Loading…

Protocol - Personal and Family History of Respiratory Symptoms/Diseases - Adult Protocol

Add to My Toolkit
Description:

This protocol obtains information about the personal history of respiratory symptoms and illnesses. Duration of disease, other allergic diseases, occupational history, smoking status, and family history of selected respiratory diseases are also assessed. Supplemental questions were added from other studies in areas judged to be inadequately covered by this questionnaire.

Specific Instructions:

None

Protocol:
SYMPTOMS

These questions pertain mainly to your chest. Please answer yes or no, if possible. If a question does not appear to be applicable to you, check the "Does Not Apply" space. If you are in doubt about whether your answer is yes or no, record no.

COUGH

1A. Do you usually have a cough? (Count a cough with first smoke or on first going out-of-doors. Exclude clearing of throat.) [If no, skip to question 1C.]

1[ ]Yes

2[ ]No

1B. Do you usually cough as much as 4 to 6 times a day, 4 or more days out of the week?

1[ ]Yes

2[ ]No

1C. Do you usually cough at all on getting up, or first thing in the morning?

1[ ]Yes

2[ ]No

1D. Do you usually cough at all during the rest of the day or at night?

1[ ]Yes

2[ ]No

IF YES TO ANY OF THE ABOVE (1A,1B,1C, OR 1D), ANSWER THE FOLLOWING QUESTIONS. IF NO TO ALL, CHECK DOES NOT APPLY AND SKIP TO 2A.

1E. Do you usually cough like this on most days for 3 consecutive months or more during the year?

1[ ]Yes

2[ ]No

8[ ]Does not apply

1F. For how many years have you had this cough?

_____________ Number of years

88[ ]Does not apply

PHLEGM

2A. Do you usually bring up phlegm from your chest? (Count phlegm with the first smoke or on first going out-of-doors. Exclude phlegm from the nose. Count swallowed phlegm.) [If no, skip to 2C.]

1[ ]Yes

2[ ]No

2B. Do you usually bring up phlegm like this as much as twice a day, 4 or more days out of the week?

1[ ]Yes

2[ ]No

2C. Do you usually bring up phlegm at all on getting up or first thing in the morning?

1[ ]Yes

2[ ]No

2D. Do you usually bring up phlegm at all during the rest of the day or at night?

1[ ]Yes

2[ ]No

IF YES TO ANY OF THE ABOVE (2A, 2B, 2C, OR 2D), ANSWER THE FOLLOWING. IF NO TO ALL, CHECK DOES NOT APPLY AND SKIP TO 3A.

2E. Do you bring up phlegm like this on most days for 3 consecutive months or more during the year?

1[ ]Yes

2[ ]No

8[ ]Does not apply

2F. For how many years have you had trouble with phlegm?

_____________ Number of years

88[ ]Does not apply

EPISODES OF COUGH AND PHLEGM

3A. Have you had periods or episodes of (increased*) cough and phlegm lasting for 3 weeks or more each year? (*For individuals who usually have cough and/or phlegm)

1[ ]Yes

2[ ]No

IF YES TO 3A:

3B. For how long have you had at least 1 such episode per year?

_____________ Number of years

88[ ]Does not apply

WHEEZING

4A. Does your chest ever sound wheezy or whistling:

1. When you have a cold?

1[ ]Yes

2[ ]No

2. Occasionally apart from colds?

1[ ]Yes

2[ ]No

3. Most days or nights?

1[ ]Yes

2[ ]No

IF YES TO 1, 2, OR 3 IN 4A:

4B. For how many years has this been present?

____________ Number of years

88[ ]Does not apply

5A. Have you ever had an ATTACK of wheezing that has made you feel short of breath?

1[ ]Yes

2[ ]No

IF YES TO 5A:

5B. How old were you when you had your first such attack?

_______ Age in years

88[ ]Does not apply

5C. Have you had 2 or more such episodes?

1[ ]Yes

2[ ]No

8[ ]Does not apply

5D. Have you ever required medicine or treatment for the(se) attack(s)?

1[ ]Yes

2[ ]No

8[ ]Does not apply

BREATHLESSNESS

6. If disabled from walking by any condition other than heart or lung disease, please describe and proceed to Question 8A.

_________________________________________________ Nature of condition(s):

7A. Are you troubled by shortness of breath when hurrying on the level or walking up a slight hill?

1[ ]Yes

2[ ]No

IF YES TO 7A:

7B. Do you have to walk slower than people of your age on the level because of breathlessness?

1[ ]Yes

2[ ]No

8[ ]Does not apply

7C. Do you ever have to stop for breath when walking at your own pace on the level?

1[ ]Yes

2[ ]No

8[ ]Does not apply

7D. Do you ever have to stop for breath after walking about 100 yards (or after a few minutes) on the level?

1[ ]Yes

2[ ]No

8[ ]Does not apply

7E. Are you too breathless to leave the house or breathless on dressing or undressing?

1[ ]Yes

2[ ]No

8[ ]Does not apply

CHEST COLDS AND CHEST ILLNESSES

8A. If you get a cold, does it usually go to your chest? (Usually means more than 1/2 the time.)

1[ ]Yes

2[ ]No

8[ ]Dont get colds

9A. During the past 3 years, have you had any chest illnesses that have kept you off work, indoors at home, or in bed?

1[ ]Yes

2[ ]No

IF YES TO 9A:

9B. Did you produce phlegm with any of these chest illnesses?

1[ ]Yes

2[ ]No

8[ ]Does not apply

9C. In the last 3 years, how many such illnesses, with (increased) phlegm, did you have which lasted a week or more?

_____ Number of illnesses

_____ No such illnesses

8[ ]Does not apply

PAST ILLNESSES

10. Did you have any lung trouble before the age of 16?

1[ ]Yes

2[ ]No

11. Have you ever had any of the following:

1A. Attacks of bronchitis?

1[ ]Yes

2[ ]No

IF YES TO 1A:

1B. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

1C. At what age was your first attack?

______ Age in years

88[ ]Does not apply

2A. Pneumonia (include bronchopneumonia)?

1[ ]Yes

2[ ]No

IF YES TO 2A:

2B. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

2C. At what age did you first have it?

______ Age in years

88[ ]Does not apply

3A. Hay fever?

1[ ]Yes

2[ ]No

IF YES TO 3A:

3B. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

3C. At what age did it start?

______ Age in years

88[ ]Does not apply

12A. Have you ever had chronic bronchitis?

1[ ]Yes

2[ ]No

IF YES TO 12A:

12B. Do you still have it?

1[ ]Yes

2[ ]No

8[ ]Does not apply

12C. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

12D. At what age did it start?

______ Age in years

88[ ]Does not apply

13A. Have you ever had emphysema?

1[ ]Yes

2[ ]No

IF YES TO 13A:

13B. Do you still have it?

1[ ]Yes

2[ ]No

8[ ]Does not apply

13C. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

13D. At what age did it start?

______ Age in years

88[ ]Does not apply

14A. Have you ever had asthma?

1[ ]Yes

2[ ]No

IF YES TO 14A:

14B. Do you still have it?

1[ ]Yes

2[ ]No

8[ ]Does not apply

14C. Was it confirmed by a doctor?

1[ ]Yes

2[ ]No

8[ ]Does not apply

14D. At what age did it start?

______ Age in years

88[ ]Does not apply

14E. If you no longer have it, at what age did it stop?

______ Age stopped

88[ ]Does not apply

15. Have you ever had:

15A. Any other chest illnesses?

1[ ]Yes

2[ ]No

If yes, please specify ____________________________________________

15B. Any chest operations?

1[ ]Yes

2[ ]No

If yes, please specify ____________________________________________

15C. Any chest injuries?

1[ ]Yes

2[ ]No

If yes, please specify ____________________________________________

16A. Has doctor ever told you that you had heart trouble?

1[ ]Yes

2[ ]No

IF YES to 16A:

16B. Have you ever had treatment for heart trouble in the past 10 years?

1[ ]Yes

2[ ]No

8[ ]Does not apply

17A. Has a doctor ever told you that you have high blood pressure?

1[ ]Yes

2[ ]No

IF YES to 17A:

17B. Have you had any treatment for high blood pressure (hypertension) in the past 10 years?

1[ ]Yes

2[ ]No

8[ ]Does not apply

OCCUPATIONAL HISTORY

18A. Have you ever worked full time (30 hours per week or more) for 6 months or more?

1[ ]Yes

2[ ]No

IF YES to 18A:

18B. Have you ever worked for a year or more in any dusty job?

1[ ]Yes

2[ ]No

8[ ]Does not apply

_________________________ Specify job/industry

___ Total years worked

Was dust exposure

1[ ]Mild?

2[ ]Moderate?

3[ ]Severe?

18C. Have you ever been exposed to gas or chemical fumes in your work?

1[ ]Yes

2[ ]No

8[ ]Does not apply

_________________________ Specify job/industry

___ Total years worked

Was fume exposure

1[ ]Mild?

2[ ]Moderate?

3[ ]Severe?

18D. What has been your usual occupation or job - the one you have worked at the longest?

1. Job-occupation: __________________________________________________

2. Number of years employed in this occupation:__________________

3. Position-job title: __________________________________________________

4. Business, field, or industry: __________________________________________

TOBACCO SMOKING

19A. Have you ever smoked cigarettes? (NO means less than 20 packs of cigarettes or 12 oz. of tobacco in a lifetime or less than 1 cigarette a day for 1 year.)

1[ ]Yes

2[ ]No

IF YES to 19A:

19B. Do you now smoke cigarettes (as of 1 month ago)?

1[ ]Yes

2[ ]No

8[ ]Does not apply

19C. How old were you when you first started regular cigarette smoking?

____ Age in Years

88[ ]Does not apply

19D. If you have stopped smoking cigarettes completely, how old were you when you stopped?

____ Age stopped

[ ] Check if still smoking

88[ ]Does not apply

19E. How many cigarettes do you smoke per day now?

___ Cigarettes/day

88[ ]Does not apply

19F. On the average of the entire time you smoked, how many cigarettes did you smoke per day?

___ Cigarettes/day

88[ ]Does not apply

19G. Do or did you inhale the cigarette smoke?

1[ ]Does not apply

2[ ]Not at all

3[ ]Slightly

4[ ]Moderately

5[ ]Deeply

20A.Have you ever smoked a pipe regularly?

1[ ]Yes (YES means more than 12 oz. tobacco in a lifetime.)

2[ ]No

IF YES to 20A:

20B1. How old were you when you started to smoke a pipe regularly?

____ Age

20B2. If you have stopped smoking a pipe completely, how old were you when you stopped?

____ Age stopped

Check if still smoking pipe ____

88[ ]Does not apply __

20C. On the average over the entire time you smoked a pipe, how much pipe tobacco did you smoke per week?

____ oz. per week (a standard pouch of tobacco contains 1 1/2 oz.)

88[ ]Does not apply ___

20D. How much pipe tobacco are you smoking now?

___ oz. per week

88[ ]Not currently smoking a pipe ___

20E. Do or did you inhale the pipe smoke?

1[ ]Never smoked

2[ ]Not at all

3[ ]Slightly

4[ ]Moderately

5[ ]Deeply

21A. Have you ever smoked cigars regularly?

1[ ]Yes (YES means more than 1 cigar a week for a year.)

2[ ]No

IF YES to 21A:

21B1. How old were you when you started smoking cigars regularly?

____ Age

21B2. If you have stopped smoking cigars completely, how old were you when you stopped?

____ Age stopped

Check if still smoking cigars___

88[ ]Does not apply __

21C. On the average over the entire time you smoked cigars, how many cigars did you smoke per week?

___ Cigars per week

88[ ]Does not apply

21D. How many cigars are you smoking per week now?

___ Cigars per week

88[ ]Check if not smoking cigars currently

21E. Do or did you inhale the cigar smoke?

1[ ]Never smoked

2[ ]Not at all

3[ ]Slightly

4[ ]Moderately

5[ ]Deeply

FAMILY HISTORY

22. Were either of your natural parents ever told by a doctor that they had a chronic lung condition such as:

FATHER

22A. Chronic bronchitis?

1[ ]Yes

2[ ]No

3[ ]Dont know

22B. Emphysema?

1[ ]Yes

2[ ]No

3[ ]Dont know

22C. Asthma?

1[ ]Yes

2[ ]No

3[ ]Dont know

22D. Lung cancer?

1[ ]Yes

2[ ]No

3[ ]Dont know

22E. Other chest conditions?

1[ ]Yes

2[ ]No

3[ ]Dont know

MOTHER

22A. Chronic bronchitis?

1[ ]Yes

2[ ]No

3[ ]Dont know

22B. Emphysema?

1[ ]Yes

2[ ]No

3[ ]Dont know

22C. Asthma?

1[ ]Yes

2[ ]No

3[ ]Dont know

22D. Lung cancer?

1[ ]Yes

2[ ]No

3[ ]Dont know

22E. Other chest conditions?

1[ ]Yes

2[ ]No

3[ ]Dont know

23. Have you ever had wheezing or whistling in your chest?

1[ ]Yes

2[ ]No

If Yes, about how old were you when you first had wheezing or whistling in your chest?

_____ Age in years (Answer 1 if younger than age 1 year)

24. In the last 12 months, have you had wheezing or whistling in your chest at any time?

1[ ]Yes

2[ ]No

If Yes, in the last 12 months, does your chest ever sound wheezy or whistling:

When you have a cold?

1[ ]Yes

2[ ]No

More than once a week?

1[ ]Yes

2[ ]No

Most days and nights?

1[ ]Yes

2[ ]No

25. In the last 12 months, have you been awakened from sleep by coughing, apart from a cough associated with a cold or chest infection?

1[ ]Yes

2[ ]No

26. In the last 12 months, have you been awakened from sleep by shortness of breath or a feeling of tightness in your chest?

1[ ]Yes

2[ ]No

27. In the past 12 months, have you been bothered by sneezing or a runny or blocked nose when you did not have a cold or the flu?

1[ ]Yes

2[ ]No

28. In the past 12 months, have you been bothered by watery, itchy, or burning eyes when you did not have a cold or the flu?

1[ ]Yes

2[ ]No

29. In the past 12 months, have you had periods or episodes of cough with phlegm that lasted 1 week or more? (If you usually have cough and phlegm, please count only periods or episodes of increased cough and phlegm.)

1[ ]Yes

2[ ]No

If Yes, for how many years have you had at least one such episode per year?

Number of years___

If Yes, about how many such episodes have you had in the past 12 months?

Number of episodes ___

30. In the past year, have you been to the emergency room or hospitalized for lung problems?

1[ ]Yes

2[ ]No

If Yes, how many times? ___

31. In the past year, have you been treated with antibiotics for a chest illness?

1[ ]Yes

2[ ]No

If Yes, how many times? ___

32. In the past year, have you been treated with steroid pills or injections, such as prednisone or solumedrol, for a chest illness?

1[ ]Yes

2[ ]No

If Yes, how many times? ___

Protocol Name from Source:

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Major equipment No
Specialized training No
Specialized training No
Specialized requirements for biospecimen collection No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered or interviewer-administered questionnaire

Life Stage:

Adolescent, Adolescent, Adult, Adult, Senior

Participants:

An individual aged 14 years or older

Selection Rationale

The American Thoracic Society-Division of Lung Diseases 1978 Questionnaire was created by a panel of respiratory experts. This protocol has been widely used over several decades and is valid and reliable.

Language

English, English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Respiratory Symptom Family And Personal Medical History Text 2969935 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Resp fam hx resp sympt adult proto 62625-9 LOINC
Derived Variables

None

Process and Review

Not applicable.

