Check@ir: Assessing your lung health English

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Check your lung health in just 2 steps!

Do you feel tired for no real reason? Do you have trouble breathing, frequent coughing, or discomfort when doing any physical activity?

Check@ir helps you quickly and easily assess your respiratory health. By completing the questionaire, you'll receive:

✅ A personalized report that you can share with your doctor. It will help you understand which factors might be affecting your health and well-being.

✅ Our 2025 Guide “Clean Air, Healthy Lives” with tips to protect your lungs from pollutants, smoke, allergies, and other environmental risks.

Before continuing, please read and accept this information:

I have read and accept the Legal Notice, Privacy Policy, Cookies Policy and Terms of Service of the HappyAir Ecosystem

Informed consent *

I authorize the Lovexair Foundation to collect my personal and health data to register them on the HappyAir platform and to send me a personalized report via email or other channels, about this project.
I consent to the use of my aggregated information to support research and improve the HappyAir Ecosystem. (optional)

Communication *

Yes, I would like to receive information from Lovexair Foundation about our activities and projects
No, I don't wish to receive further communication

Name of the Patient

Full Name – to avoid duplication or fake profiles

Full Name *

Please add your first and last name

Email *

We need your email to send you the results of your assessment.

Telephone

Date of birth *

Age and gender are important to personalize your health report.

gender *

Male
female
I'd rather not say

Country *

City

Post Code

Where you live may affect your health. Your post code helps us determine that (optional).

DIAGNOSIS

Have you been diagnosed with a respiratory disease? *

What chronic disease have you been diagnosed with? (You can select more than one option. If in addition to Asthma or COPD you have another respiratory condition, please tell us about it by selecting the option "I have a different pathology") *

Asthma
COPD
I don't know or I'm not sure
I have a different pathology

What other pathology do you have?

allergies
sleep apnea
bronchiectasis
Lung cancer
Long COVID
Alpha-1 Antitrypsin deficiency
Primary ciliary dyskinesia
Neuromuscular disease
Cystic fibrosis
Idiopathic pulmonary fibrosis
Pulmonary hypertension
LAM
sarcoidosis
Chronic cough
Lung transplant
Other respiratory problems

Asthma control

Assess the impact asthma has on your health by completing the following test.

Asthma Control Assessment Questionnaire

For each question, please check the box that best describes the impact asthma currently has on your daily life.

1. In the last month, how has your asthma been controlled? *

not at all
Poorly controlled
not much
Ok
Completely

2. In the last month, how much have you been prevented from doing activities in your workplace, school or at home? *

very much
A lot
Some
A little bit
not at all

3. In the past month, how often have you experienced dyspnea (shortness of breath or difficulty breathing)? *

Several times a day
Only once a day
More than 3 times per week
1 to 3 times a week
I have not had dyspnea

4. In the past month, how often have your asthma symptoms (cough, shortness of breath, wheezing, or feeling of tightness in your chest) woke you up during the night or earlier than usual? *

Almost every night (4 or more times per week)
A few times a week (2 or 3)
Once a week
Occasionally during the last month (1 or 2)
It hasn't

5. In the last month, how many times have you had to use your rescue medication? *

Daily: 3 or more times
Daily: 1 or 2 times
No more than 2 or 3 times a week
No more than once a week
I haven't had to use it

Questionnaire result

This test helps us assess how much control you've had over your asthma over the past month.

result

COPD Control

Assess the impact COPD has on your health by completing the following test.

COPD Assessment Test™ (CAT)

This questionnaire will help you and your healthcare professional measure the impact COPD (Chronic Obstructive Pulmonary Disease) is having on your well-being and daily life.

You and your healthcare professional can use your answers, and test score, to help improve the management of your COPD and get the greatest benefit from treatment.

https://www.catestonline.org/patient-site-test-page-english.html

Cough *

0 I never cough
1
2
3
4
5 I cough all the time

Phlegm *

0 I have no phlegm (mucus) in my chest at all
1
2
3
4
5 My chest is completely full of phlegm (mucus)

Chest tightness *

0 My chest doesn't feel tight at all
1
2
3
4
5 My chest feels very tight

Feeling short of breath *

0 When I walk up a hill or one flight of stairs I am not breathless
1
2
3
4
5 When I walk up a hill or one flight of stairs I am very breathless

Domestic activities *

0 I am not limited doing any activities at home
1
2
3
4
5 I am very limited doing activities at home

Going out *

0 I am confident leaving my home despite my lung condition
1
2
3
4
5 I am not at all confident leaving my home because of my lung condition

Better sleep *

0 I sleep soundly
1
2
3
4
5 I don't sleep soundly because of my lung condition

Energy Level *

0 I have lots of energy
1
2
3
4
5 I have no energy at all

result

This test tells us what impact COPD has on your daily life.

CAT result

SYMPTOMS

The appearance of respiratory symptoms, such as coughing or wheezing, may indicate the presence of a respiratory problem. Early diagnosis and appropriate treatment are essential for a favorable evolution. Why don't you tell us how you feel?

