Table 3.
# 1. In the last 2 weeks, I have been breathless climbing stairs or walking up an incline or hill | ||||||
1. All of the time | 2. Most of the time | 3. A good bit of the time | 4. Some of the time | 5. A little of the time | 6. Hardly any of the time | 7. None of the time |
# 4. In the last 2 weeks have you avoided doing things that make you breathless? | ||||||
1. All of the time | 2. Most of the time | 3. A good bit of the time | 4. Some of the time | 5. A little of the time | 6. Hardly any of the time | 7. None of the time |
# 11. In the last 2 weeks has your lung condition interfered with your job or other daily tasks? | ||||||
1. All of the time | 2. Most of the time | 3. A good bit of the time | 4. Some of the time | 5. A little of the time | 6. Hardly any of the time | 7. None of the time |
# 13. In the last 2 weeks, how much has your lung condition limited you carrying things, for example, groceries? | ||||||
1. All of the time | 2. Most of the time | 3. A good bit of the time | 4. Some of the time | 5. A little of the time | 6. Hardly any of the time | 7. None of the time |
This questionnaire is designed to assess the impact of your lung disease on various aspects of your life. Please circle the response that best applies to you for each question.