Age: | |
Smoking status: | |
"Do you cough regularly?" | |
"Do you cough up phlegm regularly?" | |
"Do even simple chores make you short of breath?" | |
"Do you wheeze when you exert yourself, or at night?" | |
"Do you get frequent colds that persist longer than those of other people?" | |
Is patient well? |
Spirometry should be rescheduled for 2 weeks. Do not continue with spirometry today. |
Spirometry recommended for this patient. |
|
Spirometry not indicated for this patient. |
Pack Years: |
Cessation and intervention given today:
|
1
"I only get breathless with strenuous exercise" |
2
"I get short of breath when hurrying on the level or walking up a slight hill" |
3
"I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level" |
4
"I stop for breath after walking about 100 yards or after a few minutes on the level" |
5
"I am too breathless to leave the house" or "I am too breathless when dressing" |
Ethnicity: For calculation of predicted values only |
|
Height: | cm |
Weight: | kg |
Actual | Predicted | % of Predicted | |
---|---|---|---|
FEV1: | |||
FVC: | |||
Ratio (FEV1:FVC): | |||
Post-bronchodilator FEV1: | |||
Were inhalers withheld today: | Record inhaler use in notes below. | ||
Is patient well? |
Spirometry should be rescheduled for 2 weeks. Do not continue with spirometry today. |
Spirometry is contraindicated when:
If any of above exists, refer to GP to assess if spirometry is required at this time. NB Spirometry is NOT an emergency procedure.
Title: | |
Linked Condition: | |
Date of next review: |
Please ensure that patient is informed and consents to the care plan information being shared with others involved in their care.
This is a: