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Table 2 Questionnaire used for the assessment of history, smoking habit, family history and treatment.

From: A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece

1st visit Questionnaire
1. What medication do you use?
   □ None I do not use medication
   □ Yes,
Name medicine Dosis Frequency
2. Have you ever smoked for longer than 1 year?
   □ Never
   □ Yes but I stopped smoking since: ..............
   □ Yes I smoke
3. How often last year did you receive antibiotics and/or prednisolone prescribed because of your pulmonary problems ? ...................times
4. At which age did your pulmonary problems appear for the first time? I was ..... (age) years old.
5. Have you ever been diagnosed with eczema, hay fever, allergy, asthma, COPD or bronchitis?
   □ No
   □ Yes (please mark the subject)
6. Does your family (parents, brothers, sisters) suffer from pulmonary problems?
   □ No
   □ Yes
   □ I do not know
7. What is or was your occupation?
....................................................................................
8. Due to what or when do you experience symptoms such as being short of breath, wheeze, mark if yes.
□ springtime □ wheeds □ cigarette smoke
□ summer □ trees □ paint
□ food □ cold air □ perfume
□ pet animals □ fog □ exercise
□ dust (house) □ cooking scent □ other: :...............