Document LKYwa0akbMmD7xjEqK21LkKEb

/Federal.Register /. Vol,, 51. No. 119 / Friday, June 20.1986 Rules and Regulations : F. Foe how many yeses have you- he'd' trouble* wi f.n-.phlegm?. EPISODES OK-COUCH AND PHLEGM * i4A. Have-you'had periods ot episodes of (in creased*) cough and phlegm. .lasting -lor 1 week* oi -mo're each' 'year? MFor persons .who usually have cough and/or . phlegm) If YES TO 34A B. For how ,lonq have you nad at least -1 such episode pec year? WHKEZINC' ' 3SA. Does your chest ever sound wheezy ox wnl6tling 1. When you have a .cold? 2.' Occasionally apart froacolds?. 3. Moot days or nights?. IF YES TO 1. 2. OC 3 in 3SA . . 8. For how-many yearo-has this been present? 34A.' Have you ever 'had an attack ot wheezing that has'made you -feel cnort-of breath? IF YES TO 36A . . v - B. How.old were you"when you had your first such -attack? 'f C. Have .you had 2 or nore ouch episodes? D. Have-you'ever required medicine or treatment tor the(se) attack(6)? . BREATHLESSNESS ' 37. ' If disabled from'valking by any. condition other than heart or'Iiuno disease, please." describe-and . proceed" to-question" 39AT Nature of condition(o) *. 1 ' 38A. Are you troubled by shortness of- breath when hurrying on the level-or walking' up a slight hill? I. Number ot years Does"not apply 1. Yes _ 2. No __ Number , of years __ Does, not' apply. __ l. Yes _ J 2. No__ 1. Yes 2. No 1. Yes 2. No ^ Number, of years __ Does not apply __ l. -.Yes - _ 2 . No .Age in years . __ Does hot apply i. yes_^ 2. No _ 3. Does not apply __ 1/ Yes __ - . 2. No __ 3. Does not" apply __ 1. Yes __ 2. No IF YES TO 38A 8. Do you have to walk slower than people ot your age on the level because ot breath lessness? C. Do you ever have to stop for breath when walking at your own pace on the level? ' D. Do you ever nave to stop tor breath after walking about 100 yards (or after a few minutes) on the level? E. Are you too breathless to leave the house or breathless oo dressing or Climbing one flight of stairs? TPMCgO_SHP|tlNC 39A. Have you ever smoked cigarettes? (No means less than 20 packs of cigarettes or 12.o*. of tobacco in a lifetime or le68 than l cigarette a day for l year.) IF YES TO 39A B. Do. you now smoke cigarettes (a6 of one month ago) C. How old were you when you first started regular cigarette smoking? D. If you have slopped smoking cigarettes completely.- how old were you when you stopped? E. How many cigarettes do you smoke per day now? F. On the average of the entire time you smoked, how many cigarettes did you smoke per day? 6. Do or did you inhale the elgarette smoke? 40A. Have you ever smoked a pipe regularly? (Yes means more than 12 oz. of tobacco in a lifetime.) I. Yes __j 2. No 3. Does not apply 1. Yes __ 2. No 3. Does not apply ;. 1. Yes 2. No 3. Does not apply 1. Yes __ 2. No 3. Does not apply 1. Yes __ 2. No 3. Does not apply ." Age la years Does not apply Age stopped Check if still smoking Does not apply Cigarettes per day Does not apply Cigarettes per day Does not apply 1. Does not apply. 2. Not at all 3. Slightly 4. Moderately $. Deeply 1. Yes 2 22773 GLEASON-001021