D: What brings you in here today?

P: Yeah, so over this past five days I've had um worsening shortness of breath and uh some discomfort in my chest um and this cough that that's been getting worse as well.

D: OK, so it's just been for the past uh past week or five days?

P: Yeah, I mean I've had um a cough and uh in the in the in the past, and and and shortness of breath in the past. But yeah, just over these past five days it's been there um at all, like it's been there all day and it's been getting uh worse as well.

D: OK, and what is the cough like? Is it wet or dry?

P: Yeah, I'm bringing up sputum uh pretty much um like every time I'm coughing up I'm bringing up some yellowish or greenish uh sputum.

D: OK, and have you noticed at all any blood?

P: No, no, no blood.

D: No blood, OK, um and how much sputum are you bringing up like uh every time you cough?

P: I I would say its um would would be the like just the little inside of my uh palm each time.

D: OK, and uh is this uh, and then what about the shortness of breath, is it uh are you having trouble taking deep breaths or do you find yourself breathing faster? Like how would you describe it?

P: It's um yeah, I'm just really feeling like I just can't, uh catch my breath even with um some small things around the apartment uh that normally I can do, it's any type of exertion, I just can't catch my breath. I'm OK right now just sitting here though.

D: OK yeah, so at rest you're fine but like when you exert yourself, it gets worse.

P: Yeah, well I'm I still have this like uh chest discomfort. Um so while while sitting here, it doesn't feel um like my breathing is normal.

D: OK, and when do you get that chest discomfort? Is it when you're breathing in or breathing out or it, can it be just due to exercise?

P: It's it's kind of just always, it's just kind of been there over these past uh like four or five days.

D: OK, and how would you describe uh, is it pain at all or is it like sharp stabbing or pressure like pain?

P: Um no, nothing like that. I kind of I just I feel congested I guess.

D: OK, um so just discomfort. Do you do your symptoms get worse at all when you're laying down flat?

P: No. 

D: No, OK. Uh, do you wake up at night gasping, gasping for air?

P: No, I haven't done that before.

D: OK, um have you had any fevers or chills?

P: Yeah, uh now that you mentioned, I do think I I feel a bit feverish. Um uh yeah, and I I've noticed that actually over the last uh couple of days.

D: Oh, have you had a chance to take your temperature at all?

P: No, I just felt feverish. 

D: OK, um do you have any other symptoms like um sore throat, runny nose, anything like that?

P: No, I don't.

D: OK, um have you traveled at all recently?

P: No, I I I I've been been home.

D: OK, have you tried anything to help you with your symptoms?

P: Yeah, I I did try uh, using an inhaler. I have um a couple up those and um usually that that helps, but hasn't really been able to um help much this time.

D: OK, um how often are you having to use it?

P: Um so uh I I used it um I I took three or four puffs this morning and um and that was about it. I was using it last night as well, uh but typically I will use it maybe two or three times a week. 

D: OK. Um and have you had any headaches or changes in your vision or anything like that?

P: No, I haven't noticed anything like that.

D: OK. Any nausea or vomiting?

P: No.

D: Um any increased fatigue?

P: I, I mean, I haven't been able to do as much with uh being so short of breath, but my energy has been been OK.

D: OK, and how about um, do you have any sensation of palpitations or your heart is racing at all?

P: No, I haven't felt anything like that.

D: OK. Um and any kind of diarrhea or constipation?

P: No.

D: OK. Any issues with urination?

P: No, uh no problems there.

D: Uh any changes in your sleep or appetite?

P: Um no, that that's been pretty good.

D: OK, any night sweats?

P: Uh no, I haven't had any night sweats.

D: OK. Um any kind of uh significant weight change recently?

P: Um I I I might have, uh no, I think my weight's been about the same.

D: OK, um any exposure to anyone sick around you recently?

P: No, I don't think so. Um but I I've had I've had a couple of uh chest colds over the last year that I needed um antibiotics for uh and it, they they went away after that, I got that, those from a walk in clinic.

D: Sorry, you got antibiotics from the walk in clinic?

P: Yeah, the last time was uh probably about about four months ago.

D: OK.

P: So I haven't been around anybody sick recently, but um but I mean I I've had similar symptoms um before, I feel like this time might be just a bit worse though. 

D: OK. Um and do you have any past medical history? Uh any conditions you've been diagnosed with?

P: Um yeah, so I I have been I've been diagnosed with COPD uh as well as uh, high blood pressure and uh GERD.

D: OK, and when were you diagnosed with COPD?

P: Uh about three years ago.

D: Three years ago, OK. Do you take any medications for any of these conditions?

P: Yeah, so I have a medication uh Ventolin, I take Symbicort daily um which is like a steroid type medication. And then um I take an ACE inhibitor I think for blood pressure and just Tums or something like that if my reflux is bad.

D: OK. Um and do you have any allergies to any medications? 

P: Um, no.

D: No, OK. Any past hospitalizations or surgeries?

P: Um, no. 

D: OK, any family history of any medical conditions, any lung or heart conditions?

P: Uh nothing like that, no. 

D: OK. Um and any cancers in the family?

P: Um, no. 

D: OK. Um and any, currently right now, what's your living situation like?

P: Yeah, so um I'm living with um with just my uh daughter in a in an apartment. 

D: OK. Um and currently do you work?

P: Yeah, so I I've been working at the um at the grocery store. Uh yeah, I've been at the grocery store.

D: OK, and do you smoke currently?

P: I do, yeah. Uh I smoke about a pack a day. Um and I I've smoked for, now well, probably like 30 or 40 years. I used to smoke more. 

D: OK. Um you have cut down, that's good. Um yeah, definitely the more you cut down, and if you need to talk about quitting, there's a lot of resources that we can go through. Um do you use anything else besides uh cigarettes, like any marijuana or any other drugs?

P: Uh no, no, just just cigarettes.

D: OK, um and any alcohol?

P: Uh yeah, I mean I'll have some uh wine with dinner on the weekends, but that's about it. 

D: OK. Alright, so those are all the questions I had for you. Do you have any questions?

P: No, that was, uh, about it I was uh I was wondering if you think I I have an infection or is this uh COPD acting up, or what's going on?

D: Yeah, so definitely with your history of COPD and um these symptoms, it can just be an exacerbation of your COPD and that can happen sometimes when you have COPD and then you get a either viral or bacterial infection and that makes your symptoms worse, and you've also had a fever, so we'll do like a full physical examination, get your vitals, everything, but uh and then we'll give you some uh like nebulized like um for your home puffers too, but all just in the hospital and monitor your response to them. Uh and then we'll also get like your, some of your blood work and chest X-ray just to see if there's any like pneumonia. And lastly we'll just get like a Covid swab done since some of these symptoms also overlap with Covid symptoms. Um and yeah so we'll, so that's what we'll do um and I'll let the emergency department know that you're on your way. I think you'll need to get all those tests there, and then they'll decide whether or not you need any kind of admission or you can just go home on antibiotics um from there, OK?

P: OK, that sounds good. Thank you.

D: Yeah yeah alright take care.

P: Bye.