Aapendt | = otvqusetsnquae verso ofthe PumonsyFnctionl tatu and Dygncs Questinaie = aiid Dyspnea assessment ‘nstactons the following questions ae relate to your respiratory Aste. Pease, choose the most wine gen cer had shoes of tat? Yes” Ho) 2 How many times 2 month da you have severe to exteme shortness of breath? 5-7 Months Using the scale below, puta mark onthe lire betneen 0 (no shoriness of breath) and 10 (extreme Shornes of breath in response to the flowing questions: 2. indicate how you Fl om mont days during ast yar Shores of bes Tae a Maseute aa amy “m TIetsteps bettie! rs) wo 4 Inate how you fel days © cress pe a te 5. cate how ou fel dri most vey actives: Shoes of bas Tae wm oe Saar eae © TIaTsteisretrTetsy Assessment of dyspnea stration: cif the sctvtes belo an sete of Oo 10 acconding to the degre of shores of breath that each ett usally causes. Example: ark the colombo the “0° with an the acts es not wsslly cause shortness of breath blow the“, "5" or “UW caves maderately severe ‘Sorts of breath and below the “10° it causes extreme shortness fireath. For aches in which have never engaged, mark no clu, Degree of shortness of breath a 1 Sushing ale ora Setets fete fe Peo ig or fats Bes Pete te fs To tia os els Petr te Pe Ping ope teats fete te Ps] 6 Pessin wh oe ets bet te Po Wing wap ope po tes Sere Pe cing te Sep oa gfe pte Po TO. Waly or we oan oe eet er Pe Ps‘arpa Assessment of fatigue ‘retractor the folloing questions sre ented to how ted ar existed yo fel Pease, choose ‘the most oecrae ase |e your nd or hated? YOU Nok) 2. How many times a month do you fee! severe to extreme fatigue? 3+ Times Using the sale teow, put a mark onthe line between O (no fatigue) and 10 (extreme fatigue ‘response tothe following questions: 3. este how you elton mst days during lst year Faia Ta a Mee Tae eae SE 4 Indicate how you fel Te Tm i Nosenie Soe ee * a popende 1 = Coninnion Assessment of change in activities Instructions: for cach activity, put a “Xin the appropiate square nating your involvement wth the aetity now, compared to what it was Ike before you developed respon problems. For example, ‘mate te square inthe 0" column ifthe actity didnot change afer you devcloped respiratory problems: in the4",°5" 0176" column if you had to moderately change the activity and in the "10" column if you ‘0 longer perform this activity fou have never entiaged In the actty. mark the fst column. Degree of change Sig barat | tae] Gv fom 1. Busing a ang sabe ead Sci Wisin a ting oa 5. Pring ine ating ps Se inking thee = Wang ees = Ta. Wahing on nee gaond_ | ——— elelelelelel=lelol=lelf a Appendix 2 ~ Portuguese-language version of the Medical Research Council scale, 1. Only experiencing shortness of breath during vigorous exercise 2, Experiencing shortness of breath when walking briskly or ascending a mild slope. 53, Walking slower than other people of the same age due to shortness of breath or having to stop in order to recover rnormal breathing even when walking slowly. 4, Stopping in order to reeaver normal breathing after walking less than 100 m of for only @ few minutes. 5. Experiencing such severe shortness of breath that it no longer possible to leave the home, or experiencing shortness cof breath when getting dressed.