Bronchiectasis Review

If you have been advised by the surgery to do so, please use this form.

Bronchiectasis Review

Section

Have you received a letter, text message or verbal invitation to complete this assessment?
Do you smoke/vape? *
What do you smoke?

Are you using any inhalers or tablets for your bronchiectasis? Record what inhaler and how many.

Do you use a spacer device with your inhaler?
Have you ever attended an exercise course to improve your breathing?
Have you had any overnight admissions relating to your lungs in the past 12 months? *
Do you cough up phlegm? *
What colour is it?
How often do you cough up phlegm?
We would like to know about your level of breathlessness, please select the most appropriate comment: *
Has this changed since your last review? *
If we need to speak to you about your review, would you prefer a face to face or telephone appointment? *