D: So I understand you're having some chest tightness?

P: Yeah, it's uh, for the last maybe three days, um it's not really pain, not in any specific spot, it just feels a bit tight in my chest area when I breathe in especially, and it just gets a bit harder to breathe and it feels more tight like especially when I go for my walks, which I do everyday, uh I try to walk my dog. So I was just, you know, worried that it could be something serious and I wanted to come and get checked out.

D: OK, for sure. So you said it started about 3 days ago. Have you noticed it's been getting better, worse or about staying the same?

P: I think it's staying the same.

D: OK, was there anything that happened 3 days ago that you can recall where you first noticed it?

P: No, nothing in particular um yeah, it just kind of came on and now it's been pretty steady.

D: OK and when it came on three days ago, what were you doing?

P: Uh I think I first noticed it when I was gone for my walk.

D: OK, now when you're walking, you say you have some chest tightness, do you have any chest pain? 

P: No, there's not there's not pain, it just feels like, when I breathe in it feels tight.

D: OK, did you feel anxious or sweaty or the feeling of impending doom at all? 

P: Uh, no I can't say that I did.

D: Nothing like that, OK, and did you feel yourself becoming out of breath at all?

P: Uh I I feel like it was kind of harder to get a whole breath, um so yeah, yeah, I guess.

D: OK, and was this tightness all across your chest or was it in one particular area?

P: Kind of just all over. 

D: OK. And since then, that happened when you were out for a walk, how many times does it happen a day would you say? 

P: Well, I feel like it's kind of always there, but it gets worse when I go for my walk. Um and well sometimes I go for more than one walk, right, 'cause I walk my dog. It's always kind of there, and especially when I'm like getting up out of the chair, I can feel it more, or when I take a big like a big breath in, as I said.

D: OK, so it's been there pretty constantly for the past three days, but it's more noticeable, if not worse, when you're going for a walk?

P: Exactly.

D: OK. Have you had any cough at all in the last little while?

P: Uh no like I feel a little more hoarse and like there's maybe some more phlegm, like I'm clearing my throat more, but I haven't actually been coughing.

D: OK, any fevers? 

P: No, can't say that, no.

D: OK, any night sweats, so waking up and the sheets are soaked?

P: No.

D: Any chills?

P: No.

D: Any unexplained weight loss at all?

P: Nope.

D: OK, and have you ever had anything like this happen to you before?

P: Uhm, I mean I have asthma um so I've had some trouble breathing before, it, this feels feels uh different than other times. I I guess it could be related, but uh I don't know, this this feels a bit different, that's why I wanted to come in and get it checked out.

D: OK, so you have asthma, do you use any puffers at the moment?

P: Yeah, I just use the one that um I take every day. I don't really use the uhm, the one thats as needed because I just haven't had to in a really long time so I didn't refill my last one.

D: OK, so you don't have any anymore of the as needed, but you have used it in the past?

P: Yeah, exactly like it's been a couple of years since I needed that, but I still I still take the daily one.

D: OK. And you haven't stopped taking the daily one in last three days either?

P: No, I always take it um so I'm supposed to actually take it morning and night, um for a while though sometimes I was skipping the night one because I didn't feel that I was needing it. Um so so lately I've been taking it everyday, but I've just been taking it in the morning.

D: OK, uh, what makes you say you haven't really needed the one at night? Have you just been doing well without it?

P: Exactly, like I haven't needed the rescue one in a few years and even when I was just taking it in the morning, I I haven't had any problems.

D: OK, understood. And then have you had, I should have asked, do you work currently?

P: Uh I I, I'm a financial advisor, I'm like semi retired so I do some stuff from home.

D: OK, got it. I suppose just, has this kind of chest tightness stopped you from doing activities that you normally would do, any missed time from work?

P: I haven't missed any work, but I'm not I'm not doing a ton of work right now. I don't think it would stop me, it just would make me uncomfortable um during work and it keeps me, maybe this, the last few days, it's kept me from, I usually go on a couple of walks a day, the last couple days I've just gone on one usually so yeah, it's a little bit, yeah.

D: So it's really not stopping too much of your day to day functioning, but it's noticeable?

P: Exactly, yeah.

D: OK. Now, is there any other issue that you see your doctor regularly for aside from the asthma?

P: Uhm, I have uh high blood pressure, I don't really see my doctor very much, I just am on um medication.

D: OK, how about we just talk about your medications a little bit? What are you taking currently?

P: Uh I take the, uh, salbutamol.

D: Yeah.

P: That we talked about, and I take um Ramipril.

D: Yep.

P: And, uh, sometimes a Tylenol if you know, if I have a headache or something, but not very often.

D: OK understood, so aside from the high blood pressure you're really not taking medications for much else?

P: No, no.

D: OK. Do you have any other lung issues or any trouble with your lungs in the past?

P: No, nothing major, just the asthma. But you know, like I said, it's been a few years since it has bothered me.

D: OK, got it, and just in terms of your life itself, so do you smoke at all?

P: No, never.

D: OK, so no smoking, any other recreational substances, drugs?

P: Oh no, no. I mean I I have um you know a few beers on the weekend, but I don't do very, I don't do any drugs and I don't drink much other than that.

D: OK, got it. Any allergies that you have?

P: Uhm no, no, like I, uh, when I was younger I got some seasonal allergies sometimes in the springtime, but other than that, I I like I, it's really been uh many years since I've noticed that.

D: OK, and so nothing new in the environment? You haven't changed where you've been living or you haven't introduced a new pet or a new dog?

P: Exactly.

D: OK, so sounds like you're pretty much staying the course last little while, just kind of a new onset of this new chest tightness, and aside from that, seems that it comes on mainly on walks outdoors, but you've kind of been limiting the, some of the medication you're taking for asthma the last couple of years because you haven't really felt that you needed it as much. 

P: Yeah, like just the morning was, it was enough.

D: OK. Alright John, I think I've got most of the information I need just to go talk to the doc and talk about your story. Next of course we're going to do a quick physical exam, going to take a listen to your lungs and see what else we might want to do in terms of investigations. I have a feeling that this actually might be your asthma reoccurring in some capacity or that would be on the top of the differential for now, barring any other new findings. So I think maybe what we would like to do is, we'd like to try having those rescue puffers available to see if that helps at all when you are on walks, and if they don't help, then we'll come back to the table and see what other possible directions we could head in in order to help you next. Does that sound good John?

P: Sounds great, I'm just, you know, glad to know that it's probably not my heart.

D: No, it sounds well, I suppose you said that you didn't really get out of breath with exercise, more sounds like a chest tightness, and you haven't had any pain associated with it, so that puts more cardiac ischemic pictures kind of lower on the differential. But of course we're going to try one thing at a time, and then we'll come back to the table um depending on how you're feeling after that, OK?

P: Sounds great, thank you.

D: No problem. OK, I'll go talk to the doctor, I'll be back with you in a moment.

P: Thank you.