DOCTOR DISCUSSION GUIDE

Prepare for a productive conversation with your doctor

Get your Doctor Discussion Guide in 3 easy steps:

Fill out the short form as best as you can.
Email the guide with your responses.
Bring the guide to your next doctor’s appointment and use it to help discuss your treatment options.

The answers to this form are meant to guide your conversation with a qualified doctor. They are not intended to diagnose a condition or disease state.

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COPD GUIDE

ASTHMA GUIDE

How would you describe your condition?

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1/8

How would you describe your breathing?
(Select all that apply.)

i Why it matters? This helps your doctor understand your symptoms and work with you to find a treatment that best fits your needs.

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2/8

How would you describe their breathing?
(Select all that apply.)

i Why it matters?This helps their doctor understand their symptoms and work with them to find a treatment that best fits their needs.

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2/8

Which of these symptoms do you experience regularly?
(Select all that apply.)

i Why it matters? Tracking symptoms is key to managing asthma. You can also note how often you experience these symptoms and if you notice any patterns—all of these details will help you and your doctor decide on the right care.

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2/7

Which of these symptoms do you experience regularly?
(Select all that apply.)

i Why it matters? Tracking symptoms is key to managing COPD. You can also note how often you experience these symptoms and if you notice any patterns—all of these details will help you and your doctor decide on the right care.

Back

3/8

Which of these symptoms do they experience regularly?
(Select all that apply.)

i Why it matters? Tracking symptoms is key to managing COPD. You can also note how often they experience these symptoms and if you notice any patterns—all of these details will help them and their doctor decide on the right care.

Back

3/8

What kinds of medications or supplements do you take?
(Select all that apply. When you review this form with your doctor, have a list of your medications.)

i Why it matters?Try to keep track of all the medications and supplements you’re taking. It’s important for you and your doctor to discuss any potential interactions or side effects.

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3/7

How often in the past year have you experienced a flare-up—when your normal COPD symptoms suddenly got worse and required steroids/antibiotics, hospitalization, or an ER visit?

i Why it matters? Noting how many times you get flare-ups will give your doctor a better idea of your condition and if a change in treatment is needed.

Since your last doctor visit, has there been any change in how often you use your rescue inhaler?

i Why it matters? If you’ve been using your rescue inhaler for quick relief more often than before, it may be a sign that your COPD symptoms are getting worse and need attention.

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4/8

How often in the past year have they experienced a flare-up—when their normal COPD symptoms suddenly got worse and required steroids/antibiotics, hospitalization, or an ER visit?

i Why it matters? Noting how many times they get flare-ups will give their doctor a better idea of their condition and if a change in treatment is needed.

Since their last doctor visit, has there been any change in how often they use their rescue inhaler?

i Why it matters? If they’ve been using their rescue inhaler for quick relief more often than before, it may be a sign that their COPD symptoms are getting worse and need attention.

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4/8

How often do you have to use your rescue inhaler or nebulizer for quick relief?

i Why it matters? Rescue inhalers and nebulizers are helpful for treating sudden symptoms but using them too often might mean it’s time to consider adjusting your treatment.

Since your last doctor visit, has there been any change in how often you use your rescue inhaler or nebulizer?

i Why it matters? If you’ve been using your rescue inhaler or nebulizer for quick relief more often than before, it may be a sign that your asthma symptoms are uncontrolled and need attention.

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4/7

What kinds of medications or supplements do you take?
(Select all that apply. When you review this form with your doctor, have a list of your medications.)

i Why it matters? Try to keep track of all the medications and supplements you’re taking. It’s important for you and your doctor to discuss any potential interactions or side effects.

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5/8

What kinds of medications or supplements do they take?
(Select all that apply. When you review this form with their doctor, have a list of their medications.)

i Why it matters? Try to keep track of all the medications and supplements they’re taking. It’s important for them and their doctor to discuss any potential interactions or side effects.

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5/8

Have you ever had to seek emergency medical attention due to asthma?

i Why it matters? Emergencies can be scary to talk about, but it’s important to open up with your doctor about your medical history. This will help them tell if a change in your treatment plan is needed.

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5/7

Since your last doctor visit, have any of the following become more difficult for you?
(Select all that apply.)

i Why it matters?Opening up about how COPD affects you day-to-day will help your doctor understand your condition and how it’s impacting your lifestyle.

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6/8

Since their last doctor visit, have any of the following become more difficult for them?
(Select all that apply.)

i Why it matters?Opening up about how COPD affects them day-to-day will help their doctor understand their condition and how it’s impacting their lifestyle.

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6/8

Since your last doctor visit, have any of the following become more difficult for you?
(Select all that apply.)

i Why it matters?Opening up about how asthma affects you day-to-day will help your doctor understand your condition and how it’s impacting your lifestyle.

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6/7

Do you smoke? If so, how often?

i Why it matters? Don’t worry, no judgment here. Being honest about smoking will help your doctor get a better idea of how it might factor into your COPD.

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7/8

Do they smoke? If so, how often?

i Why it matters? Don’t worry, no judgment here. Being honest about smoking will help their doctor get a better idea of how it might factor into their COPD.

