1. COPD : Chronic Obstructive Pulmonary
Disease
A small survey test for COPD disease existence:
Please tick the Symptoms if present in you Yes No
1. Mucus Hyper secretion
2. Airflow limitation and hyper inflation because of air trapping
3. Abnormalities in gas exchange
4. Skeletal muscle wasting which further reduces the exercise capacity
and worsens prognosis.
5. Intermittent cough in the early morning.
6. If progressive coughs daily.
7. Sputum produced in the morning daily.
8. Sputum is usually tenacious (gum like), mucoid.
9. A Change in sputum colour (purulent) i.e. dirty,
10. Increase in volume suggests an infectious exacerbation.
11. Progressive dyspnoea (difficult respiration) and persistent.
12. Breathlessness occurs during exercise (climbing stairs).
13. Difficult to breathe even at rest.
14. Winter bronchitis:
15. Sputum production in yellow/green with chest infection:
16. Ankle swelling:
17. Tightness in chest:
18. An unexplained increase / decrease in weight:

2. 19. Increased feeling of fatigue and lack of energy that is persistent
20. Increased morning headaches, dizzispells, restlessness:
Lung Symptoms:
1. For the last two years, have you had a cough for at least three months per year?
Yes No
2. For the last two years, have you brought up phlegm from your chest at least three
months per year?
Yes No
3. Does your chest ever sound like it is wheezing or whistling?
a. With a cold Yes No
b. Apart from colds Yes No
c. Most days Yes No
Breathlessness
1. At the present time, are you limited in your activities because of breathing problems?
Yes No
2. If you are limited, how much are you limited?
100% 75% 50% 25%
3. Do you have to stop for breath after you walk a few minutes on level ground (about 100 yards)?
Yes No
Smoking History
1. Have you smoked at least 100 cigarettes (5 packs) in your entire life?
Yes No Uncertain
2.If you smoked, how old were you when you started smoking? years old
3. If you have quit smoking, how old were you when you quit smoking? years old
4. How many years did you smoke or have you smoked cigarettes? years
5. On average, how many cigarettes do you/ did you smoke per day?
Currently Ye N In the past Ye N
0 - quit
1-5 cig/day 1-5 cig/day
6-10 cig/day 6-10 cig/day
11-20 cig/day 11-20 cig/day
1 pack/day 1 pack/day
1.5 packs/day 1.5 packs/day
2 packs/day 2 packs/day
3+ packs/day 3+ packs/day
No. of pack years = No of cigarettes smoked per day X No of yrs of smoking

3. 20
(For you) =
Exacerbations
1. Over the last year, how many times have you had breathing problems that required?
None 1 2 3 4+
a. Antibiotics
b. Prednisone
c. Visit to a physician
d. Visit to an emergency room
e. Hospitalization
f. Intensive care unit
Respiratory History:
1. What respiratory illnesses or diseases have you had? (Answer all that apply.)
Yes No Age at onset
Asthma
Bronchiectasis
Bronchitis
Emphysema
Pneumonia Other lung disease
Thank You
If information is provided please send this sheet carefully to:
J.25, Thiyagu Mudaliar Nagar.
Mudaliarpet,
Puducherry – 605 004.

4. By (NSS team)
P.J.Janakiram And
Students of
Amalorpavam Hr.Sec.
School.
Please Don’t Imitate This Sheet or Throw Off as this is Valuable .
COPD : Chronic Obstructive
Pulmonary Disease
COPD is a life-threatening lung disease that tends to get progressively worse and is most commonly
caused by smoking. A chronic illness is one that lasts a long time, sometimes for the rest of the
affected person’s life.
Chronic bronchitis:
Chronic bronchitis is inflammation of your bronchi – the main airways that lead from your windpipe
(trachea) to your lungs. This inflammation can produce excess mucus that may block your airways
and make you cough.
Emphysema:
Emphysema damages the structure of your alveoli – these are tiny air sacs where oxygen passes
You’re also more likely to get COPD:
• if your body exposes you to certain dusts or fumes and air pollution
• from environmental factors, such as from inherited problems – an inherited shortage of a
protein called alpha antitrypsin that helps protect your body
COPD is not curable but treatment can slow the progress of the disease. Nearly 66 million Indians
suffer from COPD. But COPD has not received due attention by both patients and doctors making it a
leading cause for morbidity and mortality.
This fact sheet is to provide the user friendly scientific information about COPD and to take survey
whether people affected with this COPD.
Please provide the correct information that listed below.
If information is provided please send this sheet carefully to:
J.25, Thiyagu Mudaliar Nagar.

5. Mudaliarpet,
Puducherry – 605 004.
By (NSS team)
P.J.Janakiram And
Students of
Amalorpavam Hr.Sec.
School.
Please Don’t Imitate This Sheet or Throw Off as this is Valuable .

6. Mudaliarpet,
Puducherry – 605 004.
By (NSS team)
P.J.Janakiram And
Students of
Amalorpavam Hr.Sec.
School.
Please Don’t Imitate This Sheet or Throw Off as this is Valuable .