Identifying a Group Identify an area of chronic illness of specific interest to you and that is represented as a Healthy People 2020 topic (healthypeople.gov). Explain your choice and your interest in it. Prepare a questionnaire utilizing your knowledge

Example of an questionnaire

Questionnaire

1.      Do you have a family history of lung disease?

2.     Do you have a history of asthma or frequent respiratory infections?

3.     Do you or have you ever smoked? If yes, how many packs/day for how long?

4.     Does or has anyone in your home smoked?

5.     Have you been exposed to environmental or occupational dust or pollution?

6.     Does your ability to breathe impact your activities of daily living?

7.     Have or do you experience any of the following symptoms:

Shortness of breath or breathlessness? If yes, is it at rest or on exertion?

Does changing you position make breathing easier?

When you are short of breath do you find yourself breathing through your mouth?

Cough? If yes, is it productive? Color of sputum? Is it ever bloody?

Have you noticed a blue color around your mouth or on your fingers?

8.     Have you seen a doctor for any of the symptoms? If yes, what was treatment?

9.     What makes your symptoms better? Worse?

10.  What medication including inhalers to you currently take or use?

11.  Do you have any additional information that you would like to provide?