HELP!! Asthma and Osteoporosis?

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 can help in any way or you or anyone you know has asthma and osteoporosis, female and between 45-65, could you please fill out my survey, it will take no longer than a few minutes, promise. The results can be emailed via this website or my email is: emmamersseman@hotmail.com. Thank you for your time it is much appreciated. x

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 ‘yes’ 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 CONFIDENTIAL

Age: ___ 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 –person ___ Manual ___ Unemployed ___

Clerical ___Student ___Other: ___

3) How long have you been diagnosed with Asthma?

5-10 years ___10-15 years ___15-20 years ___

20years or more ___

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 applicable

Exercise:

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 – 45 minutes ___

45 – 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 ___

Diet

17) 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?

* OPTIONAL

NAME:

CONTACT TELEPHONE NO.:

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