Office Visit Prep Tool

1. How often do you experience the following symptoms?

Wheezing

Coughing

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?