D: What brings you in?

P: Hi, yes I just came in today because I've been a bit concerned about some breathing difficulties over the last few days. It all started out with like a cough over the last week, but now I'm having trouble breathing as well.

D: Oh OK, well I'm sorry to hear that. So you said a cough as well, so the cough at least a week back and the shortness of breath or difficulty breathing, when did that start? 

P: So yeah, the cough, I usually have a cough. I've had COPD for a long time, but this past week the coughing has been much worse with a lot of more sputum and. Other than that, it started I would say two to three days ago. The cough got worse and then every time I'm moving around I like have to sit down and catch my breath, which is pretty abnormal for me.

D: OK yeah, so alright. So let's focus on the cough first. You said it's a wet cough?

P: Yes, I am producing a lot of sputum. 

D: OK, what color is your sputum?

P: It's mainly like clear white.

D: OK yeah so you don't see yellow pus or anything green or bloody in there?

P: No, I don't think so. But there's definitely like a lot more than what I usually produce.

D: OK, umm this cough, does it sound harsh, barky or does it sound muffled?

P: I would say it's a bit harsh at times. I wouldn't say it's barky or muffled. I do find myself wheezing a little over the last few days as well. 

D: OK. Do you find you have any chest pain associated with the shortness of breath?

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

D: OK, and have you ever experienced anything like this before?

P: I did a couple of years ago, I had to be admitted because I had some shortness of breath. 

D: OK.

P: But that was, I think, two years ago. 

D: OK. And when you were admitted two years ago, did they tell you what you had?

P: Yeah, they said I had some kind of lung infection at that time, so they gave me some antibiotics while I was in the hospital.

D: OK, did they ever say to you that you had anything else like asthma, COPD, any longstanding conditions?

P: Yeah so I've had COPD for more than... I guess more than 10 years now so I think it just got a lot worse with the infection.

D: OK yeah alright. So this time around, have you had any fevers?

P: I've been having a couple of chills but like they would come and go. I didn't really think it was a fever.

D: OK, any weight loss?

P: No.

D: OK, how about changes in your hair or nails like or or skin like rashes? 

P: Umm, no. 

D: Any changes in your vision or hearing?

P: Nope. 

D: And how about smell or taste?

P: Umm, no. I think they're the same. 

D: OK. Have a stuffy nose or runny nose?

P: I do feel a bit stuffy, but it's not too bad. 

D: OK. And any swelling in your in your legs or upper limbs?

P: No, not that I know.

D: How about calf pain? 

P: Nope.

D: Dizziness or fainting spells?

P: No. 

D: Headaches?

P: No headaches. 

D: Memory loss or confusion?

P: Nope.

D: Changes in your bowel movement or abdominal pain?

P: Nope. 

D: Changes to urinating?

P: No, that's all fine 

D: OK, so besides the COPD, do you have any other longstanding conditions?

P: I do have some high blood pressure which I take, I think I take one of these medications called metoprolol. 

D: OK, and when was the last time you had your blood pressure checked?

P: Umm, probably like a month ago and it was pretty good. I've been checking by myself at home too and it hasn't been changing too much. I think the last one I took was probably like 135 / 80.

D: Oh, I see. OK, any hospitalizations besides the one that you had for COPD a year back?

P: Umm, back when I was a kid I had my tonsils removed.

D: OK, are you on any medications besides the metoprolol? 

P: I do take multivitamins.I think that's yeah, that's about it.

D: Do you take any puffers for your COPD?

P: Yeah, so I do have three like different puffers I take. I can't remember the name. I do have some puffers I don't take. I've been using them right now. It has been helping with some of my shortness of breath, but I've definitely been having to use them way more than I used to.

D: OK. Do you know which puffer you're on?

P: Yeah, so I think one of them is called ventolin. OK, and then I think the second one is called the Spiriva.

D: OK, sure, Yep.

P: So one of them should be a short acting beta agonist.

D: Just wanna make sure that you have one with a long acting and then the other one is a long acting beta agonist. OK, good. Alright, are you up to date with all your immunizations?

P: Yeah, I think so.

D: And are you allergic to anything?

P: No, not that I know.

D: Any family history of lung conditions?

P: Umm, no I don't think so. Yeah, no, I don't think so.

D: OK. How about heart conditions?

P: Yeah, my father died of a heart attack in his 60s. 

D: OK. Alright, any cancers?

P: My uncle had skin cancer. 

D: OK. Do you know what type of skin cancer like melanoma, basal cell, squamous cell?

P: No, I think it wasn't the bad one. It was like the one they can remove right away.

D: Oh I see. OK, OK, that's good.Do you smoke?

P: Yeah, I've been smoking for around, I would say the last 20 years.

D: OK, how much do you smoke?

P: Probably I would say pack a day for the last 20 years.

D: Umm, have you ever thought about quitting?

P: Yeah I did. I did once and then went back onto it. I definitely do smoke less than before though. OK, but yeah, I don't think I'm ready to quit yet.

D: OK, yeah no problem. Do you drink alcohol? 

P: Umm, yeah, maybe once a week I would have a small Cup of whiskey.

D: OK, sure, that's fine. And any other drugs?

P: No, no marijuana, no other drugs.

D: OK, and where do you live right now?

P: Right now I live in a small bungalow in London. 

D: OK, any reasons to believe there are carpets, dust, mold, asbestos, anything that could be triggering your COPD?

P: Umm, I don't think so. Everything is pretty up to date.

D: OK, have you had any contact with anyone that's been sick recently?

P: No, I've been mostly trying to isolate and like just be in my own home. 

D: OK, how about travel to anywhere?

P: Nope, I've been in Ontario since the beginning of the pandemic.

D: Yeah OK, that makes sense. Well, those were all the questions that I had for you today. Did you have any questions of your own?

P: Yeah, I was just worried if it can be COVID or if it's just like another infection that I had like before.

D: Yeah, so we're definitely going to do a COVID swab on you and those results should take about 24 to 48 hours to come back to you. And in the meantime, because your symptoms do overlap with COVID, you should isolate for 14 days. Public health will be in touch with you if it's positive to do some contact tracing. If it's not COVID, it could be another viral infection that's been going around during this time of year which is likely because you have COPD, since you're already coughing more than you usually are and seeing more sputum. We will reassess to see whether your puffers are working. If we need to add any additional things like inhaled corticosteroids as well as antibiotics and so just keep an eye on your symptoms for now and will also want to do probably a chest X Ray and possibly a pulmonary function test. How does that sound?

P: Thank you. 

D: OK yeah no problem.