COPD Assessment Test.

Name *

Date of Birth *

Contact number *

I never cough - I cough all the time *

0 - I never cough

1

2

3

4

5 - I cough all the time

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

0 - I have no phlegm (mucus) in my chest at all

1

2

3

4

5 - My chest is completely full of phlegm (mucus)

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

0 - My chest does not feel tight at all

1

2

3

4

5 - My chest feels very tight

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 *

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

1

2

3

4

5 - When I walk up a hill or one flight of stairs I am very breathless

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

0 - I am not limited doing any activities at home

1

2

3

4

5 - I am very limited doing activities at home

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

0 - I am confident leaving my home despite my lung condition

1

2

3

4

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

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

0 - I sleep soundly

1

2

3

4

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

I have lots of energy / I have no energy at all *

0 - I have lots of energy

1

2

3

4

5 - I have no energy at all

What is your total score? (add each number you have selected)

Cookies on the Bangholm Medical Centre website

Further Information