I have caught up with Gerrit in person three months since the last appointment. Around a month after I last saw Gerrit, he ceased Symbicort due to a lack of benefit. Since that time, he has had further assessment with Andrew Teh and I note Andrew is happy with Gerrit’s cardiac status with a recent echocardiogram showing normal systolic function, no significant diastolic dysfunction and trivial mitral regurgitation. Gerrit has since undergone repeat lung function testing that demonstrates some deterioration comparing to the numbers from early last year and indicate a moderately-severe mixed obstructive/restrictive ventilatory defect without bronchodilator response. Gas transfer is relatively preserved. A CT chest scan does not reveal any notable change in the right lower lobe rounded atelectasis comparing back to 2015, although I do get a sense of increased pleural thickening bilaterally which is likely to be contributing to the …show more content…
I will have his imaging reviewed with a thoracic radiologist to ensure nothing has been missed on the scan. What has been noted on spirometry and indeed the previous VQ scan is that of airflow obstruction, but thus far Gerrit has had a disappointing response to Spiriva, Symbicort, Incruse and Breo Ellipta inhalers. He has also had some issues tolerating the inhalers with side-effects of cough and dysphonia. I have proposed a 10-day trial of oral prednisolone 25mg daily combined with twice daily Seretide with spacer. I have also suggested to Gerrit that referral to a pulmonary rehabilitation program may be worthwhile, but he is not keen on this. Gerrit also feels that he would not be able to undertake a cardiopulmonary exercise test and we have put this aside for now. He will give me a call in a month to provide an