Source
The American Thoracic Society-Division of Lung Diseases 1978 Questionnaire (ATS-DLD 78), questions 7-28 (source for questions 1A-22A).

Genetic Epidemiology of COPD Study (COPDGene), Respiratory Disease Questionnaire, Version 08, January 2008, (source for questions 23-32).

General References

Ferris, B.G. (1978). American Thoracic Society (ATS) statement: epidemiology standardization project. American Review of Respiratory Disease, 118, 1-120.

Protocol ID:

90901

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX090901_Asthma_Doctor_Confirmed PX090901140300 PAST ILLNESSES - Asthma Was it confirmed by more
a doctor? show less
Variable Mapping
PX090901_Asthma_Ever PX090901140100 PAST ILLNESSES - Asthma Have you ever had asthma? Variable Mapping
PX090901_Asthma_Start_Age PX090901140400 PAST ILLNESSES - Asthma At what age did it start? Variable Mapping
PX090901_Asthma_Start_Age_Coded PX090901140401 PAST ILLNESSES - Asthma At what age did it start? Variable Mapping
PX090901_Asthma_Still_Have PX090901140200 PAST ILLNESSES - Asthma Do you still have it? Variable Mapping
PX090901_Asthma_Stop_Age PX090901140500 PAST ILLNESSES - Asthma If you no longer more
have it, at what age did it stop? show less
Variable Mapping
PX090901_Asthma_Stop_Age_Coded PX090901140501 PAST ILLNESSES - Asthma If you no longer more
have it, at what age did it stop? show less
Variable Mapping
PX090901_Breathlessness_Condition_Nature PX090901060000 BREATHLESSNESS If disabled from walking by more
any condition other than heart or lung disease, please describe Nature of condition(s). show less
Variable Mapping
PX090901_Breathlessness_Hurrying_Slight_Hill PX090901070100 BREATHLESSNESS Are you troubled by shortness more
of breath when hurrying on the level or walking up a slight hill? show less
Variable Mapping
PX090901_Breathlessness_Leave_House_Dressing_Undressing PX090901070500 BREATHLESSNESS Are you too breathless to more
leave the house or breathless on dressing or undressing? show less
Variable Mapping
PX090901_Breathlessness_Need_Stop_100_Yards PX090901070400 BREATHLESSNESS Do you ever have to stop for more
breath after walking about 100 yards (or after a few minutes) on the level? show less
Variable Mapping
PX090901_Breathlessness_Need_Stop_Own_Pace PX090901070300 BREATHLESSNESS Do you ever have to stop for more
breath when walking at your own pace on the level? show less
Variable Mapping
PX090901_Breathlessness_Need_Walk_Slower PX090901070200 BREATHLESSNESS Do you have to walk slower more
than people of your age on the level because of breathlessness? show less
Variable Mapping
PX090901_Bronchitis_Doctor_Confirmed PX090901110102 PAST ILLNESSES - Bronchitis Was it more
confirmed by a doctor? show less
Variable Mapping
PX090901_Bronchitis_Ever PX090901110101 PAST ILLNESSES - Bronchitis Have you ever more
had Attacks of bronchitis? show less
Variable Mapping
PX090901_Bronchitis_First_Age PX090901110103 PAST ILLNESSES - Bronchitis At what age was more
your first attack? show less
Variable Mapping
PX090901_Bronchitis_First_Age_Coded PX090901110104 PAST ILLNESSES - Bronchitis At what age was more
your first attack? show less
Variable Mapping
PX090901_Chest_Illness_Keep_Home_Bed PX090901090100 CHEST COLDS AND CHEST ILLNESSES During the more
past 3 years, have you had any chest illnesses that have kept you off work, indoors at home, or in bed? show less
Variable Mapping
PX090901_Chest_Illness_Phlegm PX090901090200 CHEST COLDS AND CHEST ILLNESSES Did you more
produce phlegm with any of these chest illnesses? show less
Variable Mapping
PX090901_Chest_Illness_Phlegm_Lasting_Week PX090901090300 CHEST COLDS AND CHEST ILLNESSES In the last more
3 years, how many such illnesses, with (increased) phlegm, did you have which lasted a week or more? show less
Variable Mapping
PX090901_Chest_Injury_Ever PX090901150301 PAST ILLNESSES - Chest Injuries Have you more
ever had Any chest injuries? show less
Variable Mapping
PX090901_Chest_Injury_Specify PX090901150302 PAST ILLNESSES - Chest Injuries Please more
specify chest injuries you had. show less
N/A
PX090901_Chest_Operation_Ever PX090901150201 PAST ILLNESSES - Chest Operations Have you more
ever had Any chest operations? show less
Variable Mapping
PX090901_Chest_Operation_Specify PX090901150202 PAST ILLNESSES - Chest Operations Please more
specify chest operations you had. show less
N/A
PX090901_Chronic_Bronchitis_Doctor_Confirmed PX090901120300 PAST ILLNESSES - Chronic Bronchitis Was it more
confirmed by a doctor? show less
Variable Mapping
PX090901_Chronic_Bronchitis_Ever PX090901120100 PAST ILLNESSES - Chronic Bronchitis Have more
you ever had chronic bronchitis? show less
Variable Mapping
PX090901_Chronic_Bronchitis_Start_Age PX090901120400 PAST ILLNESSES - Chronic Bronchitis At what more
age did it start? show less
Variable Mapping
PX090901_Chronic_Bronchitis_Start_Age_Coded PX090901120401 PAST ILLNESSES - Chronic Bronchitis At what more
age did it start? show less
Variable Mapping
