Date:  <<Miscellaneous:Date (long)>>(Ask your doctor to review each year with your care plan)
Patient Name: <<Patient Demographics:Full Name>>	Date of Birth: <<Patient Demographics:DOB>>	
GP Name: <<Doctor:Name>>	GP Phone: <<Doctor:Phone>>	
Nurse/Health Worker Name: <<Nurse/Health Worker Name>>	Nurse/Health Worker Phone: <<Nurse/Health Worker Phone>>	
Feeling your usual self	
*I can do my usual activities	*Taking usual medicine	My FEV1 is: <<My FEV1 is>>	
*Sleeping as usual	*Usual amount of phlegm	CO2 Retainer: <<CO2 RETAINER >>	
ACTION: Continue taking your usual medicines as listed below.	
Annual Influenza Immunization - Date: <<Influenza date given>>	
Last Pneumococcal Immunisation - Date: <<Pneumococcal date given>>	
My usual medicines	Colour of device	How many puffs or tablets	How often	

USUAL MEDICATIONS <<Clinical Details:Medication List>>
Feeling harder to breathe/Feeling sick	
*More phlegm or thicker than usual	*More coughing	*Not sleeping well	
	*Loss of appetite	*Not much energy	
ACTION: Follow plan below for extra medicines. Plan your day, get rest, relax, use breathing techniques, huff and cough to clear phlegm as required.  	
My extra medicine	Colour of device	How many puffs or tablets	How often	

				
FEELING SICK	
*Taking reliever medicines 3-4 hourly, but not getting adequate relief.
ACTION: Start taking Prednisolone. Contact your Nurse/Health Worker or Doctor.  	
Prednisolone Strength 
	Prednisolone tablets each day 	Number of days 	
*A change in colour and/or volume of phelgm.   *Fever
ACTION: Start taking antibiotics as well as prednisolone. Contact your Nurse/Health Worker or Doctor.  	
Antibiotics *  	Antibiotic Strength 	Antibiotic doses per day 	No. of days on antibiotics
	
* GP to fill in if prescribed.
Not feeling Good (trouble breathing and/or wheezing)	
*Difficulty sleeping/woken easily	*Blood in your phlegm	*Swollen ankles	ACTION: Contact Doctor	
	
*Very short of breath at rest	*High fever	*Chest pain	ACTION: Phone an Ambulance 000	
*Confused, slurring of speech	*Drowsy	*Afraid/scared	ACTION: Phone an Ambulance 000
Show them this plan	
CAUTION! Ambulance/Paramedics: Oxygen supplementation to maintain SpO@ 92% max (exeeding 92% risks hypercapnia)	

Resources available via Lung Foundation Australia - Contact to order your copy. 
Better Living with COPD - Patient Guide 
Better Living with Your Lung Disease DVDs
1800 654 301 | www.lungfoundation.com.au | enquiries@lungfoundation.com.au