Quality of Life Inventory(2)

3 very a bit

4 much

34. I have been short of breath

35. I am losing weight

36. My thinking is clear

37. I have been coughing

38. I have been bothered by hair loss

39. I have a good appetite

40. I feel tightness in my chest

41. Breathing is easy for me

42. Have you ever smoked? NO_____ YES_____

If yes: I regret my smoking

43. Looking at the above 9 questions, how would you say your ADDITIONAL CONCERNS affects your quality of life? (Circle one number)

0 1 2 3 4 5 6 7 8 9 10

Not at all            Very much so