PX090901_Chronic_Bronchitis_Still_Have PX090901120200 PAST ILLNESSES - Chronic Bronchitis Do you more
still have it? show less
Variable Mapping
PX090901_Cold_Usually_Go_To_Chest PX090901080000 CHEST COLDS AND CHEST ILLNESSES If you get more
a cold, does it usually go to your chest? (Usually means more than 1/2 the time.) show less
Variable Mapping
PX090901_Cough_Consecutive_Months PX090901010500 COUGH Do you usually cough like this on most more
days for 3 consecutive months or more during the year? show less
Variable Mapping
PX090901_Cough_Day_Night PX090901010400 COUGH Do you usually cough at all during the more
rest of the day or at night? show less
Variable Mapping
PX090901_Cough_Frequently PX090901010200 COUGH Do you usually cough as much as 4 to 6 more
times a day, 4 or more days out of the week? show less
Variable Mapping
PX090901_Cough_History PX090901010100 COUGH Do you usually have a cough? (Count a more
cough with first smoke or on first going out-of-doors. Exclude clearing of throat.) show less
Variable Mapping
PX090901_Cough_In_Morning PX090901010300 COUGH Do you usually cough at all on getting more
up, or first thing in the morning? show less
Variable Mapping
PX090901_Cough_Phlegm_Episode_Lasting_Time PX090901030200 EPISODES OF COUGH AND PHLEGM For how long more
have you had at least 1 such episode per year? show less
Variable Mapping
PX090901_Cough_Phlegm_Episode_Lasting_Time_Coded PX090901030201 EPISODES OF COUGH AND PHLEGM For how long more
have you had at least 1 such episode per year? show less
N/A
PX090901_Cough_Phlegm_Period_Episode PX090901030100 EPISODES OF COUGH AND PHLEGM Have you had more
periods or episodes of (increased*) cough and phlegm lasting for 3 weeks or more each year? (*For individuals who usually have cough and/or phlegm) show less
Variable Mapping
PX090901_Cough_Years PX090901010600 COUGH For how many years have you had this cough? Variable Mapping
PX090901_Cough_Years_Coded PX090901010601 COUGH For how many years have you had this cough? N/A
PX090901_Dusty_Job_Ever PX090901180201 OCCUPATIONAL HISTORY - Dusty Job Have you more
ever worked for a year or more in any dusty job? show less
Variable Mapping
PX090901_Dusty_Job_Exposure_Degree PX090901180204 OCCUPATIONAL HISTORY - Dusty Job Was dust more
exposure show less
N/A
PX090901_Dusty_Job_Industry_Specify PX090901180202 OCCUPATIONAL HISTORY - Dusty Job Specify more
job/industry. show less
N/A
PX090901_Dusty_Job_Total_Years PX090901180203 OCCUPATIONAL HISTORY - Dusty Job Total more
years worked? show less
Variable Mapping
PX090901_Emphysema_Doctor_Confirmed PX090901130300 PAST ILLNESSES - Emphysema Was it confirmed more
by a doctor? show less
Variable Mapping
PX090901_Emphysema_Ever PX090901130100 PAST ILLNESSES - Emphysema Have you ever more
had emphysema? show less
Variable Mapping
PX090901_Emphysema_Start_Age PX090901130400 PAST ILLNESSES - Emphysema At what age did more
it start? show less
Variable Mapping
PX090901_Emphysema_Start_Age_Coded PX090901130401 PAST ILLNESSES - Emphysema At what age did more
it start? show less
Variable Mapping
PX090901_Emphysema_Still_Have PX090901130200 PAST ILLNESSES - Emphysema Do you still have it? Variable Mapping
PX090901_Full_Time_Ever PX090901180100 OCCUPATIONAL HISTORY Have you ever worked more
full time (30 hours per week or more) for 6 months or more? show less
N/A
PX090901_Gas_Chemical_Fumes_Exposed_Ever PX090901180301 OCCUPATIONAL HISTORY - Gas or Chemical Fumes more
Have you ever been exposed to gas or chemical fumes in your work? show less
Variable Mapping
PX090901_Gas_Chemical_Fumes_Exposure_Degree PX090901180304 OCCUPATIONAL HISTORY - Gas or Chemical Fumes more
Was gas or chemical fumes exposure show less
N/A
PX090901_Gas_Chemical_Fumes_Industry_Specify PX090901180302 OCCUPATIONAL HISTORY - Gas or Chemical Fumes more
Specify job/industry. show less
N/A
PX090901_Gas_Chemical_Fumes_Total_Years PX090901180303 OCCUPATIONAL HISTORY - Gas or Chemical Fumes more
Total years worked? show less
Variable Mapping
PX090901_Hay_Fever_Doctor_Confirmed PX090901110302 PAST ILLNESSES - Hay fever Was it confirmed more
by a doctor? show less
Variable Mapping
PX090901_Hay_Fever_Ever PX090901110301 PAST ILLNESSES - Hay fever Have you ever more
had Hay fever? show less
Variable Mapping
PX090901_Hay_Fever_Start_Age PX090901110303 PAST ILLNESSES - Hay fever At what age did more
it start? show less
Variable Mapping
PX090901_Hay_Fever_Start_Age_Coded PX090901110304 PAST ILLNESSES - Hay fever At what age did more
it start? show less
Variable Mapping
PX090901_Heart_Trouble_Ever PX090901160100 PAST ILLNESSES - Heart Trouble Has doctor more
ever told you that you had heart trouble? show less
N/A
PX090901_Heart_Trouble_Treatment_Ever PX090901160200 PAST ILLNESSES - Heart Trouble Have you more
ever had treatment for heart trouble in the past 10 years? show less
N/A
PX090901_High_Blood_Pressure_Ever PX090901170100 PAST ILLNESSES - High Blood Pressure Has a more
doctor ever told you that you have high blood pressure? show less
Variable Mapping
