CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 34-year-old man
with a lifelong history of severe asthma with multiple
admission, status post multiple intubations, who now returns
with a presumed asthma exacerbation.  He was in his usual
state of health until the morning of [**7-20**] when he awoke
with increasing shortness of breath, a cough productive of
yellow sputum; otherwise no fever, chills, abdominal pain or
chest pain.  The patient's dyspnea worsened, but he went to
work anyway and upon return home took several nebulizer
treatments without relief.

MEDICAL HISTORY: 1.  Asthma with multiple admissions, multiple intubations,
and chronic prednisone use; followed by Dr. [**Last Name (STitle) 217**].
Peak flows normally 350 to 600.
2.  Question of gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Prednisone 30 mg p.o. q.o.d.
2.  Accolate 20 mg p.o. b.i.d.
3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
4.  Albuterol inhaler.
5.  Albuterol nebulizer.
6.  Triamcinolone 0.5 mg intramuscular every month.
7.  Serevent 4 puffs q.i.d.
8.  Flovent 2 puffs b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with his wife and children.  The
patient continues to smoke tobacco.  Drinks 4 to 10 drinks of
alcohol per week.  Works as an automobile mechanic at a VW
dealership.
Asthma, unspecified type, with status asthmaticus
Asthma w status asthmat
Name:  [**Known lastname **], [**Known firstname 77**]                       Unit No:  [**Numeric Identifier 14754**]

Admission Date:                 Discharge Date:

Date of Birth:                  Sex:  M

Service:

ADDENDUM:

ASSESSMENT AND PLAN:
1.  Pulmonary:  At the end of the paragraph, continuing.  The
patient continued on accolade and [**Doctor First Name 1866**] as per usual.
Prior to discharge, he had a peak flow of 430.

2.  Endocrine:  In the Medical Intensive Care Unit the
patient was found to have elevated blood glucoses.  He was
placed on an insulin sliding scale and his fingersticks were
checked qid.  His blood glucoses were normal prior to
discharge.

DISCHARGE CONDITION:  The patient was discharged home in
stable condition.

DIAGNOSIS:
Asthma flare.

DISCHARGE MEDICATIONS:  1) Zantac 150 mg [**Hospital1 **], 2) accolade 20
mg [**Hospital1 **], 3) [**Doctor First Name 1866**] 60 mg [**Hospital1 **], 4) Albuterol and Atrovent
nebulizers and inhalers, 5) prednisone 60 mg q day, tapered
to 30 mg qod over nine days.





Dictated By:[**Last Name (NamePattern1) 4499**]

MEDQUIST36

D:  [**2167-7-25**]  13:20
T:  [**2167-7-28**]  22:53
JOB#:  [**Job Number 14755**]


Admission Date:  [**2167-7-21**]     Discharge Date:  [**2167-7-22**]

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

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  The patient is a 34-year-old man
with a lifelong history of severe asthma with multiple
admission, status post multiple intubations, who now returns
with a presumed asthma exacerbation.  He was in his usual
state of health until the morning of [**7-20**] when he awoke
with increasing shortness of breath, a cough productive of
yellow sputum; otherwise no fever, chills, abdominal pain or
chest pain.  The patient's dyspnea worsened, but he went to
work anyway and upon return home took several nebulizer
treatments without relief.

He presented to the Emergency Room with increasing tachypnea.
He was treated with magnesium sulfate and intravenous
Solu-Medrol 80 units, and continued to receive nebulizer
treatments.  His dyspnea improved from a [**7-7**] to a [**5-7**], and
a peak flow at this time was 275.  He was transferred to the
Medical Intensive Care Unit for close observation and
treatment with Solu-Medrol 60 mg q.8.h. and nebulizer
treatments q.2h.   In the morning he showed significant
improvement with no tachypnea.

The patient has multiple asthma triggers which are detailed
in previous notes.  He feels that this flare was triggered by
change in the weather.

