Discuss COPD Symptoms with Your Doctor

Use this questionnaire to record your specific COPD symptoms. Share your answers with your COPD treatment team. Only they can assess your COPD symptoms and determine if adjustments need to be made to your treatment. This information is provided for your education and is not intended to replace discussions with a healthcare provider. Ask your doctor, nurse or respiratory therapist about your treatment options.

Please answer Yes or No to ALL questions. Viatris does not collect, retain or receive any information from this questionnaire.

1. Do you have a hard time taking deep breaths?
2. Do you experience shortness of breath when active?
3. Are you using your rescue inhaler more often?
4. Do you wake up in the middle of the night to use your inhaler?
5. Have your symptoms increased and/or changed over time?
6. Are you often short of breath?
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