D: What brings you in today?

P: This afternoon, I'm just here because I've been experiencing some breathlessness as well as a bit of cough.

D: OK, when did it start?

P: So I think it's a it started around three months ago and I believe it's just been getting worse.

D: OK. Um, how often are you experiencing the shortness of breath?

P: I feel it like a lot of the time, especially outside when I'm in the cold or at at night when I go outside at night, my chest feels a little tight too at the same time.

D: OK, and how long does it last?

P: I would say it lasts up to an hour every time I'm out in the cold and then once I come back in. So I'd say it lasts at least one hour. 

D: OK, does anything else make it worse, like dust? You know, laying down anything like that? 

P: Sometimes when I'm near dust, sometimes when I'm running during gym class, increased activity does make it worse. 

D: OK, OK. And if you were to describe the quality of your breathing difficulties, is it more like a burning kind of feeling? Is it like you can't catch your breath? What does it feel like?

P: I think it's more just a I can't catch my breath and it feels like my my throat is just kind of like closing off and I can't take deep breaths.

D: OK, yeah, that's scary. And one to 10, 10 being the worst, how bad is your shortness of breath?

P: It can get up to I would say like an 8 at times. It can get pretty scary. And sometimes, like I feel like heaviness in my chest too when it happens. 

D: Yeah, and the coughing, has it been going on for as long as your breathlessness?

P: I would say around the same same time frame like 3 months, but I'm not always coughing. It comes and goes. 

D: OK, and for your coughing, is it kind of like the same triggers, the cold, dust, things like that? 

P: Yeah, I would say so.

D: And do you ever have do you ever cough up blood?

P: No, I don't. It's mostly just a dry cough. I don't cough up anything. 

D: OK so no sputum or phlegm, no? OK, do you ever feel wheezy?

P: I I I do hear like a like a weird sound when I breathe out sometimes, I I think it might be wheeziness.

D: OK, OK. Do you have a sore throat?

P: Uh, no I don't have a sore throat, no. 

D: No? Um, how about a runny nose or stuffy nose?

P: No, nothing like that.

D: Any changes in your smell?

P: No, no changes in my smell, no.

D: OK. How about hearing?

P: Uh, no hearing is fine.

D: OK and like no pus or liquid's coming out of your ear or anything like that, right? 

P: No.

D: No ear pain?

P: No.

D: OK, and how about your vision, everything OK there?

P: Yeah, everything is OK.

D: OK, any fevers?

P: I don't know about a fever, I haven't checked, but some nights I do, especially in the last week I have woken up feeling a bit chilly. I haven't really checked. 

D: OK, so you woke up feeling chilly, any night sweats? 

P: Uh no.

D: OK, any weight loss?

P: No no. 

D: How about changes in your skin? Like have you noticed a rash anywhere?

P: Uh, not that I've really noticed no, no rashes.

D: OK and any chest pain at all?

P: No, just sometimes when I I'm coughing a lot I feel a little bit of just tension and heaviness in there. But that's just when I'm like really coughing a lot. 

D: Yeah OK, and any any feelings like your heart's racing?

P: Nope.

D: No? OK. And how about swelling? Have you noticed swelling anywhere in your body?

P: No, nothing like that. 

D: No? OK um, OK, how about um, does your shortness of breath get worse when you're falling asleep?

P: No, nothing like that. I think it's mainly just worse if I go out in the cold or I'm like running around, doing more activities. 

D: Does it ever wake you up at night?

P: No never. 

D: OK and any nausea or vomiting?

P: No, no nausea or vomitting. 

D: OK, how about changes in your in your bowel movement?

P: No, bowel movements are normal.

D: How about in terms of urinating, any changes there?

P: No no.

D: OK any headaches? 

P: No.

D: No? Any dizziness or fainting spells?

P: No. 

D: Confusion, memory loss?

P: No, nothing like that. 

D: OK, good are you otherwise healthy?

P: Yeah, I don't have any other condition, I I do remember my doctors saying I have hay fever before, but that's about it.

D: When was that? 

P: I think that was like more than three years ago.

D: OK, um, any recent surgeries?

P: No. 

D: No? Are you on any medications?

P: I just take some Tylenol sometimes for the like Tylenol cold, sometimes for the symptoms. I don't think it has really helped.

D: No? OK, do you have any allergies? Not just to medications, but to anything else?

P: Uh just like hay fever but nothing, nothing else that I can think of, no.

D: OK. Um, are you up to date with all your immunizations?

P: As far as I know, yeah everything's up to date.

D: OK, any family history of lung conditions?

P: Uh, don't think so. My sister, I think she they were saying she might have asthma and she also has eczema. No one else in the family has any other conditions. 

D: Not not even like heart conditions, cancer?

P: No, uh no, not that I know. 

D: OK, OK, have you been in contact with anyone who's been sick recently? 

P: No.

D: No, OK, and any travel recently?

P: No, I've been here in Ontario. 

D: OK, and where do you live?

P: So I currently live in London, but I just recently moved into a new flat around two months ago.

D: Two months ago, OK. Um, is it more is it an older flat?

P: Uh, no, it's fairly new. But one thing I did notice, I don't know if this has anything to do with it, but my flatmate actually smokes. Sometimes that can really irritate and make me cough more sometimes at night. 

D: Yeah, any any pets?

P: Oh no, I don't have any pets.

D: OK and and do you smoke?

P: No, I don't smoke, no.

D: OK. And do you smoke marijuana?

P: Nope, never tried marijuana. 

D: OK, any recreational drugs?

P: No, I don't smoke marijuana or cigarettes.

D: OK, how about alcohol? Do you drink alcohol?

P: Um, just like, maybe sometimes at parties, but very rarely. Maybe I would say once a month.

D: OK, OK. Um, and is there anything that you wanted to discuss today that I missed?

P: Uh, so no, I think that that was all like just the shortness of breath was scaring me a lot. But yeah, just the coughing, but other than that I just want to know what's going on. 

D: OK, yeah, and you mentioned you are otherwise healthy so you don't have any history of asthma or anything like that, right? 

P: No, no ones ever told me that, but my sister has asthma, so I was wondering, maybe? 

D: Um, have you ever experienced shortness of breath when you were younger with like exercise?

P: Uh, not really. Just maybe like the normal amount. Like if I'm running around too much, I feel shortness of breath, but I think it just got worse over the last few months. 

D: OK and then have you ever had any imaging done in the past like a chest X-Ray or investigations like a pulmonary function test?

P: No, I don't recall having any of that done. 

D: OK alright well those are all the questions I had for you. If you didn't have anything else to add, I guess we will conclude by saying that what you have, we have a differential diagnosis for this. Um, it sounds like what you have is asthma. Since your symptoms started three months ago when you moved into a flat with your friends, and it seems like this smoking and cold is triggering that and so we'll work you up with a pulmonary function test to start and we'll see if bronchodilators will help with your symptoms. And if it doesn't, we'll also rule out other things like pneumonia or like allergic rhinitis. How does that sound?

P: Yeah, that sounds good. 

D: OK, sounds great. Well, we'll see you soon then.

P: Alright, thank you.

D: Take care. 

P: You too.