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7/8

What are your goals for treatment?
(Select all that apply.)

i Why it matters? Setting and voicing goals is a key first step to making a real change. This helps your doctor be a proactive partner throughout your health journey.

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7/7

Done

Start over

What are your goals for treatment?
(Select all that apply.)

i Why it matters? Setting and voicing goals is a key first step to making a real change. This helps your doctor be a proactive partner throughout your health journey.

Back

8/8

Done

Start over

What are their goals for treatment?
(Select all that apply.)

i Why it matters?Setting and voicing goals is a key first step to making a real change. This helps their doctor be a proactive partner throughout their health journey.

Back

8/8

Done

Start over

Your personalized Doctor Discussion Guide is ready.

Send this guide to yourself and review your responses at your next doctor’s visit.

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The email address you provide will only be used to send you this Doctor Discussion Guide form. GSK will not use the email address you provide in any other way. GSK will not sell or transfer your information to any other party for any reason.

Convenience of once-daily TRELEGY dosing

Watch Jamaur's story. Real patient compensated by GSK. Individual results may vary.

Approved Uses & Safety Info

Approved Uses

Once-daily TRELEGY is a prescription medicine used long term to treat COPD, including chronic bronchitis, emphysema, or both and to treat asthma in adults. TRELEGY 100/62.5/25 mcg is the only strength approved for COPD. TRELEGY is not used to relieve sudden breathing problems and won’t replace a rescue inhaler.

Limitations of Use
TRELEGY is not used to relieve sudden breathing problems and will not replace a rescue inhaler. TRELEGY should not be used in children younger than 18 years of age. It is not known if TRELEGY is safe and effective in children younger than 18 years of age.

Important Safety Information

TRELEGY contains vilanterol. Long-acting beta₂-adrenergic agonist (LABA) medicines such as vilanterol,

TRELEGY contains vilanterol. Long-acting beta₂-adrenergic agonist (LABA) medicines such as vilanterol, when used alone, increase the risk of hospitalizations and death from asthma problems. TRELEGY contains an ICS, an anticholinergic, and a LABA. When an ICS and LABA are used together, there is not a

TRELEGY contains vilanterol. Long-acting beta₂-adrenergic agonist (LABA) medicines such as vilanterol, when used alone, increase the risk of hospitalizations and death from asthma problems. TRELEGY contains an ICS, an anticholinergic, and a LABA. When an ICS and LABA are used together, there is not a significant increased risk in hospitalizations and death from asthma problems.
Do not use TRELEGY to relieve sudden breathing problems. Always have a rescue inhaler with you to treat sudden symptoms.
TRELEGY should not be used in children younger than 18 years of age. It is not known if TRELEGY is safe and effective in children.
Do not use TRELEGY if you have a severe allergy to milk proteins or are allergic to any of the ingredients in TRELEGY. Ask your healthcare provider if you are not sure.
Do not use TRELEGY more often than prescribed.
Do not take TRELEGY with other medicines that contain a LABA or an anticholinergic for any reason. Tell your healthcare provider about all your medical conditions and about all the medicines you take.
Call your healthcare provider or get medical care right away if your breathing problems get worse, if you need your rescue inhaler more often than usual or it does not work as well to relieve your symptoms.
TRELEGY can cause serious side effects, including:
- fungal infection in your mouth or throat (thrush). Rinse your mouth with water without swallowing after using TRELEGY to help reduce your chance of getting thrush.
- pneumonia. People with COPD have a higher chance of getting pneumonia. TRELEGY may increase the chance of getting pneumonia. Call your healthcare provider if you notice any of the following symptoms: change in amount or color of mucus; fever; chills; increased cough; increased breathing problems.
- weakened immune system and increased chance of getting infections.
- reduced adrenal function. This can happen when you stop taking oral corticosteroids and start taking inhaled corticosteroids.
- sudden breathing problems immediately after inhaling TRELEGY. If this happens, stop taking TRELEGY and call your healthcare provider right away.
- serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms: rash; hives; swelling of your face, mouth, and tongue; breathing problems.
- effects on heart: increased blood pressure; a fast or irregular heartbeat, awareness of heartbeat; chest pain.
- effects on nervous system: tremor; nervousness.
- bone thinning or weakness (osteoporosis).
- eye problems including glaucoma, increased pressure in your eye, cataracts, blurred vision, worsening of narrow-angle glaucoma, or other changes in vision. You should have regular eye exams while using TRELEGY. Acute narrow-angle glaucoma can cause permanent loss of vision if not treated. Symptoms of acute narrow-angle glaucoma may include: eye pain or discomfort; nausea or vomiting; blurred vision; seeing halos or bright colors around lights; red eyes. If you have these symptoms, call your healthcare provider right away before taking another dose.
- new or worse urinary retention. Symptoms may include: difficult, painful, or frequent urination; urination in a weak stream or drips. If you have these symptoms, stop taking TRELEGY and call your healthcare provider right away.
- changes in laboratory blood values, including high levels of blood sugar (hyperglycemia) and low levels of potassium (hypokalemia).
- slowed growth in children.
Common side effects of TRELEGY 100/62.5/25 mcg for COPD include: upper respiratory tract infection; pneumonia; bronchitis; thrush in your mouth and throat (rinse your mouth with water without swallowing after use to help prevent this); headache; back pain; joint pain; flu; inflammation of the sinuses; runny nose and sore throat; taste disturbance; constipation; painful and frequent urination (signs of a urinary tract infection); nausea, vomiting, and diarrhea; mouth and throat pain; cough; and hoarseness.
Common side effects of TRELEGY for asthma include: runny nose and sore throat; upper respiratory tract infection; bronchitis; respiratory tract infection; inflammation of the sinuses; painful and frequent urination (signs of a urinary tract infection); flu; headache; back pain.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report negative side effects to GSK at gsk.public.reportum.com or 1-888-825-5249.

