E. If you no longer have it, at what age did it stop? 27A. Has a doctor ever told you that you had heart trouble? 2. No_ IF YES TO 27A: .B. Have you ever had treatment for heart trouble in the past 10 years? 1. Yes 2. No 28A. B. Has a doctor ever told you that you had high blood IF YES TO 28A: Have you had any treatment for high blood pressure (hypertension in the past 10 years? 29. 1. Yes 2. No 3. Does Not Apply When did you last have your chest X-rayed? (Year) 30. Where did you last have your chest X-rayed (if known)? What was the outcome? FAMILY HISTORY 31. Were either of your natural parents ever told by a doctor that they had a chronic lung condition such as: FATHER MOTHER 32A. Do you usually have a cough? (Count cough with first smoke 32C.] 1. Yes No 2. 32B. Do you usually cough as much as 4 to 6 times a day 4 or more days out of the week? C. D. Do you usually cough at all on getting up or first thing in the morning? Do you usually cough at all during the rest of the day or 2. No IF YES TO ANY OF ABOVE (32A, B, C, or D), ANSWER THE FOLLOWING. IF NO TO ALL, CHECK DOES NOT APPLY AND SKIP TO NEXT PAGE E. Do you usually cough like this on most days for 3 1. Yes F. For how many years have you had the cough? Number of years 33A. 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 33C) C. B. D. Do you usually bring up phlegm like this as much as twice a day 4 or more days out of the week? Do you usually bring up phlegm at all on getting up or Do you usually bring up phlegm at all during the rest of the day or at night? 2. IF YES TO ANY OF THE ABOVE (33A, B, C, or D), ANSWER THE IF NO TO ALL, CHECK DOES NOT APPLY AND SKIP TO 34A. E. Do you bring up phlegm like this on most days for 3 consecutive months or more during the year? 1. Yes F. For how many years have you had trouble with phlegm? Number of years EPISODES OF COUGH AND PHLEGM 34A. Have you had periods or episodes of (increased*) cough and For how long have you had at least 1 such episode per year? Number of years WHEEZING 35A. Does your chest ever sound wheezy or whistling 1. 1. Yes 2. No 36A. B. C. D. IF YES TO 1, 2, or 3 in 35A For how many years has this been present? Number of years Have you ever had an attack of wheezing that has made you feel short of breath? IF YES TO 36A 1. Yes 2. No How old were you when you had your first such attack? Age in years Have you had 2 or more such episodes? 1. Yes 2. No 3. Does not apply Have you ever required medicine or medicine for the (se) 1. Yes 2. No BREATHLESSNESS 37. 38A. If disabled from walking by any condition other than heart or lung disease, pleasedescribe and proceed to question 39A. Nature of condition (s) Are you troubled by shortness of breath when hurrying on the level or walking up a slight hill? Do you have to walk slower than people of your age on the level because of breathlessness? C. D. 3. Does not apply Do you ever have to stop for breath when walking at your own pace on the level? Do you ever have to stop for breath after walking about 100 yards (or after a few minutes) on the level? E. Are you too breathless to leave the house or breathless on dressing or climbing one flight of stairs? 1. Yes TOBACCO SMOKING 39A. 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.) IF YES TO 39A B. C. D. E. Do you now smoke cigarettes (as of one month age)? 1. Yes How old were you when you first started regular cigarette smoking? If you have stopped smoking Age in years Does not apply How many cigarettes do you smoke per day now? F. On the average of the entire time you smoked, how many Cigarettes per day 5. G: Do or did you inhale the cigarette smoke? 1. Does not apply |