COPD Assessment

If you have been advised by the surgery to submit a COPD assessment please use this form.

This assessment will help us measure the impact of COPD (Chronic Obstructive Pulmonary Disease) is having on your wellbeing and daily life. Your score will be used by us to help improve the management of your COPD and get the greatest benefit from treatment.

COPD Assessment (NEW)

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
Please let us know your preferred contact number in case we need to contact you.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

COPD Review

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 videos below to check that you are using your inhalers correctly:

Please watch these short video(s) on how to use your inhalers

Lifestyle - Alcohol

Lifestyle - smoking

For further information, please see: www.nhs.uk/smokefree

Further Questions

Please see the following links for further information on COPD that you may find useful:

NHS.uk

Patient.Info

British Lung Foundation

COPD Assessment Test Score

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 despite 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
This is automatically calculated and will be sent to the practice upon submission.
Very High: If your score is more than 30 - There is significant room for improvement in the management of your COPD

High: If your score is 20-30 - There is room for improvement in the management of your COPD

Medium: If your score is 10-20 - There is room for optimisation in the management of your COPD

Low:If your score is less than 10 - Your COPD is well managed at present