Zach Foster OET Letter

Case Notes

You are a doctor at Bayview Medical Clinic. You are referring a 22 year old man who has worsening asthma.

Patient details

Name: Mr Zach Foster

DOB: 25/10/91 (age 22)

Address: 77 Creek Road, Bayview

Medical history:

Asthma, since age 3 – problematic at times, 2 previous hospital admissions (most recent – 3 years ago)


Smoker – 4 years, 10-20/day

Allergies: cats, Hay fever

Medications: Ventolin prn, Pulmicort 200 mg one puff

Family history: sister (age 18) – asthma

Social history: Builder, single

Presenting complaint: For last (3 weeks)

SOB – when playing sport

Wheeze & cough – waking Pt at night

Use of Ventolin for symptoms

Treatment record


Preventive inhaler (Pulmicort): compliance unclear; claims to use inhaler some of the time

Burning sensation in lower part of the chest after meals – consistent with gastro-esophageal reflux disease (GORD)

Objective: Chest clear

Peak flow 500 L/min

Abdomen lax & non-tender

Tests: CXR, FBE

Diagnosis: Unstable asthma, possible trigger GORD


Ensure compliance with Pulmicort

Trial of pantoprazole (PPI) for GORD

Discussion about smoking cessation

Review 1/52 (after 1 week)


Review: Still smoking

Non-compliant with Pulmicort – forgets to take it

PPI – effective, nil side effects

Test results:

CXR – clear

FBE – normal


Use pantoprazole for another 7/52 (7 wks) then review

Discussion about Pulmicort missed dosage – take as soon as remember then back to normal. do not double dose

Advice on smoking cessation (eg. nicotine patch, information brochures, support groups etc.)

Continue current management, refer to respiratory specialist for lung function and advice about asthma management

Review appointment 7/52

Writing task

Using the information given in the case notes, write a letter of referral to Dr Williams, a respiratory specialist, for further management of Mr. Foster’s asthma. Address the letter to Dr Tanya Williams, Respiratory Specialist, Bayview Private Hospital, 81 Canyon Road. Bayview

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Sample letter

Dr. Tanya Williams

Respiratory Specialist

Bayview Private Hospital

81 Canyon Road,


October 18th, 2014

Dear Dr. Williams,

Re: Mr. Zach Foster, D.O.B. October 25th, 1991

I am writing to refer a 22-year-old man who has multiple risk factors that contribute to the development of recurrent asthmatic attacks. Your assessment of his condition by checking his lung function and recommending medications that might prevent similar attacks in future would be highly appreciated.

Today, Mr. Foster returned to discuss results of a chest X-ray and blood test which were unremarkable. He reported having a relief from reflux symptom after taking PPI; however, he has not adhered to Pulmicort use and continues to smoke. Obviously, he needs a treatment plan like a complete course of pantoprazole regimen, a better strategy to address a missed dosage of Pulmicort, an intensive smoke cessation program and a specialist’s advice on asthma management with pulmonary function measurement. Another review was scheduled after the next 7 weeks.

A week earlier, Mr. Foster presented here complaining of heartburn after meals. He also had a 3 weeks’ history of SOB after playing sport and nocturnal wheezing which led to an increase use of Ventolin. His physical examination and PEFR were completely normal.  His symptoms suggested unstable asthma because of ineffective use of Pulmicort, GORD symptoms and his smoking habits. Therefore, a trial of pantoprazole treatment for GORD was initiated. He was also advised to stop smoking. A chest X-ray and FBE were requested with a follow-up in a week period.

Mr. Foster, a builder, has suffered from asthma since age 3 and he required 2 admissions due to the disease the most recent of which was 3 years ago. He has eczema and allergic rhinitis. His current medications are Pulmicort 200mg twice daily and Ventolin as needed. His family history is significant with his sister suffering from asthma. Please note that he is a moderate smoker.

If you have any queries please do not hesitate to contact me.

Yours sincerely,


Manjusha Nambiar

Hi, I'm Manjusha. This is my blog where I give IELTS preparation tips.