D: So what brings you in today?

P: Yeah, I've had, I've had a cough for a number of years now, but store these past like day, it's gotten a lot quite a bit worse and I've been really short of breath.

D: OK, and so how many days would you say you've been short of breath?

P: Less than a day, maybe just really kind of started last night and has carried out throughout this morning. I, I called this morning to get an appointment.

D: OK, and it, was it brought on by any activities or were you doing anything at that time before it started?

P: No, last last night I was, well, I was just doing my regular kind of routine after dinner - cleaning up and just the cough started first. And over, the over the night it got worse. I could just couldn't catch my breath and that was similar this morning.

D: OK, so you've also had a cough.

P: Yeah I have. Yeah, uh, I've had a cough for a long time now, but it's been worse over this last day.

D: Yeah, is it like a wet cough or dry cough?

P: It's wet, I I'm bring up sputum most of the time, but it's been, it's usually like white or clear and it's a lot more like, uh it's a lot more greenish, yellow and, yeah.

D: OK, and are you having any kind of fevers or chills anything like that?

P: Uhm yeah I, I did have some chills last night, so I'm not sure about a fever though.

D: OK. And are your symptoms at all, so you do have a shortness of breath, but any kind of chest pain at all?

P: I do have some chest pressure for sure. I just feels like I can't, can't ah, catch my breath.

D: OK, so is it mostly related to your breathing or do you have it at rest? Or do you have it with any exertion?

P: Yeah, I think it, it's there kind of most of the time, like the chest pressure. I kind of feel it throughout my chest when when I'm breathing but, but also just kind of sitting here I can kind of feel it.

D: OK I see. And are all of your symptoms constant? Or do they come and go?

P: They've been constant and they've got been getting worse since since last night. 

D: OK, and have you had this happen to you before?

P: It has, yeah, I, actually last last winter I was hospitalized for a COPD exacerbation for, for a few days. I I know I got some antibiotics and umm, I needed some oxygen.

D: I see and did you go home on home oxygen at all? Like do you use oxygen at home?

P: No, I was told I didn't need any any yet, but if I didn't quit smoking I might in the future. 

D: OK, and are you using any kind of puffers at all?

P: Yeah, I I do I I use I think it's called like Spiriva or something like that. I use that every day and there's another one that I'll use like if my symptoms are getting bad. My blue one. I did try that actually last night and it didn't, it helped a little bit, but, not not enough.

D: OK, so have you just tried like tried it one time last night? Have you tried it after that?

P: Yeah, we just tried it last night.

D: OK, so nothing today right?

P: No, nothing today. 

D: OK. Other than that, so you did have an admission before for this. And you have COPD. Do you have any other symptoms right now? Like runny nose, sore throat, any cold like symptoms?

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

D: Did you have it before these symptoms started? 

P: Uhm no, I've been feeling, I've been feeling OK.

D: OK. And have you traveled at all recently?

P: Uh, well, I did, I just go up to the trailer not too long ago to visit some family, but that's just an hour away.

D: OK. Anyone sick around you recently?

P: No, I don't, I don't think so.

D: And is there, are you having any headache or nausea or vomiting?

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

D: OK. And besides the time you got hospitalized, have you had any exacerbations after that?

P: No, I just had that, had that happen, the one time, last year.

D: OK. And do you feel that your symptoms are similar, worse, or how do they compare to last time, if you remember?

P: Pretty similar. I think last time I was worse, but I waited longer last time and so that's why I was concerned and and wanted to come in early.

D: OK. OK, uh, alright, so uh, have you had any fevers at all or chills?

P: Yeah, I've I've had some chills last night like I just couldn't get warm. I was loading up on blankets and it didn't seem to help.

D: OK so we'll get a temperature on you today as well. Do you feel that you're breathing faster at all?

P: Uh, not necessarily it, just it just harder to to, feel like I can't catch my breath.

D: OK, do you feel fatigued at all?

