Get the Guide to Better Breathing

To get your free Guide, please fill out the form below. Also, you can receive information about a prescription treatment option for COPD. When complete, click on the "Continue" button.

After you click the button, you will be asked a few more questions. These will help us in future communications with you. This will only take a few minutes.

If you like, you may also call 1-800-231-6568 to request a free copy by phone.

Page 1 of 2

Required Fields*

You must fill in all fields. Please provide information marked in red. Required Fields*

Title	First Name*	M.I.	Last Name*	Suffix

Address*

City*	State*	ZIP Code*

Email Address*

Confirm Email Address*

Telephone	Select One:
- -	Home Office Cell

When were you or your loved one born?* You must be over 18 to receive the guide.

I'm interested in the Guide to Better Breathing as*:

someone diagnosed with COPD, emphysema, or chronic bronchitis
someone diagnosed with asthma or breathing problems
someone who has breathing problems but has not yet been diagnosed
a friend or family member of someone with one of the conditions above
a healthcare professional

As a healthcare provider, you may also order Breathe Well, a magazine for people living with COPD, to distribute to your patients.

Yes
No

Are you sure you don't want to receive information and offers about COPD and a prescription treatment option? If so, click the "Continue" button.

	By checking here, you indicate that you agree to the below and want us to use the information you have provided to send you information and offers relating to chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis, emphysema, or both, and a prescription treatment option from time to time.
	By checking here, you indicate that you agree to the below and allow us to use your information to advertise COPD-related and other products to you. Boehringer Ingelheim and Pfizer Inc may also provide you with useful materials and contact you about health-related topics.

If you do not check either box, we will fill just this one-time request.

The information you are about to provide is being collected by Boehringer Ingelheim Pharmaceuticals, Inc. and Pfizer Inc so that we may advertise our products to you and provide you with information about them.

Boehringer Ingelheim Pharmaceuticals, Inc. and Pfizer Inc respect your right to have personal and medical information kept confidential. Boehringer Ingelheim, Pfizer, and companies working with Boehringer Ingelheim and Pfizer will use the information you provide, as well as information from redeemed coupons and/or vouchers we have provided you, which we receive from the pharmacy, to fulfill your request and to help develop products, services, and programs. It will not be shared with any other third parties (such as mailing lists).

When ready, click the "Continue" button to get your Guide. A brief questionnaire will follow.

Page 1 of 2

Page 2 of 2

What is your gender?

Male Female

CurrentlyTaking:

Advair® Diskus® (fluticasone propionate and salmeterol inhalation powder)
Foradil® Aerolizer® (formoterol fumarate inhalation powder)
Serevent® Diskus® (salmeterol xinafoate inhalation powder)
Spiriva® HandiHaler® (tiotropium bromide inhalation powder)
Other prescription treatments
Don't know
Not on therapy

When did you begin treatment with SPIRIVA?

Have you ever smoked a cigarette over the course of your life?

Yes No

If so, when was the last time you smoked a cigarette?

Within the last 6 months More than 6 months ago I don't know

"My breathing problems are a result of my smoker's cough."

Agree completely Agree somewhat Disagree

"COPD, emphysema, chronic bronchitis, or breathing problems make walking up a flight of stairs more difficult."

Agree completely Agree somewhat Disagree

Page 2 of 2

Boehringer Ingelheim Pharmaceuticals, Inc. either owns or uses under license the Spiriva® and HandiHaler® trademarks. The other trademarks referenced above are owned by third parties not affiliated with Boehringer Ingelheim Pharmaceuticals, Inc.

Important Safety Information for SPIRIVA
Talk to your doctor to see if Spiriva® HandiHaler® (tiotropium bromide inhalation powder) is right for you.

SPIRIVA HandiHaler is a prescription medicine used once every day (a maintenance medicine) to control symptoms of chronic obstructive pulmonary disease (COPD). COPD includes chronic bronchitis, emphysema, or both. SPIRIVA relaxes airways and helps keep them open, to help make it easier to breathe when used every day.

SPIRIVA HandiHaler is not a rescue medicine and should not be used for treating sudden breathing problems.

Do not swallow SPIRIVA capsules. Only use SPIRIVA capsules with the HandiHaler device. The contents of the capsule should only be inhaled by mouth using the HandiHaler device.

Stop taking SPIRIVA and get medical help right away if your breathing suddenly worsens, your throat or tongue swells, you get hives, or have vision changes or eye pain.

Tell your doctor if you have glaucoma, problems passing urine or an enlarged prostate, as these may worsen with SPIRIVA. Also discuss with your doctor all the medicines you take, including eye drops.

The most common side effect with SPIRIVA is dry mouth. Others include constipation and trouble passing urine. For a complete list of reported side effects, ask your doctor or pharmacist.

Do not get SPIRIVA powder in your eyes.

Do not use SPIRIVA if you are allergic to any of the ingredients in SPIRIVA capsules (tiotropium, lactose monohydrate) and if you have had an allergic reaction to atropine or any medicines like it, such as ipratropium (Atrovent).

Read the Patient Information and the step-by-step Patient's Instructions for Use for SPIRIVA before you take your medicine.

Your request is processing. Please wait one moment...

The FREE Guide has many more tips like this. Click here to request yours now.

This information is for U.S. residents only. Use of this site is subject to the Internet Site Legal Notices and Disclaimers and Privacy Policy.
Copyright © 2009, Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved.

Privacy Statement | Terms of Use | Contact Us | Glossary