Online COPD Assessment Name First Last Date of Birth Day Month Year PhoneEmail Enter Email Confirm Email <3>Assessment Please answer the below on a scale of 0-5 (5 being high)CoughingI never cough (0)1234I cough all the time (5)PhlegmI have no phlegm (mucus) in my chest at all (0)1234My chest is full of phlegm (mucus) (5)Tight ChestMy chest does not feel tight at all (0)1234My chest feels very tight (5)PhlegmI have no phlegm (mucus) in my chest at all (0)1234My chest is full of phlegm (mucus) (5)BreathlessnessWhen I walk up a hill or one flight of stairs I am not breathless (0)1234When I walk up a hill or one flight of stairs I am very breathless (5)Activities at homeI am not limited doing any activities at home (0)1234I am very limited doing any activities at home (5)Lung ConditionI am confident leaving my home despite my lung condition (0)1234I am not at all confident leaving my home because of my lung condition (5)SleepI sleep soundly (0)1234I don't sleep soundly because of my lung condition (5)EnergyI have lots of energy (0)1234I have no energy at all (5)
