What is a COPD Questionnaire?
Questionnaires allow you to send surveys out to patients to gather data. The COPD Questionnaire is used to help gather data that would be useful for an annual COPD review. Using the information gathered, clinicians can determine the most helpful subsequent steps in the review e.g. video call.
💬 Enrolment SMS:
Once the patient has accessed the link, they will be prompted to enter their date of birth in order to access the questionnaire 📆
Questions:
1. How often do you cough?
0 - I never cough
1
2
3
4
5 - I cough all the time
2. How much phlegm do you feel you have on your chest?
0 - I have no phlegm (mucus) on my chest at all
1
2
3
4
5 - My chest is full of phlegm (mucus)
3. How tight is your chest?
0 - My chest does not feel tight at all
1
2
3
4
5 - My chest feels very tight
4. When do you get out of breath?
0 - When I walk up a hill or a flight of stairs I am not out of breath
1
2
3
4
5 - When I walk up a hill or flight or stairs I am completely out of breath
5. How out of breath do you get?
Not troubled by breathlessness except on strenuous exercise
Short of breath when hurrying, or walking up a slight hill
I walk slower than people the same age on level ground because of breathlessness, or I have to stop for breath when walking at my own pace
I get short of breath after walking 100 metres or after a few minutes on level ground
I'm too breathless to leave the house or breathless when dressing or undressing
6. How much are you limited by your COPD when at home?
0 - I am not limited to doing any activities at home
1
2
3
4
5 - I am completely limited to doing all activities at home
7. How confident do you feel leaving your home with your lung condition?
0 - I am confident leaving my home despite my lung condition
1
2
3
4
5 - I am not confident leaving my home at all because of my lung condition
8. How well do you sleep?
0 - I sleep soundly at night
1
2
3
4
5 - I do not sleep soundly because of my lung condition
9. How much energy do you have?
0 - I have lots of energy
1
2
3
4
5 - I have no energy at all
10. How many COPD exacerbations have you had in the past 12 months?
An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack of seek medical attention (see here for more information)
Enter number
11. Did you go into hospital because of any COPD exacerbations?
An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack of seek medical attention (see here for more information)
Yes
No
12. What is your smoking status?
Current smoker
Ex-smoker
Never smoked
13. How much do you smoke? (If selected "current smoker" only)
<1 cigarettes or gram/day or equivalent
1-9 cigarettes or grams/day or equivalent
10-19 cigarettes or grams/day or equivalent
20-30 cigarettes or grams/day or equivalent
40+ cigarettes or grams/day or equivalent
14. How many years have you smoked for?
Enter number
When they have submitted their answers they will be thanked for completing the survey and sent a confirmation SMS 👇
Response in the Accurx Desktop toolbar: COPD Team 👇
Have a look at how this all looks from the patient’s view 👇
SNOMED codes saved to the record
The codes added are in bold and italics
Answers to the question: "How out of breath do you get?"
Not troubled by breathlessness except on strenuous exercise - Medical Research Council Breathlessness Scale grade 1 - 391120009
Short of breath when hurrying, or walking up a slight hill - Medical Research Council Breathlessness Scale grade 2 - 391123006
I walk slower than people the same age on level ground because of breathlessness, or I have to stop for breath when walking at my own pace - Medical Research Council Breathlessness Scale: grade 3 - 391124000
I get short of breath after walking 100 metres or after a few minutes on level ground - Medical Research Council Breathlessness Scale grade 4 - 391125004
I'm too breathless to leave the house or breathless when dressing or undressing - Medical Research Council Breathlessness Scale grade 5 - 391126003
Answers to the question: "What is your smoking status?"
Current smoker - 77176002
Ex-smoker - 8517006
Never smoked - 266919005
Answers to the question: "How much do you smoke?"
<1 cigarettes or gram/day or equivalent - 266920004
1-9 cigarettes or grams/day or equivalent - 160603005
10-19 cigarettes or grams/day or equivalent - 160604004
20-30 cigarettes or grams/day or equivalent - 160605003
40+ cigarettes or grams/day or equivalent - 160606002
Frequently Asked Questions (FAQs)
Why don't you include the 'COPD Annual Review' SNOMED code?
We had a large amount of feedback from Healthcare teams asking for annual review codes to be removed from similar Questionnaire as they weren't comfortable with marking a review as completed through the questionnaire alone.