Chronic Obstructive Pulmonary Disease (COPD) Review

COPD Online Review Questionnaire

Non-urgent advice: Welcome

Welcome to our Online Chronic Obstructive Pulmonary Disease (COPD) Review Questionnaire.

Any patient with a diagnosis of COPD can do this questionnaire.

The purpose of this questionnaire is to review your COPD symptoms and control. We will arrange a Practice Nurse review if you feel it is appropriate.

Chronic Obstructive Pulmonary Disease (COPD) Annual Review Questionnaire

IMPORTANT – Please only do this questionnaire if your are a registered patient at The Beeches Medical Centre, Widnes


Current Health Status

In this section we will ask you general questions about your current health.
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?
How many units of alcohol do you consume per day?
For example – 12st3 or 78kg
For example – 6ft or 1.82m
If you do not know your blood pressure reading, then please call into the surgery and use our free BP machine located in reception. This will also record your height and weight. No appointment is required. Please ask reception for a gold token to use the machine

COPD Control Questions

In this section we will ask you questions regarding your COPD control and management.
An exacerbation is a flare up of your condition that requires treatments with medication, usually steroids or a rescue pack.
Using the MRC breathlessness scale, please select a grade which you feel represents your current capabilities?
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?