PX090901_High_Blood_Pressure_Treatment_Ever PX090901170200 PAST ILLNESSES - High Blood Pressure Have more
you had any treatment for high blood pressure (hypertension) in the past 10 years? show less
Variable Mapping
PX090901_History_Antibiotics_Treatment_Chest PX090901310100 In the past year, have you been treated with more
antibiotics for a chest illness? show less
Variable Mapping
PX090901_History_Antibiotics_Treatment_Chest_Times PX090901310200 How many times? Variable Mapping
PX090901_History_Awakened_Breath_Tightness_Chest PX090901260000 In the last 12 months, have you been more
awakened from sleep by shortness of breath or a feeling of tightness in your chest? show less
Variable Mapping
PX090901_History_Awakened_Coughing PX090901250000 In the last 12 months, have you been more
awakened from sleep by coughing, apart from a cough associated with a cold or chest infection? show less
Variable Mapping
PX090901_History_Cough_Phlegm_Episodes PX090901290300 About how many such episodes have you had in more
the past 12 months? show less
Variable Mapping
PX090901_History_Cough_Phlegm_Lasted_Week PX090901290100 In the past 12 months, have you had periods more
or episodes of cough with phlegm that lasted 1 week or more? (If you usually have cough and phlegm, please count only periods or episodes of increased cough and phlegm.) show less
Variable Mapping
PX090901_History_Cough_Phlegm_Years PX090901290200 For how many years have you had at least one more
such episode per year? show less
Variable Mapping
PX090901_History_ER_Hospitalized_Lung PX090901300100 In the past year, have you been to the more
emergency room or hospitalized for lung problems? show less
Variable Mapping
PX090901_History_ER_Hospitalized_Lung_Times PX090901300200 How many times? Variable Mapping
PX090901_History_Father_Asthma PX090901220103 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: FATHER - Asthma? show less
Variable Mapping
PX090901_History_Father_Chronic_Bronchitis PX090901220101 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: FATHER - Chronic bronchitis? show less
Variable Mapping
PX090901_History_Father_Emphysema PX090901220102 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: FATHER - Emphysema? show less
Variable Mapping
PX090901_History_Father_Lung_Cancer PX090901220104 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: FATHER - Lung cancer? show less
Variable Mapping
PX090901_History_Father_Other_Chest_Conditions PX090901220105 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: FATHER - Other chest conditions? show less
N/A
PX090901_History_Mother_Asthma PX090901220203 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: MOTHER - Asthma? show less
Variable Mapping
PX090901_History_Mother_Chronic_Bronchitis PX090901220201 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: MOTHER - Chronic bronchitis? show less
Variable Mapping
PX090901_History_Mother_Emphysema PX090901220202 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: MOTHER - Emphysema? show less
Variable Mapping
PX090901_History_Mother_Lung_Cancer PX090901220204 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: MOTHER - Lung cancer? show less
Variable Mapping
PX090901_History_Mother_Other_Chest_Conditions PX090901220205 FAMILY HISTORY Were either of your natural more
parents ever told by a doctor that they had a chronic lung condition such as: MOTHER - Other chest conditions? show less
N/A
PX090901_History_Sneezing_Runny_Blocked_Nose PX090901270000 In the past 12 months, have you been more
bothered by sneezing or a runny or blocked nose when you did not have a cold or the flu? show less
N/A
PX090901_History_Steroid_Treatment_Chest PX090901320100 In the past year, have you been treated with more
steroid pills or injections, such as prednisone or solumedrol, for a chest illness? show less
N/A
PX090901_History_Steroid_Treatment_Chest_Times PX090901320200 How many times? N/A
PX090901_History_Watery_Itchy_Burning_Eyes PX090901280000 In the past 12 months, have you been more
bothered by watery, itchy, or burning eyes when you did not have a cold or the flu? show less
N/A
PX090901_History_Wheezing_Whistling_Chest PX090901240100 In the last 12 months, have you had wheezing more
or whistling in your chest at any time? show less
Variable Mapping
PX090901_History_Wheezing_Whistling_Chest_Cold PX090901240200 In the last 12 months, does your chest ever more
sound wheezy or whistling: When you have a cold? show less
Variable Mapping
PX090901_History_Wheezing_Whistling_Chest_Day_Night PX090901240400 In the last 12 months, does your chest ever more
sound wheezy or whistling: Most days and nights? show less
Variable Mapping
PX090901_History_Wheezing_Whistling_Chest_Multiple PX090901240300 In the last 12 months, does your chest ever more
sound wheezy or whistling: More than once a week? show less
N/A
PX090901_Longest_Job_Business_Field_Industry PX090901180404 OCCUPATIONAL HISTORY What has been your more
usual occupation or job - the one you have worked at the longest? Business, field, or industry show less
