Wheezing

Patient is here for an annual recheck on his moderate persistent asthma. He has been a long-time patient of Dr.. We saw him last on 09/30/2014. Since that time, he has been doing very well in his opinion. He uses Symbicort. He uses it approximally one puff in the night only and if he feels that his wheezing, chest tightness, or shortness of breath is getting worse, he increases his use to one to two puffs twice daily. He also tends to add a decongestant like Mucinex if he is having trouble with asthma triggers and that seems to help resolve his symptoms. His peak flow today was at 420, which is better than it was in the past in the two years. he has a history of allergies as well and was on allergy shots for many years and this really helped to resolve some of his allergy triggers. Today, although James states that he is felling very well, he on a physical exam is wheezing quite significantly. I then chose to give him a DuoNeb nebulizer treatment to see if this resolves some of his wheezing as he was feeling well, which just did not. He does have a history of smoking. He smoked for approximately 20 years, one to two packs per day, but that he has quit for a long time.

ASSESSMENT:
1. Moderate persistent asthma.
2. Wheezing.
3. History of allergic rhinitis.
4. Diabetes mellitus type 2.
5. Hypertension.
6. Morbid obesity.
7. History of lichens simplex chronicus.

PLAN:
1. Since he is wheezing today. Although he feels well, we would like to begin prednisone, short course 40 mg daily for seven days to see if this resolves his wheezing.
2. We also encouraged him to use a Symbicort 80 mcg inhaler two puff twice daily consistently to help resolve any wheezing and get him back to a stable condition of his asthma.
3. We will follow up in three to four weeks to see how he is feeling. Although he feels okay, I hope that he feels much better the next time we see him and that his wheezing is resolved.

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