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Springfield Medical Centre NHS GP Surgery in Eccles

COPD review

COPD Assessment

Section

Confirmation *

Confirmation of consent for information about your/the patient’s health to be sent to the email address provided

Assessment

Coughing

Coughing: from 0 (I never cough) to 5 (I cough all the time) *

Phlegm

Phlegm: from 0 (I have no phlegm – mucus – in my chest at all) to 5 (My chest is full of phlegm – mucus) *

Tightness

Tightness: from 0 (My chest does not feel tight at all) to 5 (My chest feels very tight) *

Stairs

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) *

Activities

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

Leaving

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) *

Sleep

Sleep: from 0 (I sleep soundly) to 5 (I don’t sleep soundly because of my lung condition) *

Energy

Energy: from 0 (I have lots of energy) to 5 (I have no energy at all) *

If you are human, leave this field blank.

384 Liverpool Road
Eccles
Manchester
M30 8QD

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0161 871 2450

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