D: Um, what brings you in today?

P: Uh yeah, hi, I just came in here today cause uh, lately, for the last couple of months, I've been getting these coughing fits. They don't really seem to be going away and I was a bit concerned.

D: So you've had this, when did this start?

P: Uh, I would say probably during the winter uh it, it kind of started, where I started having um, just coughing fits when I'm walking to school and then also during like gym class I started having these coughing fits and sometimes I also felt like I couldn't breathe.

D: Um, okay. Okay, what did you, is there anything, so it's basically worse when you're um, doing some sort of an exercise such as walking um, or being in the gym class, and it's also worse in the cold?

P: Yeah. Yeah, and then also like, I remember when I was walking down the street and someone was smoking and then I just completely just started having that episode right after I walked past them.

D: Okay um, alright. Uh um okay, sorry, one moment. Okay um, so is there anything that makes your cough better? What do you do to make it go away?

P: Uh, I just basically have to, if I, if I'm doing any kind of activities, just take a moment, sit down for like 10 to 15 minutes and then it seems like it goes away on its own.

D: And you said that sometimes you also have difficulties breathing with it?

P: Yeah, like a couple of times it got really bad where I had to um like, it was difficult get, it was, it was like I was trying to take deep breaths for air, but uh it was, it just felt like I couldn't.

D: I see. So this started a couple of months ago, has this ever happened to you before that?

P: No, before that I've been fine.

D: Okay, and so I'm going to ask you about a couple other symptoms. Let me know if you've experienced any of these in the past couple of months. Um, so have you had a headache that accompanies the cough? 

P: Uh no.

D: Um, any changes in your vision or your hearing?

P: No. 

D: Any confusion? 

P: No.

D: Um any, um, runny nose or stuffy nose or sinus congestion?

P: Uh no, not really.

D: Okay, any sore throat? 

P: Uh no.

D: Any um, chest pain?

P: Um, sometimes when I get like really bad coughing fits, like it sometimes starts hurting in my chest as well. 

D: Yeah. Um, does it go away when you stop coughing?

P: Yeah, it goes away after, I just take some rest. 

D: Um, have you had any belly pain? 

P: Uh no, not at all.

D: Do you feel like your heart's racing? 

P: Uh, no.

D: Any changes in your, any nausea or vomiting?

P: No.

D: Any changes in your bowel movements?

P: No. 

D: Any acid reflux?

P: Uh, no. 

D: Okay, um, and any certain muscle aches or joint pains?

P: Um no, nothing like that. 

D: Any numbness or tingling in your arms or legs?

P: No.

D: Okay, let's get back. Okay, great, it sounds like that the, the cough is sort of the main symptom here that you have. Um, is the cough dry or wet?

P: It's usually uh, it's usually dry.

D: Uh sorry, can you say that again?

P: It's usually dry.

D: Okay um, have you ever brought up any sputum or any blood?

P: Uh never any blood, I have like on occasion, like sometimes brought up some sputum.

D: Okay, alright. Um okay, and, uh, have you been vaccinated?

P: Uh, yeah, all my immunizations are up to date.

D: Okay, good good good. Um, does the cough sound like a barky cough or a muffled cough, or um, does it have a specific characteristic? Does it sound different than when you're sort of coughing to clear your throat, for instance? 

P: Uh yeah, it's like pretty, it can get pretty harsh. I also noticed like uh, there's like this weird noise I started making like right after when I'm trying to take deep breaths in.

D: Okay, okay. Okay, so you're wheezing. Okay, so you ever um, cough so much that you end up vomiting?

P: No, no that hasn't happen yet. 

D: Um, and do you, so you mentioned that it's worse when you're in the cold or exercising, and smoking makes it worse? What about things like dust or pollen? Um, say when you're cleaning the house and there's also dust, does that make things worse, or is it worse in a specific time of the year when you're outdoors?

P: Uh, now that you mention it, yeah, like if we're ever in the basement or anything like that, I, I do start getting like kind of irritation um, in my throat, and that kind of, sometimes I have also coughed at those times.

D: Alright. Uh, can you tell me, okay so, can you tell me if you have any medical conditions that you've been diagnosed with? 

P: No, nothing else, I've been pretty healthy. 

D: Okay. Had, did, when you were a child, did you have any sort of rash? Did you have eczema?

