COPD review

Section

Assessment

How often do you cough?

How much phlegm do you feel you have on your chest?

How tight is your chest?

When do you get out of breath?

Stairs: from 0 (When I walk up a hill or one flight of stairs I am not breathless) to 5 (When I walk up a hill or one flight of stairs I am very breathless)

How much are you limited by your COPD when at home?

Activities: from 0 (I am not limited doing any activities at home) to 5 (I am very limited doing any activities at home)

How confident do you feel leaving your home with your lung condition?

Leaving: from 0 (I am confident leaving my home despite my lung condition) to 5 (I am not at all confident leaving my home because of my lung condition)

How well do you sleep?

How much energy do you have?

How out of breath do you get?

Breathlessness *

Not troubled by breathlessness except on strenuous exercise

Short of breath when hurrying, or walking up a slight hill

I walk slower than friends 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 100 metres or after a few minutes on level ground

I’m too breathless to leave the house or breathless when dressing or undressing

COPD Exacerbations

How many COPD exacerbations have you had in the past 12 months?

An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack or seek medical attention (see www.blf.org.uk – Managing COPD Flare-Ups for more information)

Did you go into hospital because of any COPD exacerbations?

An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack or seek medical attention (see www.blf.org.uk – Managing COPD Flare-Ups for more information)

Smoking Status

What is your smoking status? *

Current smoker

Ex-smoker

Never smoked

How much do you smoke? *

Fewer than 1 cigarettes or gram/day or equivalent

1-9 cigarettes or grams/day or equivalent

10-19 cigarettes or grams/day or equivalent

20-30 cigarettes or grams/day or equivalent

40+ cigarettes or grams/day or equivalent

How many years have you smoked for? *

Smoking leads to health problems such as cancer, heart disease, and strokes. The benefits of stopping smoking include: better health, more money, and cleaner air for those around you!

Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: www.nhs.uk/smokefree.

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