{"text":"Glasgow Royal Infirmary \nQueen Elizabeth Building Direct Dial: 014 211 4785 \n16 Alexandra Parade ~ Fax:No: 0141 211 4932 \nGLASGOW \u2019 \u2019 E Mail: Anne.Green@northglasgow.scot.nhs.uk \n631 2ER \nDEPARTMENT OF RESPIRATORY MEDICINE \nDr van der Horst's Respiratory Clinic \n31\/05\/2011 \nRef: KC\/A6\/10338654X \nDictated: 31\/05\/2011 \nTyped: 07\/06\/2011 \nDr Marjory Stephens \nKilsyth Health Centre \nBurngreen Park \nKilsyth \n665 OHU \nDear Dr Stephens \nAgnes Clelland ~ 08\/09\/1955 ~ CHI: 0809555328 \n39 Rennie Road, Kilsyth, Glasgow, 665 9PQ \nDiagnoses: \nPrevious psittacosis from budgies \nGORD - \nErythema multiforme \nHypertension \nNon insulin dependent diabetes \nPrevious benign oesophageal stricture (stretched) \nSevere arthritis \nNONOL AWy e \nCurrent medications; Omeprazole, Metformin, Ramapril, Aspirin, Fluoxetine & Simvastatin \nI reviewed Mrs Clelland in Dr van der Horst's Respiratory Clinic. She was referred to us with a five month \nhistory of non productive cough and increased shortness of breath on exertion. Mrs Clelland feels these \nsymptoms all commenced following an upper respiratory tract infection before Christmas of last year. She \ndescribes her cough as being constant at first, however this has now improved and she now only coughs \nwhen she exerts herself. She remains quite short of breath on exertion, although her exercise tolerance \nis unlimited on the flat, she struggles with hills and stairs. The shortness of breath is associated with \nwheeze and Mrs Clelland describes definite diurnal variation in her symptoms. She.cirrently wakes seven \nnights out of seven due to a combination of pain from her arthritis and her cough. Mrs Clelland's cough was \ninitially productive of green sputum but is now clear. She denies any chest pain, haemoptysis or weight \nloss. On examination she was not clubbed, had no lymphadenopathy and her chest was clear to \nauscultation. \nPrior to attending clinic, Mrs Clelland underwent pulmonary function tests which revealed an FEV1 of 2.38 \n(92% predicted), a ratio of 78% predicted, transfer factor of 7.4 (92% predicted) and total lung capacity \n_of .4\u20181.49 (86% predicted). Her chest x-ray revealed no obvious abnormalities and Mrs Clelland is a 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