Do you hear any stridor (high pitch noise) breathing in and out with your mouth open?
YesNo
Do you have any saliva running from the mouth as a result of being unable to swallow?
YesNo
Can you still finish a 5-word sentence in one breath?
YesNo
Did the shortness of breath come on suddenly or slowly?
SuddenSlow
Did you notice yourself getting tired and reducing effort from breathing?
YesNo
Feel for your radial or carotid pulse using your index and middle fingers. Take your heart rate and rhythm by keeping count on the pulse for 15 seconds and multiplying the amount by 4.
>100 beats per minute (25 beats per 15 seconds)60-100 beats per minute (15-24 beats per 15 seconds)<60 beats per minute (<15 beats per 15 seconds)Irregular heart rhythm
Did you have any history of previous life-threatening episodes of a respiratory condition (COPD, Cystic Fibrosis, Brittle Asthma, Bronchiectasis etc)?
Chronic Obstructive Pulmonary Disease (COPD)AsthmaBronchiectasisPneumoniaPleural EffusionPulmonary Embolism (PE)PneumothoraxCystic Fibrosis (CF)OtherNo
Do you suffer from a severe dull 'gripping' or 'heavy' pain in the centre of your chest, that radiates to the left arm or to the neck?
YesNo
Do you feel any sharp, localised pain on your chest that worsens on breathing, coughing or sneezing?
YesNo
Can you hear or feel a wheeze in your chest?
YesMaybeNo
Do you have a cough that is productive of phlegm (mucus) of whatever colour?
YesNo
Did you suffer from any physical injury to your chest (between your clavicle and your lowest rib) recently?
YesNo
Do you know your best Peak Expiratory Flow Reading (PEFR)?
YesNo