N/A
PX090901_Longest_Job_Occupation PX090901180401 OCCUPATIONAL HISTORY What has been your more
usual occupation or job - the one you have worked at the longest? Job-occupation show less
Variable Mapping
PX090901_Longest_Job_Title PX090901180403 OCCUPATIONAL HISTORY What has been your more
usual occupation or job - the one you have worked at the longest? Position-job title show less
N/A
PX090901_Longest_Job_Years PX090901180402 OCCUPATIONAL HISTORY What has been your more
usual occupation or job - the one you have worked at the longest? Number of years employed in this occupation show less
N/A
PX090901_Lung_Trouble_Before_Age_16 PX090901100000 PAST ILLNESSES - Lung Trouble Did you have more
any lung trouble before the age of 16? show less
Variable Mapping
PX090901_Other_Chest_Illness_Ever PX090901150101 PAST ILLNESSES - Other Chest Illnesses Have more
you ever had Any other chest illnesses? show less
Variable Mapping
PX090901_Other_Chest_Illness_Specify PX090901150102 PAST ILLNESSES - Other Chest Illnesses more
Please specify chest illnesses you had. show less
Variable Mapping
PX090901_Phlegm_Consecutive_Months PX090901020500 PHLEGM Do you bring up phlegm like this on more
most days for 3 consecutive months or more during the year? show less
Variable Mapping
PX090901_Phlegm_Day_Night PX090901020400 PHLEGM Do you usually bring up phlegm at all more
during the rest of the day or at night? show less
Variable Mapping
PX090901_Phlegm_Frequently PX090901020200 PHLEGM Do you usually bring up phlegm like more
this as much as twice a day, 4 or more days out of the week? show less
Variable Mapping
PX090901_Phlegm_History PX090901020100 PHLEGM Do you usually bring up phlegm from more
your chest? (Count phlegm with the first smoke or on first going out-of-doors. Exclude phlegm from the nose. Count swallowed phlegm.) show less
Variable Mapping
PX090901_Phlegm_In_Morning PX090901020300 PHLEGM Do you usually bring up phlegm at all more
on getting up or first thing in the morning? show less
Variable Mapping
PX090901_Phlegm_Years PX090901020600 PHLEGM For how many years have you had more
trouble with phlegm? show less
Variable Mapping
PX090901_Phlegm_Years_Coded PX090901020601 PHLEGM For how many years have you had more
trouble with phlegm? show less
N/A
PX090901_Pneumonia_Doctor_Confirmed PX090901110202 PAST ILLNESSES - Pneumonia Was it confirmed more
by a doctor? show less
Variable Mapping
PX090901_Pneumonia_Ever PX090901110201 PAST ILLNESSES - Pneumonia Have you ever more
had Pneumonia (include bronchopneumonia)? show less
Variable Mapping
PX090901_Pneumonia_First_Age PX090901110203 PAST ILLNESSES - Pneumonia At what age did more
you first have it? show less
Variable Mapping
PX090901_Pneumonia_First_Age_Coded PX090901110204 PAST ILLNESSES - Pneumonia At what age did more
you first have it? show less
Variable Mapping
PX090901_Smoke_Cigars_Ever PX090901210100 TOBACCO SMOKING Have you ever smoked cigars more
regularly? show less
Variable Mapping
PX090901_Smoke_Cigars_Inhale PX090901210500 TOBACCO SMOKING Do or did you inhale the more
cigar smoke? show less
Variable Mapping
PX090901_Smoke_Cigars_Quantity_Week_Average PX090901210300 TOBACCO SMOKING On the average over the more
entire time you smoked cigars, how many cigars did you smoke per week? show less
Variable Mapping
PX090901_Smoke_Cigars_Quantity_Week_Average_Coded PX090901210301 TOBACCO SMOKING On the average over the more
entire time you smoked cigars, how many cigars did you smoke per week? show less
Variable Mapping
PX090901_Smoke_Cigars_Quantity_Week_Now PX090901210400 TOBACCO SMOKING How many cigars are you more
smoking per week now? show less
Variable Mapping
PX090901_Smoke_Cigars_Quantity_Week_Now_Coded PX090901210401 TOBACCO SMOKING How many cigars are you more
smoking per week now? show less
Variable Mapping
PX090901_Smoke_Cigars_Start_Age PX090901210201 TOBACCO SMOKING How old were you when you more
started smoking cigars regularly? show less
Variable Mapping
PX090901_Smoke_Cigars_Stop_Age PX090901210202 TOBACCO SMOKING If you have stopped smoking more
cigars completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Smoke_Cigars_Stop_Age_Coded PX090901210203 TOBACCO SMOKING If you have stopped smoking more
cigars completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Smoke_Pipe_Ever PX090901200100 TOBACCO SMOKING Have you ever smoked a pipe more
regularly? show less
Variable Mapping
PX090901_Smoke_Pipe_Inhale PX090901200500 TOBACCO SMOKING Do or did you inhale the more
pipe smoke? show less
Variable Mapping
PX090901_Smoke_Pipe_Quantity_Week_Average PX090901200300 TOBACCO SMOKING On the average over the more
entire time you smoked a pipe, how much pipe tobacco did you smoke per week? show less
Variable Mapping
PX090901_Smoke_Pipe_Quantity_Week_Average_Coded PX090901200301 TOBACCO SMOKING On the average over the more
entire time you smoked a pipe, how much pipe tobacco did you smoke per week? show less
Variable Mapping
