COPD Assessment Test

First Name *

Last Name *

DOB: *

Gender *

MaleFemaleOther

Name of clinician

Please start typing the name of the Doctor or Nurse Practitioner

This questionnaire will help you and your healthcare professional measure the impact of COPD is having on your wellbeing and daily life.

For each item below, select an option that best describes you currently.

Cough *

Phlegm *

Chest tightness *

Breathlessness *

Activities *

Confidence *

Sleep *

Energy *

Total Score

Health Impact: Low

(0-10)

Smoking cessation, preventive care, and reduced exposure to exacerbation risk factors; consider LAMA and rescue inhalers

Health Impact: Medium

Score: 11-20

Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, and LAMA and rescue inhalers; consider ICS and/or LABA, referrals for pulmonary rehab, and possible lung transplant evaluation

Health Impact: High

Score: 21-30

Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, ICS/LABA/LAMA therapy, referrals for pulmonary rehab, possible lung transplant evaluation, and O₂ supplementation

Health Impact: Very High

Score: 31-40

Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, ICS/LABA/LAMA therapy, referrals for pulmonary rehab, possible lung transplant evaluation, and O₂ supplementation

P.W. Jones, G. Harding, P. Berry, I. Wiklund, W-H. Chen and N. Kline Leidy. Development and first validation of the COPD Assessment Test. Eur Respir J 2009, 34: 648–654.