.

Evaluation of Lung Related Disabilities Among Patients with Chronic Respiratory Diseases in Uganda

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Survio
Create a survey
1

What type of chronic respiratory disease have you been diagnosed with?

Please select the chronic respiratory disease that you have been diagnosed with.
2

Are you currently receiving treatment for your chronic respiratory disease?

Please provide information on whether you are receiving treatment for your condition.
3

How frequently do you experience shortness of breath?

Please indicate how often you experience shortness of breath.
4

Do you use supplemental oxygen?

Please provide information on whether you use supplemental oxygen for your condition.
5

Have you ever been hospitalized due to your chronic respiratory disease?

Please indicate if you have been hospitalized due to your condition.
6

Have you experienced a decrease in lung function over time?

Please indicate if you have noticed a decline in your lung function over time.
7

Are you able to participate in physical activities without experiencing breathing difficulties?

Please provide information on your ability to engage in physical activities.
8

How has your lung related disability impacted your quality of life?

Please describe how your disability has affected your overall quality of life.
9

What support do you feel would enhance your management of the chronic respiratory disease?

Please share any support or resources that you believe would improve your management of the condition.
Create a survey