COPD Care Checklist

How to Use Your Checklist This checklist will make you better aware of your condition as well as help both you and your caregiver better manage your condition. The first page contains a checklist to help you manage your COPD and highlight what areas might need attention. Print this page and have your doctor or nurse fill in the instructions for your COPD medications. Also, have your healthcare team fill in their contact information. Then post it where you will see it daily (for example, on your refrigerator or bathroom mirror). Pages 2 and 3 contain tips for talking with your healthcare provider about your COPD, along with a checklist of questions you may want to ask at your next visit. The fourth page provides additional resources for you and your caregiver, including links to a COPD Action Plan.

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My Checklist My COPD Symptoms

Inhaler Technique

Knowing the symptoms of COPD will help you and your loved one better manage your condition and prevent flare-ups. Ignoring the signs of a flare-up can result in hospitalization and speed up the loss of lung function. Call your doctor or healthcare professional if you notice any new or worsening symptoms, including:

If you have been given an inhaler, be sure that your doctor or nurse has shown you the right way of using it and that you are confident that you can use it properly.

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My COPD Exercises

Shortness of breath Coughing more often Cough is more severe More wheezing (a whistling or rattling sound when you breathe) Mucus is thicker and discolored (yellow or green) Increased anxiety Trouble sleeping Loss of appetite Difficulty completing daily activities

Staying active is an important aspect of managing your COPD. Regular physical activity can strengthen the muscles you use to breathe, improve circulation, and decrease symptoms. Talk with your doctor before beginning an exercise program. Breathing exercises can help you or your loved one get the air you need without working so hard to breathe. Talk with your doctor about breathing exercises that are right for you. You may also want to ask your doctor about pulmonary rehabilitation—an exercise and support program to help you learn how to breathe and function at the highest level possible.

My COPD Medications

My Healthcare Team

Medications prescribed by your doctor are important in keeping your COPD from getting worse and preventing flare-ups. If your doctor has prescribed a daily medication for your COPD, be sure that you or your loved one takes the medication as directed

Your healthcare team works together to ensure that you are getting the best care possible. Each member plays a valuable role in helping you manage your condition. Have each member of your healthcare team (including those who help you with conditions other than COPD) fill in his/her name and phone number. Keep this list where you can find it easily, and share it with your healthcare team.

Daily Medications


When to take it

How much to take

Healthcare Professional


Phone #

Primary Care Doctor Lung Doctor/ Pulmonologist

Rescue Medications


When to take it

How much to take

Nurse/ Case Manager Pharmacist Respiratory Therapist

Additional Instructions

Cardiologist Other:

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My COPD Appointment Be Prepared • • •

Assess your condition. Are your symptoms getting better or worse? You may want to use our Patient Self-Assessment Survey to help you and your doctor know how you are doing. Write down your concerns about COPD and COPD treatments. Have a practice discussion with a friend or loved one.

Ask Questions Your doctor and healthcare team are your greatest resources, so now is the best time to ask questions. Below is a list of sample questions to get the conversation started: • • • • • •

What stage is my COPD? What can I expect as my condition progresses? What changes can I make to improve my breathing? How can I improve my quality of life and daily activities? What kind of help can I get to quit smoking? What medications are available for my condition?

Report Changes in your Breathing • It is important that you tell your doctor about any changes in your symptoms, as these may be signs of a flare-up. Your doctor can help you take steps to prevent your COPD from getting worse

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Appointment Checklist Use this checklist to help you before and during your doctor visit.

Before your appointment ‰‰Assess your condition ‰‰Take a list (or bring) all of your medications ‰‰Take a list of questions and concerns

During your appointment ‰‰Report any changes in your breathing ‰‰Review your medications (including oxygen, inhalers, and pills) ‰‰Share with your doctor how many times you missed your medications and ask about ways that can help you remember to take them ‰‰Review your inhaler technique ‰‰Discuss feelings of anxiety, depression, or loneliness ‰‰Review your daily activities and any changes in your energy level ‰‰Discuss any problems with your sleeping habits ‰‰If you are a smoker, discuss your challenges of quitting and options to help you quit ‰‰Review breathing exercises ‰‰Ask about pulmonary rehabilitation ‰‰Ask about when you should get a flu and/or pneumonia shot ‰‰Ask about when you are due for spirometry (breath test) ‰‰Share other conditions you have and tell your doctor about other healthcare professionals that you see (including doctors, therapists, and pharmacists) ‰‰Review your COPD Action Plan ‰‰Ask about when you should come back for a follow-up visit

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My COPD Resources Resources for Caregivers

American Lung Association Information for patients and caregivers about COPD symptoms, diagnosis and treatment, including management tools and lifestyle changes.

COPD Together Information and resources for COPD caregivers, including: • • •

COPD Foundation Information for patients, caregivers, family and friends affected by COPD. Resources for patients and caregivers, including: • Shared Decision-Making. Videos showing how patients successfully communicate with their healthcare providers • How to Stay Informed About My Disease. User-friendly information about a variety of diseases • Patient Diaries. Patients share their personal experiences to help others • Useful Apps. Descriptions and links to Apps to help you manage your condition and remember your medications

My Diary for COPD. A printable diary to track COPD symptoms and medications COPD Caregiver’s Guide. Information to help caregivers understand disease progression and their role in providing support for their loved ones COPD Care Mobile App. Allows you to track COPD symptoms and share information with your doctor about your symptoms and treatments

Caregiver Action Network Connects family caregivers to education, peer support, and resources, including: • Tips. 10 tips for family caregivers • Family Caregiver Forum. A place for caregivers to learn from each other’s experiences • Family Caregiver Toolbox. Assessment tools, checklists, webinars, and videos for common issues Family Caregiver Alliance Offers caregiving information, advice and discussion groups

Emphysema Foundation For Our Right to Survive (EFFORTS) A non-profit organization formed and operated by patients with COPD with information and support, including daily e-mail discussions about lung disease. EFFORTS helps patients and caregivers be active participants in their healthcare.

COPD Foundation FAQ for Caregivers

COPD Action Plan COPD Action Plan from the American Lung Association of Minnesota mn-copd-coalition/patient-toolkit/my-copd-checklist.pdf

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