Office Visit Prep Tool

1. How often do you experience the following symptoms?



Chest tightness

Shortness of breath

Bringing up mucus

2. Over the past three months, your symptoms have:

3. Do you use a rescue inhaler? (for sudden symptoms of COPD)

4. Do you take a maintenance medication to treat your COPD symptoms?
(These are COPD medicines your doctor prescribes for long-term use, either once or twice per day.)

5. Do you feel that you are using your maintenance device correctly?