WIP: COPD Review

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How is your COPD? Take the COPD Assessment Test (CAT)

This questionnaire will help you and your healthcare professional to measure the impact that COPD (Chronic Obstructive Pulmonary Disease) is having on your wellbeing and daily life. Your answers and test score can be used by you and your healthcare professional to help improve the management of your COPD and gain the greatest benefit from the treatment.

Smoking Status

Please select one of the following with regards to your smoking status.: *

If you currently smoke, are you interested in trying to quit or reduce your smoking?: *

For example – 12st3 or 78kg

For example – 6ft or 1.82m

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COPD Control Questions

In this section, we will ask you questions regarding your COPD control and management.

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

An exacerbation is a flare up of your condition that requires treatments with medication, usually steroids or a rescue pack.
1 = I am short of breath only on strenuous exercise.
5 = I am breathless when dressing or am too breathless too leave the house.

With regards to the above breathlessness score, if you have selected a score of 3 or more you are eligible for a referral to a Pulmonary Rehabilitation Programme.

Would you be interested in a referral to the programme?:

COPD Review

The last part of the questionnaire, will ask you if you feel your COPD is well controlled and will give you the option to decide if you would like further review from a Practice Nurse.

Do you feel that COPD symptoms and management are well controlled at the moment?:

Inhaler Technique

It is essential to have a good inhaler technique to ensure that your medication gets to the part of your lungs that need it. Please watch the specific inhaler video below to check that you are using your inhalers correctly.

Watch the Asthma and Lung UK Videos

Now that you have reviewed the inhaler technique guidelines, how would you rate your own inhaler technique?: *

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This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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WIP: COPD Review

How is your COPD? Take the COPD Assessment Test (CAT)

In this section, we will ask you questions regarding your COPD control and management.

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

Privacy Consent