D: So what brings you in?

P: Yeah, so um I just came in because uh so I I have this cough that's been going on for the last five years, but over the last month it's really been getting worse. Um and like last week I I've just been constantly coughing. So yeah, I was just a bit concerned.

D: Yeah, OK, so you said the past couple of years you've been coughing. So how many years exactly would that be? Two, three, four?

P: Probably five I would say, and I was diagnosed with uh COPD around that time.

D: OK, OK, um the cough that you currently have, um is it a dry cough or are you bringing up any phlegm?

P: Uh I'm pretty much always bringing up like this uh white material.

D: White, OK. Um and is it constant throughout the day or do you find it comes and goes?

P: It's pretty much there all the time, but uh it's definitely getting worse. Um it is, I think, the worst in the morning um when I wake up and I just feel like there's just a bunch of gunk stuck in the back of my throat.

D: OK. Um and if you were to describe the quality of this cough, would you say it's harsh, barky, muffled?

P: I would say it's harsh.

D: Harsh, OK. And has the quality of your cough changed at all in the past few years? Like does it sound different than it used to?

P: Um I don't know if it sounds different, but uh especially for the last month I would say I'm bringing up more of the material, and it's usually white over the five years, but um I noticed uh in the last week-ish, it's had a yellowish tinge to it as well.

D: OK, OK, so it's changed a little bit. Um and are you experiencing any shortness of breath with this?

P: No I I don't think so, like I sometimes when I'm walking around uh doing more stuff, uh working in the garden like I feel like I might have to breathe a little bit harder, but uh not regularly.

D: OK, OK, that's good. Um and any wheezing?

P: Uh, yeah. It's like usually I start coughing a lot more when I'm starting to do any kind of activities and sometimes when I start coughing more, I also start wheezing. Um but uh right now, I'm fine.

D: You're fine now, OK, uh, alright. And sorry, forgot to ask you earlier, do you see any blood in your phlegm?

P: No, no, I haven't noticed any blood.

D: OK, any uh changes to your hair or on your skin, like rashes?

P: Not that I've noticed, no. 

D: OK, any weight loss?

P: Um, I don't think so. 

D: OK, fevers?

P: No. 

D: OK, exhaustion?

P: Um yeah, I would say like for the last few months I am a bit more tired. 

D: Mhmm OK, how about changes in your vision or hearing?

P: No, I haven't experienced that.

D: How about a stuffy nose? Runny nose? 

P: Uh no, not really.

D: No, OK. How about changes to your smell or taste?

P: Uh nope. 

D: No, OK. Uh chest pain?

P: Not chest pain, but when I get into those coughing fits, sometimes it feels just really tight in my chest.

D: Oh, yeah.

P: But it tends to go away with uh just some rest.

D: Oh OK, OK. Um how about palpitations? Like feeling like your heart is racing?

P: Uh no, I don't think so.

D: No, OK. How about some swelling in your limbs?

P: I I did notice, like uh a little bit of swelling in my uh both my, like right by my ankles. My shoes, like like even when I wear my socks, it like leaves little marks and then uh I just feel my like my shoes are tighter.

D: OK, OK and how long has that been going on?

P: Probably, uh, I've had this issue for like a pretty long time um, probably I would say the last year at least. 

D: OK, OK, last year. Um any uh dizziness or fainting spells? 

P: No.

D: No, OK, any memory issues, uh confusion?

P: No. 

D: Numbness or tingling?

P: No, nothing like that. 

D: No headaches?

P: Uh no, no headaches.

D: Changes to your bowel movements?

P: No, I tend to go like once a day. And yeah, it's pretty normal.

D: OK, uh nausea or vomiting?

P: No. 

D: No, OK. And are you otherwise healthy? Do you have any longstanding conditions? I know you said you have COPD, anything else?

P: I do have high blood pressure.

D: OK. Do you have something called congestive heart failure?

P: Uh no, what's that?

D: OK, it's when um your heart's not pumping as much as it should be, um so you get some backup of fluid. I ask because you you mentioned that you um were having some swelling in your legs.

P: Oh I yeah, I I yeah, I didn't know anything about that. I just thought that was uh, it's been going on for a while now and didn't really bother me too much.

D: OK. Um alright, and are you taking any medications?

P: Yeah, I have this medication uh right now I'm taking it, it's called lisinopril. 

