Find Out if You Qualify

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Answer a few simple survey questions to learn if you qualify for clinical trials in your area.

COPDClinicalTrials.org is intended for U.S. audiences only.

Please review your entries:

1) Have you been diagnosed with COPD (chronic obstructive pulmonary disease) by a physician?

Yes: emphysema

Yes: chronic bronchitis

Yes: unspecified COPD

No

This is a required question. Please answer and resubmit.
2) If you have received a COPD diagnosis by a physician, what is the severity of your diagnosis?

Mild

Moderate

Severe

I'm not sure

Not applicable (undiagnosed)

This is a required question. Please answer and resubmit.
3) How long has it been since you were diagnosed with COPD?

Less than one year

Between one and five years

More than five years

I’m not sure

Not applicable: I haven’t been diagnosed

This is a required question. Please answer and resubmit.
4) Are you a current or former smoker?

I currently smoke

I am a former smoker

I’ve never smoked

This is a required question. Please answer and resubmit.
5) Tell us about your smoking history. (If you have never smoked, enter “0” in both fields below.)

Average number of cigarettes you smoke(d) per day (current or before)

This is a required question. Please answer and resubmit.

Number of years you smoked

This is a required question. Please answer and resubmit.
Pack-years can be determined by multiplying the number of cigarettes you smoke per day by the number of years you have smoked. For example, if you have smoked 20 cigarettes per day (1 pack) for 20 years, you have a 20 pack-year history.
6) If you’ve had a spirometry test performed, what is your Forced Expiratory Volume / Forced Vital Capacity (FEV1/FVC) ratio?

Greater than 0.70

Less than 0.70 but greater than 0.50

Less than 0.50

I’m not sure

This is a required question. Please answer and resubmit.
7) Do you have a recent history (last 12 months) of any acute exacerbations of COPD?

Yes

No

Not sure

This is a required question. Please answer and resubmit.
More than a day of coughing or difficulty breathing
8) Are you currently taking medication for your COPD? (Check all that apply.)

Short-acting bronchodilators (e.g. inhalers or nebulizers)

Corticosteroids

Methylxanthines

Long-acting bronchodilators

Combination drugs

This is a required question. Please answer and resubmit.
Examples of bronchodilators include (but not limited to):
  • Albuterol (Vospire ER®)
  • Levalbuterol (Xopenex®)
  • Ipratropium (Atrovent®)
  • Albuterol/Ipratropium (Combivent®)
Examples of corticosteroids include (but not limited to):
  • Fluticasone (Flovent®)
  • Budesonide (Pulmicort®)
  • Prednisolone
Examples of long-acting bronchodilators include (but not limited to):
  • Aclidinium (Tudorza®)
  • Arformoterol (Brovana®)
  • Formoterol (Foradil, Perforomist®)
  • Glycopyrrolate (Seebri Neohaler®)
  • Indacaterol (Arcapta®)
  • Olodaterol (Striverdi Respimat®)
  • Salmeterol (Serevent®)
  • Tiotropium (Spiriva®)
  • Umeclidinium (Incruse Ellipta®)
Examples of combination drugs include (but not limited to):
  • Glycopyrrolate/formoterol (Bevespi Aerosphere®)
  • Glycopyrrolate/indacaterol (Utibron Neohaler®)
  • Tiotropium/olodaterol (Stiolto Respimat®)
  • Umeclidinium/vilanterol (Anoro Ellipta®)
  • Budesonide/formoterol (Symbicort®)
  • Fluticasone/salmeterol (Advair®)
  • Fluticasone/vilanterol (Breo Ellipta®)
9) What is your 4-digit year of birth?
This is a required question. Please answer and resubmit.
10) What is your 5-digit ZIP code?
This is a required question. Please answer and resubmit.
11) What is your email address?
This is a required question. Please answer and resubmit.
12) What is your telephone number? (optional)
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