How have you felt lately? *

I haven't had any symptoms
chest pain
Fatigue or tiredness (physical)
Fever
Wheezing when breathing
Cough
Secretions/phlegm/mucus
Difficulty breathing or shortness of breath

What color are the secretions?

White/clean
Dark/Dirty

Watch out for the symptoms!

The presence of respiratory symptoms may be due to poorly controlled respiratory disease, a flare-up, or a problem that has not yet been diagnosed.

We recommend that you see your doctor or consult one of our HappyAir Coaches by writing to us at info@happyair.org

CRISES AND FLARE-UPS

Crises or flare-ups are when your respiratory symptoms become worse. Have you had any lately?

How many crises or flare-ups have you had in the last year? *

None
1
2
3
4
5 or more

How many times have you been admitted to hospital, during the last year, as a result of these crises or flare-ups?

None
1
2
3
4
5 or more

MEDICATION

There are many medications that can help you keep your respiratory disease under control. What type of medication have you been prescribed?

Do you use any type of medication to treat your respiratory problems or symptoms? *

What do you use? *

Frequent antibiotics
Maintenance inhaler that I have to take every day
Rescue inhaler (ventolin, salbutamol) to take if I have symptoms
Nebulizers
Nasal spray
Biological therapy: Medication that is given by injection in the hospital or at home
Alternative therapy / natural / homeopathic
Vaccines
Other Medication or Treatment

Check all the options you need.

What other type of treatment have you been prescribed?

How many times have you used rescue medication in the last week? *

I haven't
Once or twice
3 or more times

Don't overuse your rescue inhaler!

If you need your rescue inhaler frequently, this is a sign that your respiratory problem isn't correctly controlled.

We recommend that you see your doctor or consult one of our HappyAir Coaches by writing to us at info@happyair.org

ACTIVE LIFE

A sedentary lifestyle can negatively affect your lung and overall health. However, we understand that feeling short of breath sometimes makes it difficult to stay as active as you'd like. Is something similar happening to you?

On average, how much physical exercise of any type, including walking, have you done in the last week? *

More than 30 minutes a day
Less than 30 minutes a day

For the sake of your health, keep moving!

Leading a sedentary lifestyle can negatively affect your health. We recommend that you consult your doctor or speak to one of our HappyAir Coaches, who can guide you to exercise safely and according to your needs.

If you want, you can request an appointment with one of our physiotherapists by writing to info@happyair.org

Short of breath when exercising? (mMRC Test) *

I only get breathless with strenuous exercise
I get short of breath when hurrying on level ground or walking up a slight hill
On level ground, I walk slower than people of my age because of breathlessness, or I have to stop for breath when walking at my own pace on the level
I stop for breath after walking about 100 yards or after a few minutes on level ground
I am too breathless to leave the house or I am breathless when dressing/undressing

Choose the option that best describes your current situation.

Noticing that you are short of breath is not normal

The feeling of being out of breath may be linked to a poorly controlled respiratory disease, a flare-up, or even an as-yet-undiagnosed problem.

We recommend that you consult your doctor or contact one of our HappyAir Coaches by writing to us at info@happyair.org. We're here to help.

TRIGGERS AND RISK FACTORS

There are many factors that can affect your lung health. Identifying them is key to taking better care of yourself. Why don't you tell us about yours?

Environmental pollution is one of the most significant problems related to the health of our lungs. Do you spend most of the year in a population with high levels of pollution? *

Which of these substances, emotions, or other factors, are you most frequently affected by? *

Family member with liver disease (Alpha-1 Deficiency)
Family member with lung disease
Animals
pollen
Mold and damp
Irritating substances such as varnishes, paints, perfumes, pesticides
Anxiety
Stress
Tobacco smoke, vapes...
Smoke generated by vehicles
Smoke produced by biomass (firewood, charcoal...)
Other triggers or risk factors

Select as many answers as you want

What other risk factors or triggers are you frequently exposed to?

Do you notice that anxiety makes it difficult to breathe or alters your breathing? *

Yes, very much
A little bit
not at all
I don't know, I haven't stopped to think about it

Do you notice that stress makes it difficult to breathe or alters your breathing? *

Yes, very much
A little bit
not at all
I don't know, I haven't stopped to think about it

Do you smoke and/or vape? *

Yes, I smoke or vape
I don't smoke or vape, but I have done so before
I have never smoked or vaped
No, but I'm a passive smoker

Stay away from tobacco smoke and vapes!

Smoking or vaping are among the main causes of respiratory diseases and for making them worse. Quitting this habit would be a major step towards improving your health.

We recommend that you consult your doctor or speak to one of our HappyAir Coaches, who can help you in this process. If you wish, you can request an appointment by writing to info@happyair.org You can count on us!

We're done!

Please, before submitting the form, make sure that you have answered all the questions correctly.

If you wish, you can add a comment that you think may be interesting to share with your doctor or with the HappyAir Coaches

CREDITS

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