The Clinical COPD Questionnaire contains 10 questions about your health and the health of your airways during the past week. Each question is answered on a scale between 0 and 6 where 0 represents the best condition (no limitation at all) and 6 (greatest limitation possible) the worst condition, with 1 to 5 representing the whole range of possibilities in between. Please be aware, we only ask for your conditions in the past week due to COPD and no other causes.
Please read all questions carefully. You should answer each question by circling the number that best represents your condition (only one number for each question, see example). There are no “wrong” answers. This questionnaire measures your personal condition, therefore we ask you to fill in this questionnaire on your own without seeking advice from others, preferably in a quiet place where you can concentrate on the questions. If there are questions that you feel you cannot answer, or that are not applicable to your personal condition, for example you are not able to perform any of the activities, please read the question carefully again and fill in the answer that is nearest to your condition in the past week. Filling in this questionnaire will take you only a few minutes.
Please choose only one answer per question.
Please try to fill in the questionnaire on a specific day of the week and please remember to enter the respective date on the form (dd/mm/yyyy).
Below is an example of how to fill in the questionnaire: