OET letter for a COPD patient: oxygen, inhalers, smoking and breathlessness
In an OET Nursing letter about a patient with COPD or another chronic lung condition, give the reason for admission in one sentence, then describe current breathing in functional terms (how far they can walk, oxygen use and target saturations if stated), inhaler or medicine changes, smoking status and support, and what the reader must continue. Leave out the full blood-gas and X-ray story unless a result changes the reader's plan.
What the reader needs to know
Respiratory case notes, whether for chronic obstructive pulmonary disease (COPD), asthma or a chest infection on top of chronic lung disease, usually contain observations every few hours, oxygen changes, blood gases, X-ray reports, nebuliser doses and physiotherapy notes. A community nurse, GP, pulmonary rehabilitation team or residential facility does not need that history. They need to know:
- why the patient came in, in one sentence;
- how they breathe now, in terms of what they can do;
- what treatment continues: oxygen, inhalers, tablets, a course that is still running;
- what risks remain: smoking, poor technique, living alone, frequent admissions;
- what you want the reader to do.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Reason for admission (for example, a flare-up of COPD with a chest infection) | Every set of observations |
| Current breathing in functional terms | Full blood-gas values, unless they change the plan |
| Oxygen: how, how much, when, target range if given | X-ray wording when the result needs no action |
| New or changed inhalers and tablets, with doses | Each nebuliser given in hospital |
| Courses still running and when they finish (for example, steroids, antibiotics) | Courses already completed |
| Inhaler technique problems | Normal results |
| Smoking status and support offered | Unrelated past history |
| Home situation, stairs, support | Detailed pack-year calculations |
| Follow-up: rehabilitation, clinic, vaccination if the notes mention it | Routine hospital procedures |
Turning respiratory notes into sentences
| Notes | Letter sentence |
|---|---|
| Inf exac COPD, sputum ↑, green | "He was admitted with a flare-up of his COPD caused by a chest infection." |
| SOB walking 20 m, was 100 m pre-adm | "He becomes breathless after walking about 20 metres, compared with about 100 metres before this admission." |
| O2 2 L/min NP, target SpO2 88–92% | "He requires oxygen at 2 litres per minute through nasal prongs, aiming for oxygen saturation between 88% and 92%." |
| Prednisolone 30 mg, day 3 of 5 | "He is taking prednisolone 30 mg daily, with two days of the course remaining." |
| Poor MDI technique, spacer given | "His inhaler technique was poor, so he has been given a spacer and shown how to use it." |
| Smoker 15/day, wants to quit, NRT patch started | "He smokes 15 cigarettes a day but wishes to stop, and nicotine patches have been started." |
Copy oxygen flow rates, saturation targets and doses exactly. Do not turn "88–92%" into "above 90%": the two mean different care. For how to set out numbers and medicines, see vital signs and test results and medications in OET letters.
Abbreviations in respiratory letters
Respiratory notes are dense with abbreviations: SOB, SpO2, NP, MDI, NRT, ABG, CXR, LTOT. In the letter, write most of them in full or in plain words. A reasonable approach:
- Write in full: shortness of breath, nasal prongs, nicotine replacement therapy, metered-dose inhaler (or simply "inhaler").
- Acceptable after the first full mention: COPD.
- Keep the unit, not the label: "oxygen saturation of 91%" instead of "SpO2 91%".
See the OET abbreviations guide for the general rule.
Worked example (invented case)
Case summary (invented): Mr Tomasz Nowak, 69, retired bus driver, lives with wife in a first-floor flat with 14 stairs, no lift. COPD for 8 years. Admitted 3 May with increased breathlessness, cough and green sputum. Treated with antibiotics (finished 8 May), nebulisers and prednisolone 30 mg daily for 5 days (day 3 today). Oxygen 2 L/min via nasal prongs, target saturation 88–92%; now needs oxygen only overnight. Walks about 20 m before stopping (100 m before admission). Inhaler technique poor; spacer provided and taught. Smokes 15 a day; wants to stop; nicotine patch 21 mg started. Wife anxious about stairs. Appendicectomy 1979. Two COPD admissions this year. Discharge 9 May. Task: write to the community respiratory nurse.
Selection decisions:
- In: flare-up with infection, breathing now vs before, overnight oxygen and target range, prednisolone days left, inhaler technique and spacer, smoking and patches, stairs and wife's concern, repeated admissions.
- Out: antibiotic details (course finished), nebulisers, appendicectomy, former job.
Sample letter body:
Dear Respiratory Nurse,
Re: Mr Tomasz Nowak, aged 69
I am writing to refer Mr Nowak, who has chronic obstructive pulmonary disease (COPD) and is being discharged home today after a flare-up, for ongoing respiratory support at home.
Mr Nowak was admitted on 3 May with a flare-up of his COPD caused by a chest infection. This is his second COPD admission this year. He now becomes breathless after walking about 20 metres, compared with about 100 metres before this admission. He requires oxygen at 2 litres per minute through nasal prongs overnight, aiming for oxygen saturation between 88% and 92%. He is taking prednisolone 30 mg daily, with two days of the course remaining.
His inhaler technique was poor, so he has been given a spacer and shown how to use it. He smokes 15 cigarettes a day but wishes to stop, and nicotine patches have been started.
Mr Nowak lives with his wife in a first-floor flat with no lift, and she is anxious about him managing the stairs.
I would be grateful if you could review his inhaler technique and overnight oxygen use, support him to stop smoking, and consider a referral for pulmonary rehabilitation. Please contact me if you require any further information.
Yours sincerely,
Notice that "pulmonary rehabilitation" appears in the request because the letter has already shown the reason for it: reduced walking distance and repeated admissions. Every request should be supported by facts earlier in the letter.
Try a full case under timed conditions at /writing/, or check your own letter for an estimated mark on each criterion.
Mistakes to avoid
- Listing every observation. Summarise the trend and the current state.
- Vague oxygen instructions. "On oxygen" does not say how much, how or when.
- Forgetting courses still running. The reader must know when the steroid or antibiotic course ends.
- Ignoring smoking. It is often central to the plan.
- A request with no supporting detail. Each request should follow from something in the letter.
Related: social history in OET letters, discharge and transfer letters and selecting case notes.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines, oxygen settings and results are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.