Respiratory Health Assessment

Respiratory Health Assessment – Clinical Instructions

This assessment screens for respiratory symptoms such as cough, shortness of breath, chest tightness, wheezing, and exercise intolerance.

It supports identification of infectious, obstructive, restrictive, or environmental respiratory conditions.

How to Complete

  • Base responses on symptoms over the last 2–8 weeks.
  • Note exposure to smoke, dust, or occupational hazards.

Clinical Interpretation

  • Guides need for chest imaging, spirometry, or infection screening.
  • Results can be forwarded to pulmonology or internal medicine.
Urgent Warning: Severe breathlessness, cyanosis, or chest pain requires immediate emergency care.
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1 Do you experience difficulty breathing at rest?
2 Do you feel short of breath during mild physical activity?
3 Do you experience sudden episodes of breathlessness?
4 Do you experience wheezing when breathing?
5 Is your breathing worse at night or early morning?
6 Do you have a persistent cough lasting more than 3 weeks?
7 Is your cough productive (producing sputum)?
8 Have you noticed blood in your sputum?
9 Do you experience chest tightness while breathing?
10 Do you have a history of asthma or chronic lung disease?
11 Do you use inhalers or breathing medications?
12 Have you been exposed to dust, fumes, or smoke regularly?
13 Do you smoke or use tobacco products?
14 Do you experience recurrent chest infections?
15 Do you experience fatigue related to breathing difficulty?
16 Do you wake up at night due to breathing difficulty?
17 Have your respiratory symptoms worsened recently?
18 Do respiratory symptoms limit daily activities?
19 Have you experienced unexplained weight loss with cough?
20 Have you had recent exposure to tuberculosis or similar infections?
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