? *
How many cigars did you smoke on an average day? *

More information

Is there anything you would like to discuss?
For example, about your COPD, lifestyle, medication, support
Terms and conditions