P: Ah yeah, I I have a, I mean I have been feeling just tired this morning, but I think that's more to do with the fact that I just can't really do a whole lot of exertion because as soon as I move around I'm, I can't breathe.

D: I see. Uhm OK, and are you having any kind of diarrhea, constipation, or any urinary troubles at all?

P: No, I'm not.

D: OK. Any changes in your sleep or appetite?

P: That's been that's been normal. Been eating well.

D: OK. Any kind of confusion or any do you feel like yourself?

P: Yeah, I do. 

D: OK, any confusion at all that anyone's noticed?

P: No, I don't think so. I feel like that's been ok.

D: Any wheezing?

P: Yeah I I have noticed some wheezing. It's usually I usually, uh well I've been told I have a wheeze, but I can actually hear it right now.

D: OK, yeah, we'll do like a full physical examination as well. And we'll get like your oxygenation level and everything like that. Umm, do you have any, besides COPD, so when were you diagnosed with you please?

P: About 10 years ago.

D: OK, do you have any other medical conditions?

P: I do, yeah. I have a high blood pressure, type two diabetes and like and there's something wrong with my, with my kidneys as well. I think my EGFR is low or something like that. 

D: Oh, I see, OK. And do you take any medications besides your puffers? 

P: Yeah, I I do. I I take on an ACE inhibitor, Metformin, SGLT2 inhibitor and I'm also taking a, uh, a water pill as well 'cause I, over these last couple of years I've had some more swelling in my in my feet.

D: OK, I see. Do you have any swelling, increased swelling right now?

P: No, I that's been about this. Been pretty constant. 

D: OK. And do you feel recently at all that you're short of breath when lying down, or do you have to wake up to take a deep breath? Anything like that?

P: No, I haven't only brought issues like that.

D: OK, any any kind of dizziness or fainting episodes?

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

D: OK, any increased sweating associated with your chest tight or pressure or anything like that?

P: No, no, I haven't been sweaty.

D: OK. Yeah. And other than that, any previous surgeries in the past?

P: Uhm, I, yeah I had a Uterine prolapse, so I had surgery for that. I have five kids.

D: OK. Any, any complications after that surgery at all? 

P: No, it helped, it actually fixed the leaking at the time I was having, so was happy with that.

D: That's good. Currently right now, do you work at all or are you retired?

P: I am retired.

D: OK, uh, and what is your living situation like right now?

P: Yes, we live in a house just outside of the city with my, with my husband.

D: OK. Any exposures to any dust, fumes, asbestos or anything like that in your home?

P: No, I don't believe so.

D: OK. Uhm and do you currently smoke?

P: Uhm, I do, yeah. Currently, yeah, maybe half a pack to a pack per day.

D: OK, and how long have you smoked for?

P: Oh, I started in my teens, so most of my life I've I've smoked. I grew up around it, it's just what my parents did and everybody smoked.

D: OK, uhm, and do you use any recreational drugs like marijuana?

P: No, I don't. 

D: OK. And do you drink alcohol at all?

P: Uh, very rarely, don't really drink it anymore.

D: OK. Alright, so yeah, those are some of the questions I had for you today. We'll do a full physical examination, get your vitals and get your oxygenation done right now. Do you have any questions at all?

P: No, that that makes sense. Thank you.

D: You're welcome and yeah so we'll, we'll also do some lab work as well. We'll get some blood work done. Want to make sure we don't miss any kind of infection. Umm, you're in, like your you can be having another COPD exacerbation. But we also want to make sure you don't have like pneumonia or anything like that so. We might have to do a chest x-ray as well, but for now I would say just sit tight. We'll get all your vitals done and then go on from there. Does that sound good?

P: Yeah, that sounds good. Thank you.

D: Alright, and if you feel at all you're very short of breath and we can give you some ventil in here as well. And then if you need like we can give you like systemic, core steroids as well to help some of your symptoms. But yeah, let's, let's do some of that, physical examinations first.

P: OK, that sounds good. Thank you.

D: Welcome. Take care.

P: Bye 

D: Bye.