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Respiratory Diagnostics
Respiratory Assessment Questionnaire
Name
Email
Phone
Main symptom
Breathlessness
Cough
Wheeze
Chest tightness
Other
MRC Dyspnoea Grade
1 - Breathless only with strenuous exercise
2 - Short of breath when hurrying or walking up a slight hill
3 - Walks slower than people of same age because of breathlessness
4 - Stops for breath after about 100m or after a few minutes
5 - Too breathless to leave the house or breathless dressing
Smoking history
Relevant notes
Submit Respiratory Questionnaire
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CORE Diagnostics