P: Oh I, yeah, so I did I, at one point I was using like this cream um, probably when I was ten. Just for some eczema on my hands. 

D: Okay. And um, have you ever had allergic rhinitis, which is basically sort of having um, red or teary eyes, itchiness on the face, a runny nose at certain times of the year, or in um, areas with mold or dust, or termites and things like that? Have you had anything like that as a child or right now?

P: Uh, not that I know of, no.

D: Okay. Alright, uh do you have any, um, I guess going back, were you a healthy child, growing up?

P: Yeah, as far as I know, I, I didn't really have any concerns from like the school or home at all.

D: Okay, that's great. Do you uh, did you ever have any hospitalizations? 

P: No.

D: Any surgeries? 

P: No.

D: Are you taking any medications?

P: Uh, no medications.

D: Are you still using the eczema cream?

P: No, no. That kind of just went away on its own, or like right after I used the cream. Like it's good now. 

D: Okay, good. Are you allergic to anything?

P: No, I don't think so. Maybe just like environmental allergies sometimes, in the springtime.

D: What happens then?

P: Um, just sometimes like uh, I don't know if it's like a pollen allergy like I, I do get some, I guess I do get like some nasal congestion and things like that. 

D: Um, have you ever seen an allergist?

P: No, I haven't.

D: No. Uh, who prescribed the cream for the eczema? 

P: Um, just a, it was like at a walk-in clinic.

D: Okay, okay. Um alright, and do you have any family history of any um, lung-related problems? Or any other problems?

P: Um, my older sister has asthma, and uh, I don't know if anyone else in the family has asthma. Um, I think my father has high blood pressure.

D: Alright, and you mentioned that things are going well at school. Um, who do you live with at home?

P: Yeah so I live with my older sister, and my mom and dad.

D: Okay, okay. And things are good at home? Do you feel safe?

P: Yeah, yeah, I feel completely safe.

D: Any concerns about bullying at school?

P: No, no, not at all. 

D: Okay are you uh, are you taking any marijuana or any street drugs?

P: No, no, my parents would kill me.

D: What about alcohol?

P: Uh, I'll come, I've, I haven't tried it um, yet, at all.

D: Okay, okay. Just wanted to mention that the conversation that we're having right now is confidential between you and me. Um, unless you mentioned anything that harms you or harms anyone else so, so feel free to discuss whatever or talk openly about um, any issues that you have. Um, okay, and um, are you sexually active?

P: No, no. 

D: Alright, okay. So um, that's all the information I needed. Uh given that you've had these coughing fits for the past couple of months that are, that have certain triggers, uh, and also given that you've had a history of eczema, and your sister has asthma, so kind of, sort of runs in your family in a way. You might also have a diagnosis of asthma potentially. Um, and so, what I would recommend is that you get um, testing done and um, uh I guess before I sort of talk a little more about this, I just want to get a sense of how severe your asthma, if it's asthma at all, um if, does it, does it affect your ability to, you said school was going okay, does it affect your ability to do well at school at all?

P: Um definitely in, in gym class, but other than that it hasn't really affected me.

D: Does it wake you up at night?

P: No, so far no. I, I like, I get pretty good sleep.

D: Okay, okay. Um, and how often, I guess is, do these episodes occur? How many times a week, or how many times a month?

P: Uh, so they just started like two months ago, and I've had like maybe four or five of them in total.

D: Okay, okay. Uh, and they kind of get better on their own. Okay, so we can sort of talk about these, sorry, puffers that you might need to, to use as needed. Um, your sister might have some of those, so you might be familiar with what I'm talking about. 

P: Yeah.

D: Um, so we can talk about that. Um, given that your symptoms are, yes, they've been occurring for the past couple of months, but because you have had a cough, it might be a good idea just to have a COVID test done once. Um, I don't think that's what you have, seeing that this, these symptoms have been lasting for, have been occurring for the past two months, so we'll just kind of do that test to rule it out. Um, in the meantime, I would recommend that you um, try this inhaled corticosteroid puffer that you can use, that you should use on a daily basis, and try to avoid uh, the triggers. So the things that you, that cause these symptoms. Um, we can go over how to use uh, a puffer properly and I will also give you a spacer, which will help deliver most of that medication in the, uh, to your lungs. Do you have any questions?

P: Uh no, I don't have any questions at all. Thank you so much.