Sibilant

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of wheezing

Severity is ‍mildmoderatesevere

Pattern ‍constantintermittent

Recurs ‍ times per ‍

Occurs most frequently during the ‍day

Worsening factors: ‍none

Alleviating factors: ‍noneinhalers, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍shortness of breath

‍chest tightness

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍sore throat

‍hoarseness

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍fatigue

‍night sweats

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍smokingpast smoking

‍occupational exposure to irritants

‍similar symptoms in close contacts

‍exposure to tuberculosis

no history of: ‍asthma, ‍COPD, ‍pneumonia, ‍allergic rhinitis, ‍recent upper respiratory infection, ‍GERD, ‍lung cancer, ‍tuberculosis

no use of: ‍ACE inhibitors, ‍beta-blockers, ‍inhaled corticosteroids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions





ASSESSMENT:

‍Asthma ‍likelysuspectedpossible

DDx: asthma, acute bronchitis, acute exacerbation of COPD, COPD, foreign body aspiration, heart failure, pneumonia, bronchiolitis, anaphylaxis, vocal cord dysfunction, tracheal stenosis, tracheomalacia, GERD, pulmonary embolism, lung cancer, eosinophilic bronchitis





PLAN:

Investigations:

- Chest X-ray

- Pulmonary function tests

- Allergy testing

Treatments:

- ‍Short-acting bronchodilators (SABAs)

- ‍Inhaled corticosteroids (ICS)

- ‍Combination inhalers with ICS

- ‍Montelukast

- ‍Antihistamines

- Oxygen therapy if SpO2 < 92%

- Ensure proper inhalation technique and spacer use

- Smoking cessation counseling

Further care:

- Referral to pulmonologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if wheezing worsens or if new symptoms develop such as chest pain, shortness of breath, or fever