I have been attending to her since 1994. Her record in this practice starts on 20/08/1992.
Mrs Cowan suffers from the following problems:
1. Severe asthma
2. Emphysema
3. IgG4 deficiency, a condition which manifests itself as a weakness of the immune system, resulting in an increased predisposition to respiratory infections. Such infections are usually prolonged and more severe compared with similar episodes in other individuals.
I believe that her emphysema and asthma are a consequence of the latter condition. She has no other risk factors for either.
Her typical history consists of developing an initially light respiratory infection, which appears just like a common cold. It than develops into an episode of bronchitis with a heavy productive cough, followed by attacks of severe asthma, resulting in considerable restriction to her breathing and loud wheezing, audible without a stethoscope.
These episodes occur in cycles, which run into each other. Sometimes it is impossible to prevent this as her infection simply cannot be cleared fast enough. Patients who receive antibiotics for frequent respiratory infections soon become "resistant" to these antibiotics (this resistance is actually carried genetically by bacteria normally resident in the respiratory tract and passed on to incoming offenders).
She usually requires antibiotics for approximately six weeks plus treatment for asthma, including prednisolone, a drug with debilitating side effects, in particular lethargy and muscle wasting. These do not normally matter for the first few days of treatment, but if the drug is used more than approximately twice a year, it begins to have these effects on a cumulative basis.
Mrs Cowan's main problem is the inability to prevent these episodes. Because such infections are common in the community and present as either mild colds or infections requiring a short course of treatment, she is at constant risk of contracting them whenever she goes into public places or uses public transport.
When she is continually ill for a number of months at a time (a frequent occurrence for her during winter), she is unable to accomplish any real physical work. It is a considerable effort for her to walk 20 metres between where she waits for her appointment and my consulting room. During these episodes she is also very dizzy (an effect of fever), which endangers her balance whenever she is upright.
When well she is able to walk approximately 200m without getting short of breath. She is able to perform some physical work such as light cleaning, but her general fitness is very poor because of the sheer percentage of her life spent on illness and inability to perform any physical work at all. She attempts to keep as active as possible, but her efforts cannot take her past walking short distances at a modest pace.
I enclose the list of her medications [the list attached is extensive].
Her prognosis is, unfortunately, more of the same. I cannot see her improve on the current situation, although, if she continues to receive aggressive treatment, she will not deteriorate further. However, she is at great risk of a major infection if a particular virulent respiratory pathogen becomes prevalent in the community.
In the future, however, it must be anticipated that she will suffer slow deterioration of her respiratory function. Little such deterioration had taken place in the past five years, but the nature of these processes is that they begin slowly and snowball in the last few years of life. It is likely that her respiratory function will contribute to her ultimate lifespan.
Mrs Cowan currently needs assistance with all heavy work, such as vacuuming or gardening. She needs intermittent assistance with all work (such as light cleaning, shopping) when ill.
She will continue to be a heavy user of medications and medical services. In the future, she may require transport assistance for the latter.
It is hoped that for the foreseeable future she will remain in her present accommodation with such assistance.