To qualify for this study we are looking for individuals who have been
diagnosed with COPD and who have had an exacerbation (flare-up) within the
last 12 months resulting in hospitalization and prescriptions of an antibiotic
or steroid.  Documentation of these events is necessary.

* Required fields
Name *
E-mail Address *
Phone Number: *
Age: *
Have you been diagnosed with COPD for at least one year? *
Have you been hospitalized for an exacerbation of the COPD within the last 12 months? *
Were you prescribed an antibiotic and/ or a steroid at the time of the exacerbation? *
Can you provide written documentation for the events that pertain to you? *

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