The Self Evaluation of Breathing Questionnaire

Name:

Date:

Scoring: (0) never/not true at all; (1) occasionally/a bit true; (2) frequently-mostly true; and, (3) very frequently/very true

1. I get easily breathless out of proportion to my fitness

0 1 2 3

2. I notice myself breathing shallowly

0 1 2 3

3. I get short of breath reading and talking

0 1 2 3

4. I notice myself sighing

0 1 2 3

5. I noticing myself yawning

0 1 2 3

6. I feel I cannot get a deep or satisfying breath

0 1 2 3

7. I notice that I am breathing irregularly

0 1 2 3

8. My breathing feels stuck or restricted

0 1 2 3

9. My ribcage feels tight and cannot expand

0 1 2 3

10. I notice myself breathing quickly

0 1 2 3

11. I get breathless when I’m anxious

0 1 2 3

12. I find myself holding my breath

0 1 2 3

13. I feel breathless in association with other physical symptoms

0 1 2 3

14. I have trouble coordinating my breathing when I am speaking

0 1 2 3

15. I can’t catch my breath

0 1 2 3

16. I feel that the air is stuffy, as if not enough air in the room

0 1 2 3

17. I get breathless even when I am resting

0 1 2 3

18. My breath feels like it does not go in all the way

0 1 2 3

19. My breath feels like it does not go out all the way

0 1 2 3

20. My breathing is heavy

0 1 2 3

21. I feel that I am breathing more

0 1 2 3

22. My breathing requires work

0 1 2 3

23. My breathing requires effort

0 1 2 3

24. I find myself breathing through my mouth during the day

0 1 2 3

25. I breathe through my mouth at night while I sleep

0 1 2 3

TOTAL

A score greater than 11 may indicate problems with your breathing.