MARKET RESEARCH – Project Asthma and COPD

We are looking for people who have been diagnosed with Asthma or COPD to take part in an online diary (via a mobile app). The online diary will last for 3 days and will take a maximum of 30 minutes per day.

Please answer the questions below.

Name:

Telephone number:

Home Postcode:

Work Postcode:

Age:

Occupation:

Working status i.e. Student, Full time working, part time working, etc.

Who do you live with at home?

If you have children, please tell us their ages

Which of the following have you been diagnosed with?

• Asthma
• COPD
• Diabetes
• Heart Disease

Have you been diagnosed with either of the following?

• Chronic Bronchitis
• Emphysema

Which of the following best describes how your doctor has classified the severity of your disease?

• Mild
• Moderate
• Severe
• Very severe

On a scale of 1-10 (1 being the lowest and 10 being the highest) how well do you feel you are able to manage your condition?

How often do you use your reliever inhaler?

How long ago were diagnosed?

Which of the following medication do you use?

• Spiriva
• Pulmicort
• Alvesco
• Qvar
• Singulair
• Serevent
• Foradil
• Relvar
• Fostair
• DuoResp
• Ventolin

Which of the following medications have changed on to in the last 3 months?

• Spiriva
• Pulmicort
• Alvesco
• Qvar
• Singulair
• Serevent
• Foradil
• Relvar
• Fostair
• DuoResp
• Ventolin

Which of the following medications have you changed off of in the last 3 months?

• Spiriva
• Pulmicort
• Alvesco
• Qvar
• Singulair
• Serevent
• Foradil
• Relvar
• Fostair
• DuoResp
• Ventolin

Please forward this on to anyone you know who may be interested.

Unfortunately, it is impossible to reply to all emails or phone messages.   We receive lots of responses to researches that are emailed out. You will be contacted by phone if your application is successful. However, we apologise if you do not hear from us, but please keep trying for future projects that are sent out.

We look forward to hearing from you.
 
Kind regards,
 
 
Daliah Salem
trend MARKET RESEARCH LTD