Campaigns

British Lung Foundation’s Annual Survey 2009

Each year the British Lung Foundation conducts a survey to find out about the experiences of people with a lung condition. To thank you for taking the time to complete this survey we will enter you into a free prize draw to win £25 of Marks and Spencer vouchers if you send back your response by 1 July 2009.

If you are a carer of someone with a lung condition then please contact the BLF Communications team (see the end of the survey for contact details) if you would like to take part in future surveys of carers of patients with lung disease. If you are filling in this questionnaire on behalf of someone with a lung condition, please answer all of the following questions.

Section 1 - About you

Your name [optional]

Please state if you are male or female

male
female

Please enter which age category you fall into *

Under 24
25-34
35-44
45-54
55-64
65-74
over 75

Date of Birth [optional] (dd/mm/yyyy)

Town nearest to where you live *

Address [optional]

Line 1
Line 2
Town
County
Postcode
Country

Phone Number [optional]

Email: [optional]

BLF Membership No [if applicable]

Name of Breathe Easy group attended [if applicable]

If you would prefer us not to contact you by email, please check the box

Section 2 - You and your lung condition
	1. Which type of lung condition do you have? (Please tick all that apply)
	Chronic Obstructive Pulmonary Disease Fibrosing Alveolitis [Pulmonary Fibrosis] Mesothelioma Bronchiectasis Asthma Lung cancer Sleep Apnoea Sarcoidosis I’m not sure Other
	If 'other' please specify

	2. How old were you when you were diagnosed with your lung condition?

	3. Who carried out your diagnosis? (Please tick the box next to your answer)
	GP Nurse at GP surgery Respiratory Specialist Hospital Nurse Hospital Doctor Other
	If 'other' please specify

	4. Have you ever been diagnosed with a different lung condition to the one you have now? (Please tick the box next to your answer)
	Yes (please go to question 5) No (please go to question 6)
	5. If you answered ‘yes’ to the above question, please tell us which lung condition[s] you have previously been diagnosed with. (Please tick all that apply)
	Chronic Obstructive Pulmonary Disease Fibrosing Alveolitis [Pulmonary Fibrosis] Mesothelioma Bronchiectasis Asthma Lung cancer Sleep apnoea Sarcoidosis I’m not sure Other
	If 'other' please specify

	6. If you have asthma or COPD, have you ever been told you have both conditions? (Please tick the box next to your answer)
	Yes, I have been told I have both asthma and COPD No, I have never been told I have both asthma and COPD Don’t know
	7. How long ago did you first experience symptoms of your lung condition? (Please tick the box next to your answer)
	6 months or less 7 months to a year 1 – 2 years 3 – 5 years 6 – 10 years 11 – 15 years 16 – 20 years Over 21 years
	8. How long was it before you were given a lung test of any kind [peak flow/spirometry/x-ray/CT scan] after you first went to your GP or hospital with breathing problems or other symptoms? (Please tick the box next to your answer)
	I was given a test immediately I was given a test within 2 weeks I was given a test within a month I was given a test within 2-3 months I was given a test within 4 - 6 months I was given a test more than 7 months later Can’t remember/Don’t know I have never been offered a test
	9. What type of lung test were you given? (Please tick all that apply)
	Peak flow Reversibility tests Spirometry test CT scan X ray Exercise test Other Can’t remember/Don’t know
	10. If you were offered a spirometry test, who gave you the test? (Please tick the box next to your answer)
	GP Pharmacist Nurse at GP surgery Physiotherapist Hospital doctor Lung Function Technician Hospital nurse BLF Nurse Can’t remember/Don’t know Not applicable
	11. How long ago did you have your last spirometry test? (Please tick the box next to your answer)
	Less than 2 months ago 3 - 6 months ago 7 months to a year ago Over a year ago More than 2 years ago I have not been offered a spirometry test since I was diagnosed
	12. Were you given any information (for example leaflets) by your GP, nurse or hospital doctor about your lung condition? (Please tick the box next to your answer)
	Yes, when I was diagnosed Yes, following my diagnosis No, I have never been given any information about my lung condition Don’t remember Other
	If 'other' please specify

Section 3 - Access to pulmonary rehabilitation
	13. Have health care professionals discussed exercise for your lung condition with you?
	Yes No, but I would like them to No and I am not interested in discussing this Don’t know
	14. Does your local health service provide pulmonary rehabilitation classes? (Please tick the box next to your answer)
	Yes (please go to question 15) No, but I wish that they did (please go to question 18) Don’t know
	15. If yes, have you attended a pulmonary rehabilitation course? (Please tick the box next to your answer)
	Yes (please go to question 16) No (please go to question 18)
	16. If yes, did you find pulmonary rehabilitation improved your quality of life? (Please tick the box next to your answer)

	17. Since attending pulmonary rehabilitation have you continued to do gentle exercise? (Please tick the box next to your answer)
	Yes, at home Yes, I attend follow on exercise classes Yes, I attend a class with a BLF Active Instructor/BLF trained instructor No, I have stopped exercising

Section 4: Smoking Habits and Smoking Cessation Support

18. Have you ever smoked? (Tick the description that best describes you)

Yes, I am a smoker but I would like to quit (please go to question 22)
Yes, I am a smoker but find it too hard to quit (please go to question 22)
Yes, I am a smoker and have no plans to quit (please go to question 22)
Yes, I am an ex-smoker (please go to question 19)
No, I have never smoked (please go to question 22)
Other

If 'other' please specify

19. If you are an ex-smoker, what services did you use to help you quit? (Tick all that apply)

Local Smoking Cessation Team
Support Helpline (For example BLF/NHS Direct etc)
Advice from Doctor
Pharmacist
I quit without using any support services
Other

If 'other' please state what other methods helped you to quit

20. What made you decide to quit smoking? (Tick all that apply)

Concerns about the impact of smoking on my health
After being diagnosed with my lung condition
Pregnancy
Following the smoking ban in public places
Encouraged to give up by family members
Encouraged to give up by friends
Concerns about the impact of passive smoking on my family’s health
Other

If 'other' please specify

21. How would you rate this support?

	Poor	Average	Good	Excellent	Don’t Know

Local Smoking Cessation Team
Support Helpline (For example BLF/NHS Direct etc)
Advice from Doctor
Other

Section 5 - Oxygen
	22. Do you currently use oxygen therapy? (Please tick the box next to your answer)
	Yes (please go to question 23) No (please go to question 27)
	23. If yes, do you take a portable oxygen supply with you when you are out and about? (Please tick the box next to your answer)
	Yes (please go to question 24) No (please go to question 27)
	24. Which of the following types of public transport have you used in the past year whilst travelling with your own oxygen supply? (Please tick all that apply)
	Taxi Train Bus Plane Coach Tube (underground train) Other
	If 'other' please specify

	25. Which of the following types of public transport have you experienced problems with while travelling with oxygen? (Please tick all that apply)
	Taxi Train Bus Plane Coach Tube (underground train) Other
	26. If you have experienced problems with public transport whilst travelling with oxygen please tell us more about your experiences below

Section 6 - This section of the questionnaire is about your opinions on a range of issues that affect people with lung conditions. Questions 27a to c are about your attitudes to lung screening and early detection of COPD. Screening for COPD should be carried out by a spirometry (lung function) test. Please tell us whether you agree or disagree with the following statements:
	27a. Everyone should be offered a spirometry test from the age of 35 onwards (Please tick only one answer)
	Strongly Agree Agree Disagree Strongly Disagree No opinion
	27b. Everyone should be offered a spirometry test from the age of 21 onwards (Please tick only one answer)
	Strongly Agree Agree Disagree Strongly Disagree No opinion
	27c. Everyone should be offered a spirometry test from the age of 7 onwards (Please tick only one answer)
	Strongly Agree Agree Disagree Strongly Disagree No opinion
	28. All smokers trying to quit smoking should have access to free Nicotine Replacement Therapy for life (i.e. for as often and as long as they need it)? (Please tick only one answer)
	Strongly Agree Agree Disagree Strongly Disagree No opinion
	29. Do you think all patients in England, Scotland and Northern Ireland with long term conditions should have free prescriptions? Please note that all prescription charges for all patients have already been abolished in Wales. [Please tick only one answer]
	Strongly Agree Agree Disagree Strongly Disagree No opinion

