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COPD Assessment Test (CAT)
COPD Assessment Test (CAT)
admin
2020-02-17T04:06:37+10:00
COPD Assessment Test (CAT)
Date
Personal Information
Please complete your personal information below.
First Name
*
First
Last Name
*
Last
Email
Phone
*
Are you an existing patient?
*
Yes
No
COPD Assessment Test™ (CAT)
This questionnaire will help you and your healthcare professional measure the impact COPD (Chronic Obstructive Pulmonary Disease) is having on your wellbeing and daily life. Your answers, and test score, can be used by you and your family healthcare professional to help improve the management of your COPD and get the greatest benefit from treatment.
For each item below, please select the score rating that best describes you currently. Be sure to only select one response for each question.
How often do you cough? (0 = I never cough, 5 = I cough all the time)
*
0
1
2
3
4
5
How much phlegm (mucus) do you experience in your chest? (0 = I have no phlegm in my chest at all, 5 = My chest is completely full of phlegm)
*
0
1
2
3
4
5
How tight does your chest feel? (0 = My chest does not feel tight at all, 5 = My chest feels very tight)
*
0
1
2
3
4
5
How breathless do you feel after walking up a hill or one flight of stairs? (0 = Not breathless at all, 5 = very breathless)
*
0
1
2
3
4
5
Are you limited doing any activities at home? (0 = I am not limited, 5 = I am very limited)
*
0
1
2
3
4
5
How confident are you leaving your home with your lung condition? (0 = Confident despite my lung condition, 5 = not confident at all because of my lung condition)
*
0
1
2
3
4
5
How soundly do you sleep? (0 = I sleep soundly, 5 = I don't sleep soundly because of my lung condition)
*
0
1
2
3
4
5
How much energy do you have? (0 = I have lots of energy, 5 = I have no energy at all)
*
0
1
2
3
4
5
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