Respiratory Questionnaires

Questionnaire from Round 4 of the National Study of Coal Workers' Pneumoconiosis

This form was used by NIOSH during the 1985 - 88 field testing of approximately 4050 active and inactive coal miners in the U.S.A. It was interviewer-administered and used in conjunction with spirometry and chest radiograph. It is made available here in two text files. The Main Questionnaire contains these sections:

• A. Identification
• B. Occupational History
• C. Symptoms
• D. Tobacco Smoking

The Occupational History Table is used to obtain specific jobs, dates, industry, company, mine, and identification codes.

American Thoracic Society 1978 Adult Questionnaire

In 1978, a document entitled the "Epidemiology Standardization Project" was published, with Benjamin G. Ferris, M.D. as the Principal Investigator (Am Rev Respir Dis 1978; 118:1-120). The goal of the project was to provide guidelines for epidemiologic studies. In particular, it was "concerned with how and when to use standard questionnaires on respiratory symptoms, tests of pulmonary function, and chest radiographs" (page 1). This publication was the result of many years of work that had been initiated by the American Thoracic Society (ATS) and supported by a contract from the Division of Lung Diseases, National Heart, Lung, and Blood Institute. The ATS-DLD-78 recommended adult questionnaire is taken from pages 10-23 of the reference (Am Rev Respir Dis 1978;118). Other materials about the questionnaire are available from the reference noted:

• Introduction (p 7-8)
• Recommendations (p 8-9)
• Instructions for use of the Adult Questionnaire (p 24-27)
• Additional Questions that have been tested and are suggested for various kinds of studies and in particular environments (p 28-31)
• Rationale and justification of the components of the recommended ATA-DLD-78 Adult Questionnaire (p32-35)
  
  

Initial Questionnaire of the NIOSH Occupational Asthma Identification Project

The Initial Questionnaire of the NIOSH Occupational Asthma Identification Project was developed by Dr. Lee Petsonk from the Division of Respiratory Disease Studies of NIOSH. It includes materials gleaned from the ATS-DLD-78-A questionnaire, the British MRC questionnaire, and other instruments used by academic investigators to gather information on respiratory symptoms and diseases. It has been used with worker groups that are at risk for occupational asthma as part of NIOSH's Occupational Asthma Identification Projecy (OAID). The document was designed to be very comprehensive, with the intention that experience would dictate subsequent refinements. The questionnaire is being evaluated in comparison to other health responses in the workers surveyed, to determine which items are most effective at identifying workers with occupational asthma.