COPD Assessment

If you have been asked to do so by the surgery, please submit our COPD assessment.

COPD Assessment

COPD Assessment

Section

Assessment

Coughing

I never cough
I cough all the time

Phlegm

I have no phlegm (mucus) in my chest at all
My chest is full of phlegm (mucus)

Tightness

My chest does not feel tight at all
My chest feels very tight

Stairs

When I walk up a hill or one flight of stairs I am not breathless
When I walk up a hill or one flight of stairs I am very breathless

Activities

I am not limited doing any activities at home
I am very limited doing any activities at home

Leaving

I am confident leaving my home despite my lung condition
I am not at all confident leaving my home because of my lung condition

Sleep

I sleep soundly
I don't sleep soundly because of my lung condition

Energy

I have lots of energy
I have no energy at all

Additional Questions

Do you smoke?
Would you like to stop smoking?
Would you like us to contact you about stopping?
Are you happy with your inhaler technique?
Would you be interested in Pulmonary Rehab?

Breathlessness Review

Please rate your level of breathlessness:
*