Please check the number of the response that best describes how you have been feeling during the past week.
(Only one response for each question).
On average, during the past week, how often did you feel: never hardly ever a few times several times many times a great many times almost all the time
1. Short of breath at rest? 0 1 2 3 4 5 6
2. Short of breath doing physical activities? 0 1 2 3 4 5 6
3. Concerned about getting a cold or your breathing getting worse? 0 1 2 3 4 5 6
4. Depressed (down) because of your breathing problems? 0 1 2 3 4 5 6
In general, during the past week, how much of the time: never hardly ever a few times several times many times a great many times almost all the time
5. Did you cough? 0 1 2 3 4 5 6
6. Did you produce phlegm? 0 1 2 3 4 5 6
On average, during the past week, how limited were you in these activities because of your breathing problems: not limited at all very slightly limited slightly limited modera-tely limited very limited extremely limited totally limited /or unable to do
7. Strenuous physical activities (such as climbing stairs, hurrying, doing sports)? 0 1 2 3 4 5 6
8. Moderate physical activities (such as walking, housework, carrying things)? 0 1 2 3 4 5 6
9. Daily activities at home (such as dressing, washing yourself)? 0 1 2 3 4 5 6
10. Social activities (such as talking, being with children, visiting friends/ relatives)? 0 1 2 3 4 5 6
 

 

 

Total CCQ Score
Symptom score
Mental state score
Functional state score