PX090901_Smoke_Pipe_Quantity_Week_Now PX090901200400 TOBACCO SMOKING How much pipe tobacco are more
you smoking now? show less
Variable Mapping
PX090901_Smoke_Pipe_Quantity_Week_Now_Coded PX090901200401 TOBACCO SMOKING How much pipe tobacco are more
you smoking now? show less
Variable Mapping
PX090901_Smoke_Pipe_Start_Age PX090901200201 TOBACCO SMOKING How old were you when you more
started to smoke a pipe regularly? show less
Variable Mapping
PX090901_Smoke_Pipe_Stop_Age PX090901200202 TOBACCO SMOKING If you have stopped smoking more
a pipe completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Smoke_Pipe_Stop_Age_Coded PX090901200203 TOBACCO SMOKING If you have stopped smoking more
a pipe completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Ever PX090901190100 TOBACCO SMOKING Have you ever smoked cigarettes? Variable Mapping
PX090901_Smoking_Cigarettes_Inhale PX090901190700 TOBACCO SMOKING Do or did you inhale the more
cigarette smoke? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Now PX090901190200 TOBACCO SMOKING Do you now smoke cigarettes more
(as of 1 month ago)? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Quantity_Day_Average PX090901190600 TOBACCO SMOKING On the average of the more
entire time you smoked, how many cigarettes did you smoke per day? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Quantity_Day_Average_Coded PX090901190601 TOBACCO SMOKING On the average of the more
entire time you smoked, how many cigarettes did you smoke per day? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Quantity_Day_Now PX090901190500 TOBACCO SMOKING How many cigarettes do you more
smoke per day now? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Quantity_Day_Now_Coded PX090901190501 TOBACCO SMOKING How many cigarettes do you more
smoke per day now? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Start_Age PX090901190300 TOBACCO SMOKING How old were you when you more
first started regular cigarette smoking? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Start_Age_Coded PX090901190301 TOBACCO SMOKING How old were you when you more
first started regular cigarette smoking? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Stop_Age PX090901190400 TOBACCO SMOKING If you have stopped smoking more
cigarettes completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Smoking_Cigarettes_Stop_Age_Coded PX090901190401 TOBACCO SMOKING If you have stopped smoking more
cigarettes completely, how old were you when you stopped? show less
Variable Mapping
PX090901_Wheezing_Apart_From_Cold PX090901040102 WHEEZING Does your chest ever sound wheezy more
or whistling: Occasionally apart from colds? show less
Variable Mapping
PX090901_Wheezing_Attack_Ever PX090901050100 WHEEZING Have you ever had an ATTACK of more
wheezing that has made you feel short of breath? show less
Variable Mapping
PX090901_Wheezing_Attack_Medicine_Treatment_Ever PX090901050400 WHEEZING Have you ever required medicine or more
treatment for the(se) attack(s)? show less
Variable Mapping
PX090901_Wheezing_Attack_Multiple_Episodes PX090901050300 WHEEZING Have you had 2 or more such episodes? Variable Mapping
PX090901_Wheezing_Day_Night PX090901040103 WHEEZING Does your chest ever sound wheezy more
or whistling: Most days or nights? show less
Variable Mapping
PX090901_Wheezing_First_Age PX090901050200 WHEEZING How old were you when you had your more
first such attack? show less
Variable Mapping
PX090901_Wheezing_First_Age_Coded PX090901050201 WHEEZING How old were you when you had your more
first such attack? show less
Variable Mapping
PX090901_Wheezing_Have_Cold PX090901040101 WHEEZING Does your chest ever sound wheezy more
or whistling: When you have a cold? show less
Variable Mapping
PX090901_Wheezing_Whistling_Chest_Ever PX090901230101 Have you ever had wheezing or whistling in more
your chest? show less
Variable Mapping
PX090901_Wheezing_Whistling_Chest_First_Age PX090901230102 About how old were you when you first had more
wheezing or whistling in your chest? show less
Variable Mapping
PX090901_Wheezing_Years PX090901040200 WHEEZING For how many years has this been present? Variable Mapping
PX090901_Wheezing_Years_Coded PX090901040201 WHEEZING For how many years has this been present? Variable Mapping
Respiratory
Measure Name:

Personal and Family History of Respiratory Symptoms/Diseases

Release Date:

January 29, 2010

Definition

Measure to assess the history of respiratory symptoms (i.e., cough, phlegm, shortness of breath, wheezing) and respiratory diseases.

Purpose

Personal and family history of respiratory symptoms and diseases are important to assess for overall health and quality of life. Standardized approaches to assess respiratory symptoms and diseases are required to define many respiratory phenotypes.

Keywords

respiratory, lung, personal history and family history of respiratory symptoms/diseases, asthma, dyspnea, cough, chest injuries, chest illnesses, chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, wheezing, family history, smoking