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CAPTURE questionnaire for identifying patients with undiagnosed COPD

CAPTURE questionnaire for identifying patients with undiagnosed COPD
Instructions: For each question, place an X in the box with the answer that is best for you. There are no right or wrong answers, only answers which are right for you.
Please answer each question No Yes
  1. Have you ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke, or dust?
    
  1. Does your breathing change with seasons, weather, or air quality?
    
  1. Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
    
  1. Compared to others your age, do you tire easily?
    
 
Please answer the question 0 1 2 or more
  1. In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis, or pneumonia?
      
The final score is a summation of patient responses to each of the five items, yielding a questionnaire score ranging from 0 ("no" to all 5 questions) to 6 ("yes" to all questions and at least two respiratory events during the past year).
CAPTURE: Chronic obstructive pulmonary disease Assessment in Primary care To identify Undiagnosed Respiratory disease and Exacerbation risk; COPD: chronic obstructive pulmonary disease.
Reprinted with permission of the American Thoracic Society. Copyright © 2019 American Thoracic Society. From: Martinez FJ, Mannino D, Leidy NK, et al. A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 195:748-756. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society.
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