PAST MEDICAL HISTORY:
1.  Asthma with multiple admissions, multiple intubations,
and chronic prednisone use; followed by Dr. [**Last Name (STitle) 217**].
Peak flows normally 350 to 600.
2.  Question of gastroesophageal reflux disease.

SOCIAL HISTORY:  Lives with his wife and children.  The
patient continues to smoke tobacco.  Drinks 4 to 10 drinks of
alcohol per week.  Works as an automobile mechanic at a VW
dealership.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Prednisone 30 mg p.o. q.o.d.
2.  Accolate 20 mg p.o. b.i.d.
3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
4.  Albuterol inhaler.
5.  Albuterol nebulizer.
6.  Triamcinolone 0.5 mg intramuscular every month.
7.  Serevent 4 puffs q.i.d.
8.  Flovent 2 puffs b.i.d.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs were
temperature afebrile, pulse 108, blood pressure 139/62,
respirations 29, oxygen saturation 95% on room air.
Generally, in no apparent distress.  HEENT revealed
oropharynx was clear.  Pupils were equal, round, and reactive
to light.  Lungs had diffuse wheezes.  No rales, and a
delayed expiratory phase.  Heart had a regular rate and
rhythm.  No murmurs, rubs or gallops.  Abdomen was soft and
nontender, normal bowel sounds.  Extremities had no clubbing,
cyanosis or edema with 2+ dorsalis pedis pulses.

LABORATORY DATA ON ADMISSION:  White blood cell count 8.9,
hematocrit 43, platelets 202.  Sodium 138, potassium 4.2,
chloride 109, bicarbonate 17, BUN 10, creatinine 0.7,
glucose 240.

RADIOLOGY/IMAGING:  Chest x-ray revealed no infiltrates.

HOSPITAL COURSE:   The patient was admitted to the Medical
Intensive Care Unit for observation and later transferred to
the floor.  In the Medical Intensive Care Unit he was given
45 mg of Solu-Medrol intravenously t.i.d. as well as
nebulizer treatments q.2h.

On transfer to the floor, his medication was switched to
prednisone 60 mg intravenously in the morning.  His
nebulizers were continued q.4h.  His inhalers were restarted
as an outpatient.  He was also continued on his Accolate and
[**Doctor First Name **] as usual.  Prior to discharge, the patient had a peak
flow of 430.

Note:  Dictation ended after 6.0 minutes.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1879**], M.D.  [**MD Number(1) 14612**]

Dictated By:[**Last Name (NamePattern1) 11548**]

MEDQUIST36

D:  [**2167-7-25**]  13:15
T:  [**2167-7-28**]  18:38
JOB#:  [**Job Number 93412**]
{'Asthma, unspecified type, with status asthmaticus'}


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: The patient is a 34-year-old man
with a lifelong history of severe asthma with multiple
admission, status post multiple intubations, who now returns
with a presumed asthma exacerbation.  He was in his usual
state of health until the morning of [**7-20**] when he awoke
with increasing shortness of breath, a cough productive of
yellow sputum; otherwise no fever, chills, abdominal pain or
chest pain.  The patient's dyspnea worsened, but he went to
work anyway and upon return home took several nebulizer
treatments without relief.

MEDICAL HISTORY: 1.  Asthma with multiple admissions, multiple intubations,
and chronic prednisone use; followed by Dr. [**Last Name (STitle) 217**].
Peak flows normally 350 to 600.
2.  Question of gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Prednisone 30 mg p.o. q.o.d.
2.  Accolate 20 mg p.o. b.i.d.
3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
4.  Albuterol inhaler.
5.  Albuterol nebulizer.
6.  Triamcinolone 0.5 mg intramuscular every month.
7.  Serevent 4 puffs q.i.d.
8.  Flovent 2 puffs b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with his wife and children.  The
patient continues to smoke tobacco.  Drinks 4 to 10 drinks of
alcohol per week.  Works as an automobile mechanic at a VW
dealership. 

### Response:
{'Asthma, unspecified type, with status asthmaticus'}
