Hello there everybody. I hope you are well. My name is Emma Mersseman and I am currently in my fourth and final year at the British College of Osteopathic Medicine. For my dissertation I am doing a survey on the association of Asthma and Osteporosis and I am desperate for your help! I originally thought I would beable to distribute through medical centres and hospitals but since found out they are unable to help. Please, please if you or anyone you know has asthma and osteoporosis and female, could you please fill out my survey, it will take no longer than a few minutes, promise. The rsults can be emailed via this website or my email is: firstname.lastname@example.org. Thank you for your time and look forward to hearing from you.ARE YOU AGED BETWEEN FORTY-FIVE AND SIXTY-FIVE AND FEMALE?HAVE YOU SUFFERED WITH ASTHMA LONGER THAN FIVE YEARS AND NOW HAVE OSTEOPOROSIS?If you can answer â€˜yesâ€™ to both of these questions, please take a few minutes to answer the following questionnaire. Answer all the questions to the best of your knowledge. Simply tick the relevant boxes. A few questions may require you to write something in full. Please write in capitals.PERSONAL INFORMATION WILL BE TREATED ASSTRICTLY CONFIDENTIALAge: ___ Weight: ___Height: ___ Medication: ___1) Which of the following best describes your ethnic origin?Bangladeshi ___Black other ___Pakistan ___ Black African___ Chinese ___ White___Black Caribbean ___Indian ___ Other ___2) Please state your occupation:Retired___House â€“person ___Manual ___ Unemployed ___ Clerical ___Student ___Other: ___3) How long have you been diagnosed with Asthma?5-10 years ___10-15 years ___15-20years ___>20years ___4) What medication do you take for your asthma?Salbutamol ____Beclametasone dipropionate _____ Budesonide _____ Fluticasone _____ Mometasone ____ Trimcinolone ____ Other -: _____5) At what measure is your medication?50ug ____100ug ____200ug ____250ug ____500ug ____800ug ____1000ug ____2000ug ____6) For the majority of that time, at what stage would you consider your Asthma?Mild/ occasional use of inhaler (0-5x per week) ___Moderate/ Daily use of inhaler ___Severe/ High use 2-4x daily ___Irratic/ uncontrolled(>4x per day) ___7) How long have you been diagnosed with osteoporosis?0-5 year ___5-10 years ___10-15 years ___15-20 years ___ 20 years or more ___8) Is there any family history of osteoporosis?Yes ___No ___If applicableExercise:9) How often do you partake in regular exercise?Once every two weeks ___Once a week ___Twice a week ___Three times a week ___Three times a week or more ___10) How long has exercise been a regular occurrence in your lifestyle?1-month ___1-3months ___3-6months ___6months- 1-year ___ 1- 3 years ___3-6years ___6-9 years ___10 years or more ___11) On average how long does each session last?0-15 minutes ___15- 30 minutes ___ 30 â€“ 45 minutes ___ 45 â€“ 60 minutes ___ 60 minutes or more ___12) Please state what type of exercise you do:________________________________13) How long were/have you been smoking?Less than 1 year ___1-5 years ___5-10 years ___10-20 years ___ 20 years or more ___14) If you have given up, how long ago did you stop?Less than 1 year ___1-5 years ___5-10 years ___10-20 years ___ More than 20 years ___15) Do you regularly drink alcohol?Yes ___No ___Once every two weeks ___Once a month ___Every few months ___16) If yes, on average how often per week?1-5 glasses ___5-10 glasses ___10-15 glasses ___15-20 glasses ___ 20 glasses or more ___Diet17) On average, how many portions of fruit and vegetables do you consume on a daily basis?0 ___1-3 ___3-5 ___5-7 ___7-9 ___9 or more ___18) On average, how many portions of dairy do you consume on a daily basis?0 ___1-3 ___3-5 ___5-7 ___7- 9 ___9 or more ___19) Do you receive daily sunlight?Yes ___No ___20) On average, how many fizzy drinks do you consume?Less than 1 a month ___1 every two weeks ___ 1 every week ___3-4 a week ___ 1 daily ___ 1 daily or more ___21) What supplements do you take, if any?* OPTIONALNAME:CONTACT TELEPHONE NO.:
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