II. Indications
- COPD Screening of patients with frequent cough and breathing difficulties
III. Questions: Symptoms (3 questions)
- Scale (use to answer the following 3 questions)
- Score 5: Never
- Score 4: Rarely
- Score 3: Sometimes
- Score 2: Often
- Score 1: Very often
- Questions (use scale above to answer the following 3 questions)
- How often do you cough up mucous?
- How often does your chest sound noisy (wheezy, whistling or rattling) when you breath?
- How often do you experience Shortness of Breath during Physical Activity?
- Walking up stairs or walking up an incline without stopping to rest
IV. Questions: History (2 questions)
- How many years have you smoked?
- Score 5: Never
- Score 4: 10 years of less
- Score 3: 11 to 20 years
- Score 2: 21 to 30 years
- Score 1: More than 30 years
- What is your age?
- Score 5: Younger than age 40 years
- Score 4: Age 40 to 49 years
- Score 3: Age 50 to 59 years
- Score 2: Age 60 to 69 years
- Score 1: Age 70 years or older
V. Interpretation
- Add scores for all 5 questions
- Score 18 or less suggests increased risk of COPD