D: OK, so that's for your blood pressure? 

P: Yeah. 

D: OK. Are you on any puffers? Sorry, go ahead. 

P: Yes I'm on, no worries, I'm on um uh two puffers right now. One of them is like just one that I use when I really need it. And then um there's another one, so I think that's like the Ventolin puffer.

D: Yeah.

P: And then the other one is called, I think it's called Spiriva.

D: OK, OK perfect. And are your puff puffers giving you any relief at all from the coughing fits?

P: Yeah, I've been using the Ventolin uh more and it it does seem to help.

D: OK, OK. Uh do you find they're not working as much as they used to though?

P: Yeah, I feel like uh before, I didn't really like, it, just last year I didn't really have to take it too much. Um like even when I use the puffer, I start getting coughing like maybe half an hour later and so it's not, I don't think it's as effective.

D: OK, yeah. Um OK. And have you had any recent blood work done? 

P: Uh, no, I haven't been to the doctor for a while.

D: OK. And do you have any allergies?

P: Um I think I have allergies to uh like um amoxicillin, I got like a rash once. 

D: OK. Have you had any, uh, amoxicillin, or like penicillin type antibiotics recently?

P: No.

D: No, OK. Um are you up to date with all your immunizations? 

P: Yep. 

D: OK. Um, you're not quite at this age range yet, but uh we do recommend the pneumococcal vaccine when you turn 65. And um did you get the flu vaccine this year?

P: Uh yeah I did, with the pandemic going on, I usually don't get it, but I got it this year. 

D: OK, good good. Um any family history of lung conditions or heart conditions?

P: Uhm, lung conditions I don't think so. Heart conditions, uh my father did have a heart attack in his 60s, but he's fine. He's he's living right now.

D: OK OK, any cancers? 

P: Cancers, I think my uncle from my father's side um had uh bladder cancer. 

D: OK, OK. Um do you smoke? 

P: I used to smoke. Um I just quit a few years ago. 

D: OK, congrats. Um how much did you used to smoke? 

P: Uhm, I don't know, probably I went through a like a whole pack every day, I would say for at least 30 years of my life.

D: OK, OK um so it's good that you stopped. Um do you take any other recreational drugs?

P: Uh no, nothing like that.

D: No, OK. How about alcohol? Do you drink?

P: Uh I drink every like, maybe a beer a day.

D: OK. Um are you um living with anyone right now?

P: Yeah, it's just uh me and my wife.

D: OK, where do you guys live?

P: Uh we just live uh outside of the city in in a condominium.

D: OK, any uh old carpets? Mold, dust, asbestos, anything like that in the condo?

P: No, it's pretty well maintained.

D: OK, good. And have you been in contact with any anyone sick recently? 

P: No, I've mainly just been trying to stay inside. I work from home too, so haven't really been seeing anyone.

D: OK, that's good. And um travel to anywhere recently? Outside the province?

P: Uhm, outside of the province, no, not not for like the last year at least.

D: OK, OK. Um so those were kind of all the questions that I had for you. Did you have any questions for me?

P: Um yeah, I was just wondering like what you think it might be.

D: Yeah, so it definitely sounds like a COPD exacerbation, but because your symptoms overlap with those of Covid, we will take a swab and you should hear back in about 24 to 48 hours. Um and you can you can self isolate for 14 days um and if it's positive, public health will be in touch with you to um do some contact tracing, but in the meantime we'll also do a work up for the COPD exacerbation. Um it seems like you have taken the correct steps so far in like stopping like stopping your smoking and um taking your puffers as needed. Um so right now we will continue using the puffers that you have, and if you don't already have a long acting beta agonist, we'll give you that as well as, if it's like if it gets really severe, we'll also give you some inhaled corticosteroids um and we'll also check your oxygen saturation to make sure it's over uh 88% um and we'll give you oxygen if you need it. Um as well, some antibiotics to consider, you mentioned that you were allergic to amoxicillin, so we might give you like a macrolide like azithromycin for now. Um and hopefully your symptoms subside and we can get you home. How does that sound?

P: OK, that sounds good. Thank you so much.

D: Yeah, no problem. And I forgot, sorry we'll also probably do like a chest X Ray and a pulmonary function test.

P: OK, sounds good.

D: Yeah, no problem.