D: How can I help you?

P: Hi, my son Dave who's 5 years old, who comes to the clinic quite often, has uh, his asthma has been really bad over the past few days. I've tried his puffers, but they're not really helping much, and I'm just worried about him.

D: So what symptom is he experiencing now?

P: Uhm so, he's just having this wheezing that just doesn't go away, like, I can actually hear it, it's frightening, he's having like he's having difficulties falling asleep, he's just been very irritable, uhm, he didn't go to school yesterday. It's just, yeah, it's just, it seems like, it's just, he's not eating well either.

D: OK, so yeah, it's been affecting, uh, sleep, appetite, his mood, has he been short of breath?

P: If he was like, he said that he was having some difficulty breathing, yeah. 

D: OK, has he, uh, able to talk like in full sentences, like, how is he right now?

P: Yeah, he's  able to talk in full sentences but he just gets a little bit breathless when he's eating, which I think is probably why he's not eating much. But yeah, he's able to talk, he's not talking much either, just been like, just been in a mood, you know, he gets a little bit breathless when he's crying.

D: OK, I see, and, has he had a cough?

P: Yeah he does, he does have a cough, yeah.

D: OK, and when did the cough start?

P: I want to say about two days ago.

D: OK, and has he been bringing up any sputum?

P: No.

D: Or any blood?

P: No no no. 

D: OK, and has the cough been getting any better or any worse?

P: It's been the same.

D: OK, uhm, and has he complained of having a sore throat or painful ears?

P: No, he hasn't complained of those. 

D: OK, and have you noticed any eye redness or or any discharge from his eyes or nose?

P: No. 

D: OK, and has he been having any chest pain?

P: Uh, no.

D: OK, and you mentioned, uh, a wheeze, have you been able to hear a wheeze like this before?

P: It's usually not this bad. 

D: OK, has he been having any abdominal pain?

P: No. 

D: Any nausea or vomiting?

P: No.

D: Has he had any urinary problems like, painful when he's going to the bathroom? 

P: No, he hasn't complained of anything like that.

D: I see, OK, and has he had any diarrhea or Constipation?

P: No.

D: OK, has he had any skin changes or rashes?

P: No, no, I checked for those very carefully. He used to get rashes when he was a child, but no, he doesn't, he doesn't have anything right now. 

D: Alright, and has he had any muscle aches or joint pains?

P: Uh, he's just been, he's just been not, he's not been as active as he usually is, so I don't, he hasn't said that any anything in particular about muscle pains, but I don't know if he knows how to, you know? He's just been, yeah.

D: OK, and two days ago, can you think of any triggers like, was there any exposure to dust or smoke or maybe even pets that could have brought this on?

P: Yeah, you know, if I think about it, he did go outside to play with his brother and, I don't know he might have got something out there maybe.

D: Yeah, uh, certainly possible and was it like a particularly cold day? 

P: Yeah, it was a very windy, little bit chilly too.

D: And when, like, during the winter time, does cold air trigger attacks for Dave?

P: Oh yeah. 

D: OK, and how about exercise?

P: No, I don't think, well, they went outside to play, so I mean he was, uhm, exercise does make it worse sometimes, so it could be that too.

D: OK, and so, has dave been experiencing any other symptoms besides the the wheezing and the irritability and what you've described so far?

P: No, I don't think so, that's, I think that's it.

D: OK, you tried some inhalers, how often have you been using them?

P: Yeah, we used his blue inhaler about five times yesterday, and another two or three times earlier today.

D: OK, and do you use a spacer?

P: Uhm, no we don't. I have to go get that and learn how to use it.

D: OK, for sure we can go through, Uh, the proper technique, throughout this visit as well, just to review that again.

P: I would love that.

D: That's great, and has he been using any other medications to help over these last couple of days besides the inhalers?

P: No, just the inhalers, we've also kept it the usual one, the one that he takes, the other inhaler.

D: OK, does he have one that he uses, once, like, he uses daily?

P: Yeah, yeah the one that he uses, I think the orange one.

D: OK, so he does use a steroid inhaler?

P: Yeah.

D: OK, and does he have any allergies?

P: Uhm, no he doesn't.

D: OK, and does he have any medical conditions that have diagnosed previously?

P: Just the dermatitis and asthma?

D: OK, and when was his last asthma exacerbation?

P: Last year. 

D: OK, has he ever needed to be hospitalized for one?

P: Oh no, no, nothing like that, he's a healthy kid. 

D: OK, that's good, has he had any surgeries before?

P: No.

D: OK, and in regards to birth history, were there any complications throughout pregnancy or with delivery?

P: Oh no, everything was normal. He was born via vaginal delivery and no complications. He was a healthy baby.

D: OK, and have you had any concerns with growth or developmental milestones?

P: No, no, the doc was pretty happy when he did the regular, the checkup and yeah things are good with him, he's a good kid.

D: Awesome, OK, and could you tell me a little bit about the living situation, like who's the main caregiver and who he's living with?

P: Yeah, so he lives with me, his dad and his brother who is 2 years older and he's not going to school right now. We're just keeping him at home due to Covid and trying to do some home schooling. I'm a homemaker, so I do have enough time to spend time with him and his older brother and, yeah.

D: OK, has anybody in the home been sick, either his brother, yourself, or father?

P: Uh, no.

D: OK, and anybody, at work or any other places that you maybe traveled to, that, uh, been around anybody who's been sick? 

P: Uhm, no, I don't think so. I don't think there was anyone that was sick.

D: OK, and have you traveled anywhere recently?

P: No, no. We're just staying at home.

D: OK, and are there any pets in the home?

P: No.

D: Alright, any carpets or like, uh, curtains or anything like that, covering the windows? 

P: No, we got all those removed when he had his big exacerbation last year. 

D: I see, OK, and does anybody smoke in the home, either cigarettes or marijuana?

P: Uhm, my husband smokes, but he smokes outside, he never smokes in front of the kids.

D: OK, I see, and uh, does anybody in the family, have any heart or lung conditions?

P: No, uhh, I have some, I have high blood pressure but that's it 

D: OK, any, like, congenital diseases that run in the family? 

P: No.

D: Or how about any genetic diseases?

P: No 

D: Cystic fibrosis or anything like that?

P: No no, no.

D: OK, uhm, so was there any other, anything else that maybe I forgot to ask about or I'm missing that you'd like to add today?

P: No, I'm just worried that he's going to have a big asthma attack like last year, I just also want to make sure nothing else is going on and if he can be taken care of and he's just, he's feeling awful.

D: For sure, yeah, we'll, uh, check his his vital signs and do a physical exam. And it does sound like it could be an asthma exacerbation, and so we can trial some inhaler medications, a little bit different than what you use at home. But also using Ventolin as well and we'll assess the need for potential, uh, antibiotics and also steroid if necessary and if his breathing gets worse or you're starting to hear that the wheezing is getting worse or his work of breathing is becoming more intense then certainly we'll need to add on some oxygen and possibly, some other therapies.

P: Thank you so much doc. 

D: Alright, thank you.