D: I was uh, wondering what I could help you with today?

P: Yeah hi, um, I have been coughing nonstop for the past three days, and today I have been feeling very short of breath. So I just wanted to get it all checked out.

D: Yeah, for sure. And, so you said the cough started uh, three days ago. Were there any triggers to the cough or anything that, uh that changed three days ago?

P: No, nothing that I can think of um, I have, like the only thing that I've been doing is going to the grocery stores, uh the bank, and laundromat. Um, and once I ran all these errands, like, I just started having this coughing fit that hasn't stopped. 

D: Okay, uh, has the cough gotten any better, or stayed the same, or gotten worse these past three days?

P: Uh, it seems like it's getting worse. 

D: Okay, are you bringing up any uh, sputum or phlegm? 

P: Um yes, it's yellow.

D: Okay, is this um, any different from before? Like have you had a cough in the past and, and brought up phlegm, or is this entirely new for you?

P: Um no, this has happened to me before, um, like I don't know, like maybe a year or two years back. Uh, and it kind of feels the same, but just a little bit worse.

D: Okay. Um, and uh, have you seen any blood in the sputum?

P: No, no blood. 

D: Okay. Um, and you mentioned you've been short of breath as well. Uh, how has that come on?

P: Um, it was, I, I don't know if it's because of all the coughing that I've been doing, but it just started this morning.

D: Okay, um, and have you been experiencing uh shortness of breath um, on exertion otherwise, like prior to this?

P: Um no, no.

D: Okay. And have you had any shortness of breath after, like if you lie down flat?

P: Um, no, not that I've noticed 

D: All right, and have you had a wheeze? 

P: A little bit, yeah.

D: Okay um, uh, and have you had any um, infectious-like symptoms such as like red eyes, runny nose, or, or a sore throat?

P: No, nothing like that. 

D: Okay, um, have you had any, any chest pain?

P: Nope, nothing like that. 

D: Have you had any lightheadedness or, or feeling dizzy? 

P: No.

D: Or feeling like your heart's racing or, or beating really fast?

P: No.

D: Okay. And, um, have you had any fevers or chills?

P: No, not that I've noticed.

D: Have you had any night sweats?

P: No. 

D: And how has your weight been over the last several months? Have you had any weight loss or gain?

P: Uh no, it's been pretty stable. 

D: Okay. Um, and have you had any abdominal pain?

P: Um, no. 

D: Any diarrhea?

P: No.

D: Or any urinary problems?

P: No. 

D: Okay. Um, and in the past um, oh sorry, before that, have you had any nausea or, or vomiting? 

P: No. 

D: Okay. Uh, and any confusion or, or changes to um, um memory?

P: No.

D: Okay, uh, or loss of taste or sense of smell?

P: Uh no. 

D: Okay uh, so the, you've been experiencing this cough that's been getting worse over the last couple of days, as well as bringing up some yellow sputum, um, and been short of breath. Have you been experiencing any other symptoms?

P: No, that's pretty much it. 

D: Okay. Um, and in the past, have you um, been diagnosed with any medical conditions?

P: Um, I have diabetes, I have high blood pressure and I have high cholesterol.

D: I see. Alright, and do you take uh, medications for those things?

P: Yes, so I am on ramipril for the high blood pressure, rosuvastatin for the cholesterol, and insulin for the diabetes.

D: Okay, thank you. And uh, you mentioned you had a similar episode in the past. Um, what, uh, were you diagnosed with COPD before?

P: I was, I was diagnosed with COPD about five years back.

D: Okay, did you have pulmonary function tests for this? The test where you had to breathe into a tube.

P: Um yeah, I had that done like five years ago.

D: Okay, um, alright um, just wanted to see if it was uh like formally diagnosed. Sometimes people uh, um, yeah, it's important to have that, uh, those tests done. Um, and do you have any allergies?

P: Um, no none. None, yeah.

D: Okay. Um, and uh, are your immunizations up to date?

P: Yes, I believe so. 

D: Okay, um and have you had any surgeries or, or um, hospitalizations?

P: Um, I had my Gallbladder removed when I was in my 50s. Um, and I had a hip fracture three years ago.

D: Okay, and how is your mobility now?

P: Um pretty good. My hips still give me some issues once in awhile, but um, for the most part, it's been okay.

D: Okay, that's good. It sounds like the rehab went well.

P: Yeah.

D: And uh, right now, can you tell me um, a little bit about your living situation? Like where you're living and who you're living with?

P: Um, I live by myself in an apartment on the 1st floor.

D: Okay, um and, do you smoke cigarettes?

P: Uh no, I quit two years ago.

D: Okay, and that's, that's great. Um, prior to that, how long did you smoke for, and how much?

P: Oh, for like 40-plus years um, I used to smoke a pack a day.

D: Okay, well that's great that uh, that you quit, so congratulations.

P: Thank you. 

D: And do you drink alcohol?

P: I drink once in a while. Like maybe every other day, I'll have a glass of wine.

D: Okay, and um, uh anybody, or sorry, have you been around anybody who's been sick recently? 

P: Uh no.

D: You said you went to the stores and stuff like that. 

P: Yeah, maybe from there, yeah.

D: Okay, and have you traveled anywhere else, outside of the city?

P: Um, not recently, no. 

D: Alright, um, and any exposures to any like dust, chemicals, things like that?

P: Um, I live in an old building so maybe. Um, but it hasn't bugged me before.

D: Okay, uh, and are you working currently or, or retired?

P: I'm retired.

D: Okay, well, what did you do before? 

P: I used to work uh, on the assembly line for Chrysler.

D: Okay, were there any exposures uh, there that you were aware of, like things that you were breathing in?

P: Uh not that I was aware of, but they were always like smoke and fumes and things like that because it was like a factory, so maybe.

D: Right, okay, that makes sense. Um, and in the family, are there, anybody who, who's had problems with their hearts or lungs?

P: Um, my mom had lung cancer when she was 50. And, like, all the, like diabetes, hypertension and high cholesterol runs on my, ran on my father's side of the family.

D: I see, did anybody have uh, heart attacks or, or stroke?

P: Uh, yeah, so my father had a heart attack when he was 49. Uh, stroke I'm not too sure about.

D: Okay, thank you. And, um, so that was all I wanted to ask about. Um, was there anything else that you wanted to add that I maybe forgot?

P: Um, no, that's about it, but I, how can I treat myself now? How do I make this cough go away?

D: For sure, so, um, we will first get your vitals here and we'll see if your oxygen levels um, are low, then it would be important to put on some oxygen first, um, just to make sure that that's stable. Um, and from there we will um, get a chest x-ray um, and uh, run some lab work to, to try to help figure out the, the diagnosis better, but in the meantime, we'll use um, some inhalers because it's possible that this is a COPD exacerbation similar to uh last year, um, and the inhalers should help open up the airways and dilate, so make breathing easier, and then um, also if it is a COPD exacerbation, it will likely require antibiotics, as well as some steroids for the, the inflammation for five days. Uh, but since your symptoms currently overlap with uh, COVID as well, you'll have to get a, a COVID nasal swab.

P: Okay, okay for sure.

D: Okay, so uh, we'll get that started.

P: Okay. Thank you so much.