Dr Mandy sutton
Department of Respiratory Medicine
Dear Dr Sutton
Re: Mr William McGuire, aged 65
Mr McGuire, who is a dignosed case of chronic obstructive pulmonary disease and being referred to your facility for further evaluation and management following the discharge after conservative treatment.
On august 2016, chronic obstructive pulmonary disease was diagnosed due to the presentation of four months history of cough and increased breathing difficulty. He was a chronic smoker and had a history of smoking 40 cigerettes on a daily basis for 40 years which was quit about years back. Strong family history of chronic obstructive pulmonary disease and bronchiectasis were also mentioned.
Repeated hospitalization following acute exacerbation of chronic obstructive pulmonary disease was noticed on september 2017 and july2018 respectively. Despite intravenous antibiotic and conservative treatment condition was improved on both attacks. In addition, salbutamol (Ventolin) 100 mcrogram 02 puffs on the basis of need, salmeteraol and fluticasone (seretide) 500 microgram/50 microgram 01 puff twice a day. In addition, Tab. Allopurinol 100 mg twice a day was also prescribed for the gout.
On 06.10.18, on the day of last admission, he was presented with increased shortness of breath associated with markeldy decreased daily activities for which he was suffering from last 03 months. Poor appetite and increased anxiety were also mentioned. Physical examination revealed increased resonance and hyperinflation. In addition, chest expansion and decreased breath sounds were notified. Blood pressure is raised and documented as 140/80 mmHg.
Based on aforementioned circumstance, not only acute and comprehensive assessment but also further management would be beneficial. In case any additional information is deemed extremely relevant, please do not hesitate to contact with me.
Dr. Noor E Alam