Respiratory OPD Follow up

GP: Smith I had the pleasure of following up with John Doe who was reviewed in the Respiratory Clinic on 1 November 2024. Please refer to my letters dated 20 October 2024. Reason for referral: Shortness of breath and persistent cough. Issues: - Asthma • Patient reports increased wheezing and nocturnal cough. - COPD • Patient continues to experience exertional dyspnea. Recent investigations: - Spirometry: FEV1 65% predicted. - Chest X-ray: No acute changes. Current medications: Salbutamol inhaler as needed, Seretide 250 twice daily, Spiriva once daily. Allergies: Penicillin (rash). On review: Patient reports worsening symptoms over the past week. Examination: Patient appears in mild respiratory distress. Respiratory rate is 24 breaths per minute. Oxygen saturation is 92% on room air. There is mild wheezing on auscultation. Vital signs: Respiratory rate: 24 breaths/min, Oxygen saturation: 92% on room air, Temperature: 37.0°C, Pulse rate: 88 bpm, Blood pressure: 130/80 mmHg. Summary: - Discussed current symptoms and medication adherence. - Reviewed inhaler technique. - Advised on exacerbation management. Plan: 1. Increase Seretide to 500 twice daily. 2. Review in two weeks. 3. Arrange repeat spirometry in three months. 4. Refer to smoking cessation program. Follow up: Review in two weeks to assess response to increased medication. Issue for GP to action: Continue current medications and monitor for side effects.