Digicon

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(Kindly fill in the relevant information or tick, as appropriate.)

Age (Years)*

Weight (In kgs )*

Height (In cms)*

Occupation *

Current status

Yes No

If ex-smoker

Duration (months)

Exposure to biomass*

Yes No

Other habits

Drug*	Dose*	Frequency of administration*

	Drug	Dose(mg)	Frequency Of administration
PRN Bronchodilator
Inhaled corticosteroids + long acting beta 2 Agonist
Inhaled long acting beta 2 Agonist + Long acting muscarinic receptor antagonist

Anticholinergic*

Yes No

Xanthine*

Yes No

Oral steroids*

Yes No

Any other

	At baseline	Follow up after 30 days
FEV₁
FVC
Post bronchodilator FEV₁/FVC
Post bronchodilator increase in FEV₁ >12% and 400ml from baseline	Yes No	Yes No
Post bronchodilator increase in FEV₁ >12% and 400ml from baseline (reversible airflow limitation)	Yes No	Yes No
Number of times PRN bronchodilator needed		Reduced Increased
Chest X ray	Normal	Hyperinflation