For each item below, select the box that best describes you currently. Read the two statements for each item, and mark where on the scale (0-5) they fit. Scores for each are added to give an overall score (out of 40).
My chest does not feel tight at all
My chest feels very tight
When I walk up a hill or one flight of stairs I am not breathless
When I walk up a hill or one flight of stairs I am very breathless
I am very limited doing activities at home
I am confident leaving my home despite my lung condition
I am not at all confident leaving my home because of my lung condition
I sleep soundly
I don’t sleep soundly because of my lung condition
I have lots of energy
I have no energy at all