Your Asthma Symptoms Checklist1:

Do you have trouble breathing? It may be asthma. Fill out this checklist and use it to go over your symptoms with your healthcare provider. Remember—only your healthcare provider can diagnose asthma.

Place a check mark in the box next to any symptom you’ve experienced:






Do any of these asthma triggers make your symptoms worse?












Do your symptoms get worse at night or wake you up?



Click the “Print” button below to print this page. Use this checklist to talk with your healthcare provider about your symptoms. And ask if ProAir RespiClick® (albuterol sulfate) Inhalation Powder—the first FDA-approved multi-dose breath-activated rescue inhaler—is right for you.


Reference:

1. NHLBI Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. Available at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf. Accessed January 27, 2017.

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APPROVED USES

ProAir RespiClick® (albuterol sulfate) Inhalation Powder is indicated in patients 4 years of age and older for the treatment or prevention of bronchospasm with reversible obstructive airway disease and for the prevention of exercise-induced bronchospasm.


IMPORTANT SAFETY INFORMATION

  • Do not use ProAir RespiClick® (albuterol sulfate) Inhalation Powder if you are allergic to albuterol sulfate, lactose, or milk proteins. Call your doctor right away if you develop red, itchy bumps on your skin, swelling beneath your skin or in your throat, rash or worsening trouble breathing
  • If your symptoms become significantly worse when you use ProAir RespiClick®, seek medical attention immediately. This may indicate either a worsening of your asthma or a reaction to the medication. Either of these could be life-threatening
  • Do not increase your dose or take extra doses of ProAir RespiClick® without first talking to your healthcare professional
  • Before using ProAir RespiClick®, be sure to tell your healthcare professional if you have a heart, blood, thyroid or seizure disorder, high blood pressure, diabetes, are pregnant or planning to become pregnant, or are breastfeeding or planning to breastfeed
  • ProAir RespiClick® can cause significant heart-related side effects, such as an increase in pulse, blood pressure and/or related symptoms. If you have a heart condition, your healthcare professional will determine if ProAir RespiClick® is right for you
  • Make sure your healthcare professional knows all the medicines you are taking — especially other inhaled medicines, other asthma medicines, heart and blood pressure medicines and drugs that treat depression — because some medicines may interfere with how well your asthma medicines work
  • Common side effects in patients 12 years of age and older taking ProAir RespiClick® include back pain, body aches and pains, upset stomach, sinus headache, and urinary tract infection
  • Common side effects in patients 4 to 11 years of age taking ProAir RespiClick® include upper respiratory infections, mouth and throat pain, and vomiting
  • Tell your healthcare provider if you have any side effect that bothers you or that does not go away
  • These are not all of the possible side effects of ProAir RespiClick®. For more information, ask your healthcare provider or pharmacist
  • You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088

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APPROVED USES

ProAir RespiClick® (albuterol sulfate) Inhalation Powder is indicated in patients 4 years of age and older for the treatment or prevention of bronchospasm with reversible obstructive airway disease and for the prevention of exercise-induced bronchospasm.


IMPORTANT SAFETY INFORMATION

  • Do not use ProAir RespiClick® (albuterol sulfate) Inhalation Powder if you are allergic to albuterol sulfate, lactose, or milk proteins. Call your doctor right away if you develop red, itchy bumps on your skin, swelling beneath your skin or in your throat, rash or worsening trouble breathing
  • If your symptoms become significantly worse when you use ProAir RespiClick®, seek medical attention immediately. This may indicate either a worsening of your asthma or a reaction to the medication. Either of these could be life-threatening
  • Do not increase your dose or take extra doses of ProAir RespiClick® without first talking to your healthcare professional
  • Before using ProAir RespiClick®, be sure to tell your healthcare professional if you have a heart, blood, thyroid or seizure disorder, high blood pressure, diabetes, are pregnant or planning to become pregnant, or are breastfeeding or planning to breastfeed
  • ProAir RespiClick® can cause significant heart-related side effects, such as an increase in pulse, blood pressure and/or related symptoms. If you have a heart condition, your healthcare professional will determine if ProAir RespiClick® is right for you
  • Make sure your healthcare professional knows all the medicines you are taking — especially other inhaled medicines, other asthma medicines, heart and blood pressure medicines and drugs that treat depression — because some medicines may interfere with how well your asthma medicines work
  • Common side effects in patients 12 years of age and older taking ProAir RespiClick® include back pain, body aches and pains, upset stomach, sinus headache, and urinary tract infection
  • Common side effects in patients 4 to 11 years of age taking ProAir RespiClick® include upper respiratory infections, mouth and throat pain, and vomiting
  • Tell your healthcare provider if you have any side effect that bothers you or that does not go away
  • These are not all of the possible side effects of ProAir RespiClick®. For more information, ask your healthcare provider or pharmacist
  • You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088