Shortness of breath

Patient is 63-year-old man who comes in today to just have a checkup. He states that he has a history of sarcoidosis. He was diagnosed six years ago approximately in Salt Lake City, although he has been battling sarcoidosis ever since mid 1990s. He had increase in shortness of breath and was easily getting winded and was having symptoms of erythema nodosum. He thought at first it was gout, but turned out to be sign of sarcoid. Since that time, he has been doing much better. He did undergo a stress EKG and that was fine. He also has recently worked with Dr. to do a checkup. He got a chest x-rays two weeks ago and that was normal. He also did some blood work that was normal. I do not have the results of these. He does have some allergy triggers as well and they are significant this time of the year and feels that maybe what may be causing his shortness of breath. Dr. wanted him to come over to get evaluated for asthma. He states that currently he is doing pretty well other than on occasional allergy triggers. This morning he woke up with sinus irritation and sneezing and ocular irritation, otherwise he is feeling quite good. He states that he has occasional shortness of breath about four to five episode since he has been here in Idaho. He did move here about five months ago from Nevada. He did try to use an old inhaler of albuterol for this for one of these episodes of shortness of breath, but it caused him to be very jittery and did not like it.

He currently complains of nasal symptoms including postnasal drip, nasal stuffiness, frequent throat clearing, heartburn, and sneezing. It does seem to be worse this time of year. He states that it gets really-really bad when they start cutting hay and alfalfa, so he avoids this time. He does have headache currently that has been bothering him but does not get these frequently. He has not had any nasal surgery in the past and denies frequent bad colds or frequent tonsillitis. He has used loratadine in the past and that does help the most. He does not like to use nasal sprays.

He denies frequent ear infection, dizziness, lightheadedness, and hearing impairment.

He does have some eye itching and eye redness and eye dryness. He does not use any medication for his eye irritation. He has had multiple eye surgery for cataracts and retinal detachments.

ASSESSMENT:
1. History of sarcoidosis.
2. Shortness of breath.
3. Allergic rhinitis.
4. Allergic conjunctivitis.

PLAN:
1. At this time, I do not find any evidence of an acute sarcoidosis trouble as he does get occasional shortness of breath, but he feels quite stable. Currently, he does want to get a spirometry done to ensure that his lung function is doing okay. He also has performed a recent chest x-ray and blood work and everything came back normal from what he tells me, although I do not have the results back from this.
2. I do want him to have some medications just in case he has triggers. I gave him a new prescription of albuterol inhaler to use as rescue for any chest tightness or shortness of breath. I also gave him sample of Symbicort to use just two puffs twice daily when he is having increased trouble to see if this will help clear up some of his shortness of breath episodes, particularly since they seem to be triggered in this peak allergy season.
3. I gave him a Patanol eye drop to use one drop each eye twice daily to help with this eye irritation from his allergies and he can continue taking loratadine. He does not like to use nasal sprays. We will follow up in three months to see how he is doing and anytime to know if he is having any more trouble.

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