CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 33-year-old male with
a past medical history of asthma since childhood, status post
multiple hospitalizations and intubations, treated
chronically with steroids, admitted to the medical intensive
care unit for management of asthma flare requiring continuous
nebulizers.  The patient was recently admitted from [**3-23**]
to [**3-24**] to [**Hospital1 69**] for an
asthma flare and was discharged then on a prednisone taper
and was feeling well until about two weeks prior to this
admission when he developed a "lung infection" with cough
productive of green sputum, shortness of breath, and
subjective fever.  He was treated empirically with Biaxin and
increase in prednisone dosage to 60 mg p.o. q.d.   He
improved subsequently and eventually decreased his prednisone
down to 30 mg p.o. q.i.d. (his baseline dose).

MEDICAL HISTORY: 1.  Asthma since childhood, status post multiple admissions,
on chronic prednisone, multiple intubations; approximately 12
times.  His triggers include upper respiratory infections and
environmental allergies.  Baseline peak flow is 450 to 550.
2.  He also has gastroesophageal reflux disease.

MEDICATION ON ADMISSION: Prednisone 30 mg p.o. q.o.d.,
Flovent 4 puffs b.i.d., Serevent 4 puffs b.i.d.,
[**Doctor First Name **] 60 mg p.o. b.i.d., Accolate 20 mg p.o. b.i.d.,
Depot-Medrol 40 mg p.o. every month, Zantac 150 mg p.o.
b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married, two kids.  He smokes five
cigarettes a day.  He drinks socially.  Works as a mechanic.
He has no pets at home.
Asthma, unspecified type, unspecified,Esophageal reflux
Asthma NOS,Esophageal reflux
Admission Date:  [**2167-4-21**]     Discharge Date:  [**2167-4-22**]

Date of Birth:   [**2133-6-10**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 33-year-old male with
a past medical history of asthma since childhood, status post
multiple hospitalizations and intubations, treated
chronically with steroids, admitted to the medical intensive
care unit for management of asthma flare requiring continuous
nebulizers.  The patient was recently admitted from [**3-23**]
to [**3-24**] to [**Hospital1 69**] for an
asthma flare and was discharged then on a prednisone taper
and was feeling well until about two weeks prior to this
admission when he developed a "lung infection" with cough
productive of green sputum, shortness of breath, and
subjective fever.  He was treated empirically with Biaxin and
increase in prednisone dosage to 60 mg p.o. q.d.   He
improved subsequently and eventually decreased his prednisone
down to 30 mg p.o. q.i.d. (his baseline dose).

Today, upon awakening, he had increased shortness of breath
and wheezing.  He took two nebulizers with some improvement
and went to work.  He had more shortness of breath and came
home.  He took four nebulizers meter-dosed inhalers without
improvement and came to the emergency department.

In the emergency department he was afebrile, vital signs were
stable.  His peak flow was 270.  He was given 125 mg of IV
Solu-Medrol and continuous nebulizers for three hours without
improvement and was admitted to the medical intensive care
unit for further observation.

PAST MEDICAL HISTORY:
1.  Asthma since childhood, status post multiple admissions,
on chronic prednisone, multiple intubations; approximately 12
times.  His triggers include upper respiratory infections and
environmental allergies.  Baseline peak flow is 450 to 550.
2.  He also has gastroesophageal reflux disease.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Prednisone 30 mg p.o. q.o.d.,
Flovent 4 puffs b.i.d., Serevent 4 puffs b.i.d.,
[**Doctor First Name **] 60 mg p.o. b.i.d., Accolate 20 mg p.o. b.i.d.,
Depot-Medrol 40 mg p.o. every month, Zantac 150 mg p.o.
b.i.d.



SOCIAL HISTORY:  He is married, two kids.  He smokes five
cigarettes a day.  He drinks socially.  Works as a mechanic.
He has no pets at home.