GSK For You — If you don’t have prescription coverage, need cost information, or need help paying for your medicine, visit GSKforyou.com or call 1-866-GSK-FOR-U

The shape of the ELLIPTA inhaler is a trademark of the GSK group of companies.

Trademarks are property of their respective owners.

DOCTOR DISCUSSION GUIDE

Prepare for a productive conversation with your doctor

Get your Doctor Discussion Guide in 3 easy steps:

Save a blank version

How would you describe your condition?

1/8

How would you describe your breathing?(Select all that apply.)

2/8

How would you describe their breathing?(Select all that apply.)

2/8

Which of these symptoms do you experience regularly?(Select all that apply.)

2/7

Which of these symptoms do you experience regularly?(Select all that apply.)

3/8

Which of these symptoms do they experience regularly?(Select all that apply.)

3/8

What kinds of medications or supplements do you take?(Select all that apply. When you review this form with your doctor, have a list of your medications.)

3/7

How often in the past year have you experienced a flare-up—when your normal COPD symptoms suddenly got worse and required steroids/antibiotics, hospitalization, or an ER visit?

Since your last doctor visit, has there been any change in how often you use your rescue inhaler?

4/8

How often in the past year have they experienced a flare-up—when their normal COPD symptoms suddenly got worse and required steroids/antibiotics, hospitalization, or an ER visit?

Since their last doctor visit, has there been any change in how often they use their rescue inhaler?

4/8

How often do you have to use your rescue inhaler or nebulizer for quick relief?

Since your last doctor visit, has there been any change in how often you use your rescue inhaler or nebulizer?

4/7

What kinds of medications or supplements do you take?(Select all that apply. When you review this form with your doctor, have a list of your medications.)

5/8

What kinds of medications or supplements do they take?(Select all that apply. When you review this form with their doctor, have a list of their medications.)

5/8

Have you ever had to seek emergency medical attention due to asthma?

5/7

Since your last doctor visit, have any of the following become more difficult for you?(Select all that apply.)

6/8

Since their last doctor visit, have any of the following become more difficult for them?(Select all that apply.)

6/8

Since your last doctor visit, have any of the following become more difficult for you?(Select all that apply.)

6/7

Do you smoke? If so, how often?

7/8

Do they smoke? If so, how often?

7/8

What are your goals for treatment?(Select all that apply.)

7/7

What are your goals for treatment?(Select all that apply.)

8/8

What are their goals for treatment?(Select all that apply.)

8/8

Your personalized Doctor Discussion Guide is ready.

Email address

Thank you!Your Doctor Discussion Guide has been sent to the email address you provided.

1 daily dose. 3 medications. A full 24 hours of breathing easier.

Go inside the lungs to learn the science behind TRELEGY.

Learn about the convenience of once-daily dosing.

Using the TRELEGY ELLIPTA inhaler: the 1-2-3s of triple-action.

With once-daily TRELEGY, asthma doesn’t stop Jamaur from being the dad he always wanted to be.

Looking for a healthcare professional nearby?

How would you describe your breathing?
(Select all that apply.)

How would you describe their breathing?
(Select all that apply.)

Which of these symptoms do you experience regularly?
(Select all that apply.)

Which of these symptoms do you experience regularly?
(Select all that apply.)

Which of these symptoms do they experience regularly?
(Select all that apply.)

What kinds of medications or supplements do you take?
(Select all that apply. When you review this form with your doctor, have a list of your medications.)

What kinds of medications or supplements do you take?
(Select all that apply. When you review this form with your doctor, have a list of your medications.)

What kinds of medications or supplements do they take?
(Select all that apply. When you review this form with their doctor, have a list of their medications.)

Since your last doctor visit, have any of the following become more difficult for you?
(Select all that apply.)

Since their last doctor visit, have any of the following become more difficult for them?
(Select all that apply.)

Since your last doctor visit, have any of the following become more difficult for you?
(Select all that apply.)

What are your goals for treatment?
(Select all that apply.)

What are your goals for treatment?
(Select all that apply.)

What are their goals for treatment?
(Select all that apply.)

Thank you!
Your Doctor Discussion Guide has been sent to the email address you provided.