BWS Breathlessness Review Form

If you have been advised by the surgery to submit a breathlessness review on a regular basis please use this form.

Last Updated: 08/07/2020

Your Details






Breathlessness Review






Attacks of breathlessness


Smoking




For COPD patients only

The COPD Assessment Test provides a score to help you and your healthcare provider determine if your COPD symptoms are well controlled. Please select a score of 0 to 5 to help assess the severity of your symptoms.









Further questions