Children’s Lung Health: The British Lung Foundation is currently working on a campaigning Charter about children’s lung disease and we would be very interested to hear your views on one of the points we are planning to include in the charter.
	30. Every child should be able to enjoy a smoke free environment [Please tick only one answer]
	Strongly Agree Agree Disagree Strongly Disagree No opinion

Section 7 - Taking Control – End of Life Care This last section is about a sensitive topic so we completely understand if you do not want to complete this section of the survey. However we would be grateful for any information you can share with us as it will help us to campaign to ensure that people coping with the final stages of lung disease are given the support they need.
	31. Have you ever discussed end of life care options? (Please place a tick next to your answer)
	Yes (please go to question 32) I was offered the opportunity to discuss this but I didn’t want to talk about it (please go to question 36) No, but I would like to (please go to question 34) No and I do not wish to do so (please go to question 36) Don’t know (please go to question 36)
	32. If yes, who have you discussed this with?
	GP Respiratory specialist Nurse Palliative Care Health Professional Religious worker Family member Friend Lawyer BLF Helpline Other

33. Please tick which if any of the following topics were discussed and if not if you would have liked to have discussed them
	If you would want to be admitted to hospital if you had a bad flare up
	Yes this was discussed No, but I would have liked to discuss this No, and I would prefer not to discuss this
	If you would want to have non-invasive ventilation or not
	Yes this was discussed No, but I would have liked to discuss this No, and I would prefer not to discuss this
	If you would want to go into an Intensive Care Department and go on life-support
	Yes this was discussed No, but I would have liked to discuss this No, and I would prefer not to discuss this
	If you would you want to be resuscitated if your heart or lungs stopped working
	Yes this was discussed No, but I would have liked to discuss this No, and I would prefer not to discuss this
	Where you would like to be cared for towards the end of your life
	Yes this was discussed No, but I would have liked to discuss this No, and I would prefer not to discuss this
	34. If no, who would you like to discuss them with? (Please tick only one answer)
	GP Respiratory specialist Nurse Palliative Care Health Professional Religious worker Family member Friend Lawyer BLF Helpline Other
	If 'other' please specify

	35. Would you like to have a special appointment to discuss these types of decisions? (Please tick only one answer)
	Yes No Not Sure Other

Section 8 - Getting Involved
	36. If you would be interested in making your voice heard on all issues affecting people with lung disease, please let us know if you would be interested in joining the BLF’s Survey Group.
	Yes, I would be interested in joining the BLF’s Survey Group No, I would not be interested in joining the BLF’s Survey Group
	37. Do you have access to the internet at home?
	Yes (please go to question 38) No (please go to question 39)
	38. The British Lung Foundation has an online campaigning network which can help you to email your local politician about lung issues. Please let us know if you would like to join.
	Yes I would be interested in joining the BLF’s online campaigning network (Please provide your email address in section 1) No I would not be interested in joining the BLF’s online campaigning network
	39. The British Lung Foundation receives requests from journalists for people to speak about all aspects their experiences of living with lung disease. This is an invaluable way of raising the profile of lung diseases and the British Lung Foundation. Please be reassured that we would never pass your contact details on to any journalists without discussing it with you first. Would you be interested in helping the BLF in this way by talking to journalists about your experiences?
	Yes I would be interested in sharing my story No I would prefer not to share my story
	Protecting your personal information. We promise that any information you give us will be used by the British Lung Foundation (BLF) only. We’d like to keep in touch to let you know about the BLF’s activities, including fundraising, and how your support is making a difference. If you would rather not hear from us then please tick the box below.

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