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PERSOnAL ACtiOn PLAn tO MAintAin COPD COntROL
this plan should be completed by your doctor or respiratory case manager, in discussion with you. it will contain
the information you need to keep control of your COPD, including details about your COPD medicines, how to
tell when your symptoms are getting worse and what you should do about it, and emergency information on
what to do if you have a COPD exacerbation.
YOUR Own PERSOnAL ACtiOn PLAn tO MAintAin COPD
COntROL
how Do you take your regular treatment?
1. i take _______________ puffs _______________ times a day.
name of my 1
st
inhaler _________________________________________________________________________________
2. i take _______________ puffs _______________ times a day.
name of my 2
nd
inhaler ________________________________________________________________________________
COPD ASSESSMEnt tESt (CAt)
this questionnaire will help you and your doctor or respiratory case manager to measure the impact COPD
is having on your wellbeing and daily life. Your answers and test score can be used by you and doctor /
respiratory case manager to help improve the management of your COPD and get the greatest benefit from
treatment.
for eaCh item below, tiCk yes or no that best DesCribes you Currently
i never cough
i have no phlegm (mucus in my chest)
My chest does not feel tight at all
When I walk up hill or one flight stairs I am breathless
i am not limited doing any activities at home
i sleep soundly
y
n
y n
y n
y n
y n
y n
