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DOCTOR DISCUSSION GUIDE

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Prepare for a productive conversation with your doctor

Get your Doctor Discussion Guide in 3 easy steps:

  1. Fill out the short form as best as you can.
  2. Email the guide with your responses.
  3. 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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How would you describe your breathing?
(Select all that apply.)

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

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

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

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.

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

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.

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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.)

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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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?

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?

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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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?

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?

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

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?

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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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.)

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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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.)

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

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

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

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

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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Do you smoke? If so, how often?

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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Do they smoke? If so, how often?

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

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

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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Done

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

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.

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Done

Start over