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Lung Function Questionnaire

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Lung Function Questionnaire

  • See Also
  1. COPD Population Screener Questionnaire
  2. COPD
  3. Chronic Dyspnea
  • Indications
  1. COPD Screening of patients with frequent cough and breathing difficulties
  • Questions
  • Symptoms (3 questions)
  1. Scale (use to answer the following 3 questions)
    1. Score 5: Never
    2. Score 4: Rarely
    3. Score 3: Sometimes
    4. Score 2: Often
    5. Score 1: Very often
  2. Questions (use scale above to answer the following 3 questions)
    1. How often do you cough up mucous?
    2. How often does your chest sound noisy (wheezy, whistling or rattling) when you breath?
    3. How often do you experience Shortness of Breath during Physical Activity?
      1. Walking up stairs or walking up an incline without stopping to rest
  • Questions
  • History (2 questions)
  1. How many years have you smoked?
    1. Score 5: Never
    2. Score 4: 10 years of less
    3. Score 3: 11 to 20 years
    4. Score 2: 21 to 30 years
    5. Score 1: More than 30 years
  2. What is your age?
    1. Score 5: Younger than age 40 years
    2. Score 4: Age 40 to 49 years
    3. Score 3: Age 50 to 59 years
    4. Score 2: Age 60 to 69 years
    5. Score 1: Age 70 years or older
  • Interpretation
  1. Add scores for all 5 questions
  2. Score 18 or less suggests increased risk of COPD
  • References
  1. Hanania (2010) Respir Med 104(8): 1160-70 [PubMed]