Patient Profile Essay

Thank you for referring Margaret along for ongoing management with her airways disease. As you are aware, I saw her as an inpatient at Warringal when she had a left total shoulder joint replacement done in November and since then, she has done very well. She has continued on with her Seretide 250/50 via an Accuhaler, but unfortunately, is noticing the emergence of a hoarse voice despite good oral hygiene. Symptomatically, she remains very stable in that her exercise tolerance is well and truly greater than 1km on the flat, but she still does have trouble with any steep incline. Of note though, she manages her two sets of stairs at home without any issues. Her shortness of breath is not associated with any chest pain, palpitations or syncope …show more content…
She has not had a chest x-ray recently and so that we have an up-to-date chest x-ray and a baseline moving forward, she will have one performed in the next couple of days. Moving forward, with regards to her inhalers, given her hoarse voice, I have discussed swapping her over to Spiriva as he long-acting bronchodilator and I think she would be safe not to be on inhales corticosteroids, given the mild to moderate nature of her COPD and the fact that she had not had more than two exacerbations in the last twelve months. She had one exacerbation requiring prednisolone this year and then responded very well to this and, as such, we have started discussions of a COPD action plan that we will formalise at the next appointment. With regards to her long-acting bronchodilator, I have suggested that she tries Spiriva over the next four weeks or so and then on return from her trip, now that we have the options, she can now trial a dual LAMA/LABA and I have given her a sample of ANORO ELLIPTA. If she notices improved symptoms on the combination, we will consider continuing on with this. I will then see her again in a couple of months’ time to assess her progress, but I have asked her to call me again in the meantime if there are any