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Brief Respiratory Questionnaire (BRQ) - Hudson Valley Asthma - hudsonvalleyasthmacoalition

Brief Respiratory Questionnaire (BRQ) - Hudson Valley Asthma - hudsonvalleyasthmacoalition 2026

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The document is a Brief Respiratory Questionnaire (BRQ) designed for the New York City Department of Health and Mental Hygiene's Asthma Initiative. It aims to collect information about children's respiratory health, specifically focusing on asthma symptoms, medical history, and treatment received in the past year. The questionnaire includes demographic details and a series of questions regarding respiratory issues experienced by the child, such as wheezing, coughing, hospital visits, and current medical care.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the interviewer's name and the date of the interview at the top of the form.
Fill in the child's first name, last name, date of birth, and ethnic group. Ensure you select all applicable options.
Provide details about the parent or guardian, including their first name, last name, and relationship to the child.
Answer questions regarding the child's respiratory health over the past 12 months. For each question, select 'Yes' or 'No' as appropriate and provide numerical responses where indicated.
If applicable, complete any additional information requested for conditions diagnosed by a healthcare provider.
Review all entries for accuracy before submitting your completed questionnaire.

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How to score the chronic respiratory questionnaire?

Each domain includes 4 to 7 items, with each item graded on 7-point Likert scale; item scores within a domain are summated to provide a total score for each domain. Higher scores indicate better HRQL. The 4 domains are scored separately and can illustrate changes in individual domains of HRQL.

What is the MRC respiratory scale?

The MRC breathlessness scale comprises ﬁve statements that describe almost the entire range of respiratory disability from none (Grade 1) to almost complete incapacity (Grade 5).

What is the standard respiratory questionnaire?

The St Georges Respiratory Questionnaire is a standardized self-completed questionnaire for measuring impaired health and perceived well-being (quality of life) in airways disease.

What is the 6 score on the asthma control questionnaire?

The ACQ-6 scores are calculated as a mean of the 6 items, with scores of 0 meaning the patients has asthma that is well controlled and those with 6 indicating the patients has asthma that is extremely poorly controlled.

What is the MRC questionnaire on respiratory symptoms?

In its usual form, the MRCQ comprises 17 questions on respiratory symptoms (cough, phlegm, breathlessness, wheeze and chest illnesses, now and during the past 2 years), detailed questions on smoking history and a check-list on past illnesses.

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What is the respiratory symptom questionnaire?

The RSQ comprises four questions (items 14) related to respiratory symptoms and their impact on the patients activity: 1) frequency of symptoms of daytime shortness of breath, wheezing, coughing and/or chest tightness; 2) frequency of rescue (reliever) inhaler use in response to these symptoms; 3) degree of activity

What is the ASQ screening questionnaire for asthma?

The ASQ (Shin et al. 2010) is a six-item questionnaire that screens for the presence of asthma symptoms (cough, chest tightness, wheeze, and dyspnea) in four situations that commonly elicit asthma symptoms (laughing, exercise, lie down to sleep, talking).

What does the St. Georges respiratory questionnaire measure?

The St. Georges Respiratory Questionnaire (SGRQ) is designed to measure health impairment in patients with asthma and COPD. Symptoms, Activity, Impacts, and Total.