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DOCTOR DISCUSSION GUIDE

PERSONALIZE YOUR GUIDE

Our goal is for you or your loved one to get the most out of your visit to the doctor—whether you're just beginning your treatment journey or looking for another way to treat your moderate-to-severe asthma.

Answer the questions in this form and create your own personalized guide. You can use it to help start that conversation with your doctor to see if DUPIXENT may be right for you.

Can't fill out your guide now? Download a printable PDF.

LET’S START
YOUR GUIDE
I’M READY
  • Personal Info
  • Journey
  • Symptom Severity
  • Asthma Control
  • Review

YOUR PERSONALIZED GUIDE IS READY

We've gathered your answers in a personalized guide that you can save by choosing an option below. You can save the results of this page for easy referral by adding it to your bookmarks.

Please remember that this is intended to be a helpful way for you to prepare for your conversation with your provider, but should not replace a full conversation with your provider.

APPOINTMENT REMINDER

Let’s set an appointment on your calendar to remind you of your next doctor’s visit. It will include a link to your personalized discussion guide for easy reference, which will help you lead a productive conversation with your doctor.

Symptom Severity

SYMPTOM FREQUENCY

Coughing:   Moderate

Wheezing:   Frequently

Shortness of Breath:   Frequently

Rapid Breathing:   Moderate

Chest Tightness:   Occasionally

Indication

DUPIXENT is a prescription medicine used with other asthma medicines for the maintenance treatment of moderate-to-severe eosinophilic or oral steroid dependent asthma in adults and children 6 years of age or older whose asthma is not controlled with their current asthma medicines. DUPIXENT helps prevent severe asthma attacks (exacerbations) and can improve your breathing. DUPIXENT may also help reduce the amount of oral corticosteroids you need while preventing severe asthma attacks and improving your breathing. DUPIXENT is not used to treat sudden breathing problems. It is not known if DUPIXENT is safe and effective in children with asthma under 6 years of age.

Important Safety Information and Indication

Do not use if you are allergic to dupilumab or to any of the ingredients in DUPIXENT

Please see additional Important Safety Information for DUPIXENT (dupilumab) on next page.

Asthma Control

ASTHMA'S IMPACT

Awoken at night:

(Because of symptoms
in the past month)

Limited or missed an activity:

(Because of an attack)

Been to emergency room:

(In the past year)

Used rescue inhaler:

(More than twice a week)

TRIGGERS

    THINK ABOUT
    CONDITION

    Occasionally

    TREATMENT GOAL

      THINK ABOUT
      CONDITION

      Occasionally

      Indication

      DUPIXENT is a prescription medicine used with other asthma medicines for the maintenance treatment of moderate-to-severe eosinophilic or oral steroid dependent asthma in adults and children 6 years of age or older whose asthma is not controlled with their current asthma medicines. DUPIXENT helps prevent severe asthma attacks (exacerbations) and can improve your breathing. DUPIXENT may also help reduce the amount of oral corticosteroids you need while preventing severe asthma attacks and improving your breathing. DUPIXENT is not used to treat sudden breathing problems. It is not known if DUPIXENT is safe and effective in children with asthma under 6 years of age.

      Important Safety Information and Indication

      Do not use if you are allergic to dupilumab or to any of the ingredients in DUPIXENT

      Please see additional Important Safety Information for DUPIXENT (dupilumab) on next page.

      Next Steps

      SOME QUESTIONS TO ASK YOUR DOCTOR

      • How is DUPIXENT different
        from other treatment options?
      • How does DUPIXENT work?
      • How would I take DUPIXENT?
      • How do I get started with DUPIXENT?
      • What are the possible side effects of DUPIXENT?
      • How can DUPIXENT help treat my uncontrolled moderate-to-severe asthma?

      NOTES

      Add any additional notes to discuss with your doctor.






      Important Safety Information and Indication

      Do not use if you are allergic to dupilumab or to any of the ingredients in DUPIXENT®.

      Before using DUPIXENT, tell your healthcare provider about all your medical conditions, including if you:

      • have a parasitic (helminth) infection
      • are scheduled to receive any vaccinations. You should not receive a "live vaccine" right before and during treatment with DUPIXENT.
      • are pregnant or plan to become pregnant. It is not known whether DUPIXENT will harm your unborn baby.
      • are breastfeeding or plan to breastfeed. It is not known whether DUPIXENT passes into your breast milk.

      Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

      Especially tell your healthcare provider if you are taking oral, topical, or inhaled corticosteroid medicines or use an asthma medicine. Do not change or stop your corticosteroid medicine or other asthma medicine without talking to your healthcare provider. This may cause other symptoms that were controlled by the corticosteroid medicine or other asthma medicine to come back.

      DUPIXENT can cause serious side effects, including:

      • Allergic reactions. DUPIXENT can cause allergic reactions that can sometimes be severe. Stop using DUPIXENT and tell your healthcare provider or get emergency help right away if you get any of the following signs or symptoms: breathing problems or wheezing, swelling of the face, lips, mouth, tongue, or throat, fainting, dizziness, feeling lightheaded, fast pulse, fever, hives, joint pain, general ill feeling, itching, skin rash, swollen lymph nodes, nausea or vomiting, or cramps in your stomach-area.
      • Inflammation of your blood vessels. Rarely, this can happen in people with asthma who receive DUPIXENT. This may happen in people who also take a steroid medicine by mouth that is being stopped or the dose is being lowered. It is not known whether this is caused by DUPIXENT. Tell your healthcare provider right away if you have: rash, chest pain, worsening shortness of breath, a feeling of pins and needles or numbness of your arms or legs, or persistent fever.
      • Joint aches and pain. Some people who use DUPIXENT have had trouble walking or moving due to their joint symptoms, and in some cases needed to be hospitalized. Tell your healthcare provider about any new or worsening joint symptoms. Your healthcare provider may stop DUPIXENT if you develop joint symptoms.

      The most common side effects in patients with asthma include injection site reactions, high count of a certain white blood cell (eosinophilia), pain in the throat (oropharyngeal pain), and parasitic (helminth) infections.

      Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of DUPIXENT. Call your doctor for medical advice about side effects. 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.

      Use DUPIXENT exactly as prescribed by your healthcare provider. It’s an injection given under the skin (subcutaneous injection). Your healthcare provider will decide if you or your caregiver can inject DUPIXENT. Do not try to prepare and inject DUPIXENT until you or your caregiver have been trained by your healthcare provider. In children 12 years of age and older, it’s recommended DUPIXENT be administered by or under supervision of an adult. In children 6 to less than 12 years of age, DUPIXENT should be given by a caregiver.

      Please see accompanying full Prescribing Information including Patient Information.

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      © 2023 Sanofi and Regeneron Pharmaceuticals, Inc. All Rights Reserved.
      DUPIXENT® and DUPIXENT MyWay® are registered trademarks of Sanofi Biotechnology.
      DUP.23.01.0270     Last Update: June 2023