Never smoked

Ex smoker

Current smoker

I have had no exacerbations within the last year

I have only had one exacerbation within the last year

I have either been admitted to hospital with my COPD over the last year OR I have had 2 or more exacerbations within the last year

I cannot recall whether I have had any exacerbations within the last year

0 - I never cough

1

2

3

4

5 - I cough all the time

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

1

2

3

4

5 - My chest is completely full of phlegm/ mucus

0 - My chest does not feel tight at all

1

2

3

4

5 - My chest feels very tight

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.

0 - I am not limited doing any activities at home

1

2

3

4

5 - I am very limited doing activities at home

0- I am confident leaving home despite my lung condition

1

2

3

4

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

0- I sleep soundly

1

2

3

4

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

0 - I have lots of energy

1

2

3

4

5 - I have no energy at all