If you want to take control of your chronic obstructive pulmonary disease (COPD) symptoms, it’s important to have an action plan.

Instructions: Please review this Action Plan during a regularly scheduled appointment with your healthcare provider. Work with them to determine how you’re feeling, and what steps to take.

Healthcare Provider Phone #: ______ -______-______ Emergency Contact Phone #: ______ -______-______

I’m doing well. I am:

• Breathing with less shortness of breath

• Doing daily activities

• Coughing up usual amounts of phlegm and mucus

• Sleeping well

• Having a good appetite

I feel worse due to my COPD. I have one or more of these:

• Shortness of breath

• Difficulty completing daily activities

• More coughing than usual

• More and thicker mucus

• Using a rescue inhaler or nebulizer

more often

• Trouble sleeping

I feel I am in danger. I have one or more of these:

• Severe shortness of breath, even at rest

• Not able to do any activity because of difficulty breathing

• Not able to sleep because of difficulty breathing

• Fever or shaking chills

• Feeling confused or very drowsy

• Chest pains

• Coughing up blood

My COPD Action Plan: ✓ Keep it up! Make sure to take your medicines every day to help manage your COPD symptoms

✓ Avoid cigarette smoke and inhaled irritants at all times

My COPD Action Plan:

✓ Use pursed-lip breathing

✓ Get plenty of rest

✓ Call your healthcare provider if you continue to have symptoms

✓ If you’re feeling this bad, call 911 or your healthcare provider and follow their instructions

My COPD Action Plan:

My COPD action plan

My COPD action plan

Copyright ©2020, Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved. (11/20) PC-US-118613

My COPD checklistInstructions: This checklist will help you get the most out of future visits with your healthcare provider. Keeping the following items in mind will help you manage your COPD symptoms.

If you have any other questions about your COPD, write them down and bring them with you to your next appointment.

Preparing for a visit with your healthcare provider

Gather all of your medicines, or a list of them, to bring with you. Include herbal and over-the-counter treatments

Review your use of maintenance and rescue medicines. If you are using your rescue inhaler more frequently, your COPD may not be under control

Prepare a list of specific questions to bring to your next appointment to help start the conversation

During your visit

Share any changes in your breathing. If you are on oxygen, make sure you are using it properly

Discuss any changes in your activity and energy levels

Say if you have had trouble sleeping

Discuss any changes in your appetite

Ask for help quitting smoking. Quitting smoking is tough, but it’s important not to give up trying

Additional questions to ask your healthcare provider

Is a pulmonary rehab program appropriate for you?

When should you get a flu shot and pneumonia shot?

What factors can make your COPD worse and how can you deal with them?