Do I have a breathing disorder?
This questionnaire comes from the Australian Lung Foundation and will help you to determine whether your lung health could be at risk. If you answer yes to any of the questions below you should seriously consider talking to your doctor:
Do you:
Q. Have a new, persistent or changed cough? Yes / No
Q. Have a new, persistent or changed cough?
Yes / No
Q. Cough up mucus, phlegm or blood? Yes / No
Q. Cough up mucus, phlegm or blood?
Yes / No
Q. Experience chest tightness or wheeze? Yes / No
Q. Experience chest tightness or wheeze?
Yes / No
Q. Get out of breath more easily than others your age? Yes / No
Q. Get out of breath more easily than others your age?
Yes / No
Q. Have frequent chest infections? Yes / No
Q. Have frequent chest infections?
Yes / No
Q. Experience chest pain, fatigue or sudden weight loss? Yes / No
Q. Experience chest pain, fatigue or sudden weight loss?
Yes / No
Answering Yes to any of the above could be a sign your lung health could be at risk…particularly if you are a smoker or ex-smoker, or you have worked in a job that exposed you to dust, gas or fumes.
If you believe you are at risk of a respiratory disorder, take the responses from this questionnaire to your doctor as it will assist you in starting the conversation with them. They may refer you to our lung function lab for further testing or to one of our specialists for a consultation.
*This Lung Health Checklist has been designed by The Australian Lung Foundation to assist the community in monitoring their lung health. It is intended to be used as a guide only and is not an authoritative statement. Please consult your doctor for medical opinion or advice.
Breathlessness Assessment Questionnaire
Think of how you feel today compared to 6-12 months ago. Do you get breathless (or feel more breathless), feel faint or dizzy performing ordinary daily activities such as:
Q. Making the bed? Yes / No
Q. Making the bed?
Yes / No
Q. Having a shower? Yes / No
Q. Having a shower?
Yes / No
Q. Doing the washing and hanging it out? Yes / No
Q. Doing the washing and hanging it out?
Yes / No
Q. Walking to the corner store or around the supermarket? Yes / No
Q. Walking to the corner store or around the supermarket?
Yes / No
Q. Climbing a flight of stairs? Yes / No
Q. Climbing a flight of stairs?
Yes / No
Q. Walking up a gentle incline? Yes / No
Q. Walking up a gentle incline?
Yes / No
Q. In bed or while lying down? Yes / No
Q. In bed or while lying down?
Yes / No
Q. In the last 6-12 months, have you avoided any activities because they make you short of breath (or have you changed the way you do an activity because it makes you short of breath)? Yes / No
Q. In the last 6-12 months, have you avoided any activities because they make you short of breath (or have you changed the way you do an activity because it makes you short of breath)?
Yes / No
Q. In the last 6-12 months, have any of your friends or family commented that you seem out of breath or do things at a slower place? Yes / No
Q. In the last 6-12 months, have any of your friends or family commented that you seem out of breath or do things at a slower place?
Yes / No
