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| LTRC Clinical Data |
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| INTERVIEWS AND QUESTIONNAIRES |
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| Medical and Family History |
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| A limited medical history will be obtained around the time of the patient’s study visit. This will include data on the patient’s medical history and family history in first degree relatives of chronic lung disease as documented by biopsy and rheumatologic conditions. We will determine the onset and progression of symptoms with respect to a patient’s difficulty breathing when exercising, cough and sputum production. Questions concerning additional symptoms about coughing, dyspnea and phlegm will also be asked of the patient. To view the complete set of questions asked about Medical and Family History, see Forms: 010 (Medical History) and 011 (Family History). For symptoms see Forms 014 (Symptoms), 015 (SF-12), 016 (St Georges Respiratory Questionnaire). |
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| Exposure History |
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| Exposure history data collection will include determination of smoking status and extent of exposure to tobacco smoke. Significant occupational exposure to asbestos, silicates and related hard rock dusts, underground coal mining, beryllium, cobalt and other hard metals, and other significant occupational exposures. Environmental exposure histories to organic dusts and agents that induce hypersensitivity pneumonitis will be obtained. We will also obtain relevant histories for exposure to drugs and radiation known to induce pulmonary fibrosis. To view the complete set of questions asked about Exposure History, see Forms 012 (Smoking), 013 (Concomitant Therapy), 020 (Environmental), 021 (Occupational). |
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| All forms are available for viewing and printing here. |
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