PHYSICAL EXAMINATION:  On physical examination temperature
was 97, blood pressure was 128/63, pulse 71, respiratory rate
of 20, oxygen saturation of 98% on room air.  Generally, he
was a young, well-appearing male speaking in full sentences
without accessory muscle use.  Examination of his head and
neck revealed pupils were equal, round and reactive to light.
Extraocular muscles were intact.  There was no scleral
icterus.  Oropharynx was clear.  No sinus tenderness.  Neck
was supple with no cervical adenopathy.  No jugular venous
distention.  Lung examination revealed decreased breath
sounds throughout, diffuse expiratory wheezing, prolonged
expiratory phase.  Heart had a regular rate and rhythm,
normal S1 and S2.  No murmurs, rubs or gallops.  Abdomen was
soft, nontender, and nondistended with normal active bowel
sounds.  No hepatosplenomegaly.  Examination of the
extremities revealed no edema, 2+ pedal pulses bilaterally.
Neurologically, the patient was awake and oriented times
three.  Strength was [**5-2**] bilaterally in the upper and lower
extremities.  Sensation was grossly intact to light touch.

LABORATORY:  Analysis revealed a white blood cell count
of 7.1, hematocrit of 40.7, platelets 273.  Sodium 142,
potassium 3.8, chloride 109, bicarbonate of 21, BUN 13,
creatinine 0.7, glucose of 86.

Chest x-ray showed no infiltrates or effusions.

HOSPITAL COURSE:  The patient was admitted to the medical
intensive care unit for further management of an asthma
flare.

The patient was placed on continuous nebulizers for the first
night of his admission.  He continued to move air well
without any acute respiratory distress.  The morning
following his admission, he was weaned off continuous
nebulizers to periodic one to two hour nebulizer treatments.
He continued to do well.  He remained afebrile.

Over the course of his day his wheezing significantly
diminished.  His peak flows increased to 450 (his baseline).
The following day the patient was placed on his home
meter-dosed inhaler regimen, switched to oral prednisone and
taper started.  He denied any residual shortness of breath
and had no further wheezing on examination.

DISCHARGE STATUS:   He was discharged to home.

CONDITION AT DISCHARGE:  Stable.

DISCHARGE DIAGNOSES:  Asthma flare.

MEDICATIONS ON DISCHARGE:
1.  Prednisone taper.
2.  Flovent 4 puffs b.i.d.
3.  Serevent 4 puffs b.i.d.
4.  [**Doctor First Name **] 60 mg p.o. b.i.d.
5.  Accolate 20 mg p.o. b.i.d.
6.  Depot-Medrol 60 mg intramuscular every month.
7.  Zantac 150 mg p.o. b.i.d.

FOLLOWUP:  He was instructed to follow up with his primary
care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], as well as his pulmonologist,
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 93411**].



                          [**Known firstname **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5587**]

Dictated By:[**Last Name (NamePattern1) 16123**]

MEDQUIST36

D:  [**2167-4-22**]  13:07
T:  [**2167-4-22**]  13:25
JOB#:  [**Job Number 21048**]
{'Asthma, unspecified type, unspecified,Esophageal reflux'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 33-year-old male with
a past medical history of asthma since childhood, status post
multiple hospitalizations and intubations, treated
chronically with steroids, admitted to the medical intensive
care unit for management of asthma flare requiring continuous
nebulizers.  The patient was recently admitted from [**3-23**]
to [**3-24**] to [**Hospital1 69**] for an
asthma flare and was discharged then on a prednisone taper
and was feeling well until about two weeks prior to this
admission when he developed a "lung infection" with cough
productive of green sputum, shortness of breath, and
subjective fever.  He was treated empirically with Biaxin and
increase in prednisone dosage to 60 mg p.o. q.d.   He
improved subsequently and eventually decreased his prednisone
down to 30 mg p.o. q.i.d. (his baseline dose).

MEDICAL HISTORY: 1.  Asthma since childhood, status post multiple admissions,
on chronic prednisone, multiple intubations; approximately 12
times.  His triggers include upper respiratory infections and
environmental allergies.  Baseline peak flow is 450 to 550.
2.  He also has gastroesophageal reflux disease.

MEDICATION ON ADMISSION: Prednisone 30 mg p.o. q.o.d.,
Flovent 4 puffs b.i.d., Serevent 4 puffs b.i.d.,
[**Doctor First Name **] 60 mg p.o. b.i.d., Accolate 20 mg p.o. b.i.d.,
Depot-Medrol 40 mg p.o. every month, Zantac 150 mg p.o.
b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married, two kids.  He smokes five
cigarettes a day.  He drinks socially.  Works as a mechanic.
He has no pets at home. 

### Response:
{'Asthma, unspecified type, unspecified,Esophageal reflux'}
