CHIEF COMPLAINT: Shortness of Breath
Asthma Attack

PRESENT ILLNESS: 30 yo woman with severe asthma since childhood required multiple
intubations (>10x, with last one in [**7-28**]) was admitted due to
another episode of asthma attack. Pt reported that she has been
maintained on prednisone 20mg po qod since [**7-29**], she is
followed by Dr. [**Last Name (STitle) 50575**] of pulmonary and her most recent PFT
([**2122-10-4**]) showed worsening dz (FEV1/FVC=45(56% pred). Pt
reported that around 11pm last night she had an asthma attack(
she has on avg 3 attacks per wk). She feels this was
precipitated by here walking between the heat of her home and
the cold outside mult times.  She took nebs and went to bed at
1am and woke up at 6am wheezing, nebs didn't help, called EMS.
She them collapsed and doesnot remember anything until she woke
up in the ED.
By report of the family and ambulance, the pt given CPR by
brother when she stopped breathing.  The EMS gave her O2, nebs
a, and .3 sc epi which brought her sats to 95%.  In the ED
(arrived ~7am) she was given solumedrol 125mg x 1, heliox mask
vent at 10L, and cont nebs to maintain sats.  Her symptoms
slowly improved as the morning progressed.  By the time she
arrived at the ICU (12pm) she no longer required nebs to
maintain sats or avoid SOB.

MEDICAL HISTORY: Asthma
eczema
Fe Def Anemia
Nasal Polyps

MEDICATION ON ADMISSION: Theophylline 300mg SR [**Hospital1 **]
Montelukast 10mg qday
Albuterol 1-2 puffs q4h
Fluticasone 2 puffs [**Hospital1 **]
salmeterol 1 puff qday
albuterol nebs [**Hospital1 **]
prednisone 20mg qod

ALLERGIES: Aspirin

PHYSICAL EXAM: Admission exam:
T 98.8 P 99 RR 11 BP 129/86 O2  91 on 10L heliox
Gen - A+Ox3, [**Last Name (un) 1425**] young woman, spleaking in full sentances,
no accessory muscles when breathing,
HEENT: EOMI, PERRL, OP clear, no icterus, moon face
Neck: supple, posterior hump, acanthosis nigricans, no LAD
Cor: RRR no m/r/g
Chest: diffuse expiratory wheezes, no rales, no ronchi
Abd: obese with striae, NT/ND, +BS, no HSM
Ext: nl bulk and tone, +2 DP bilat, thickened toenails b/l, no
c/c/e

FAMILY HISTORY: Distant relatives have DM, asthma

SOCIAL HISTORY: No ETOH, No Tob, No drugs.
Married, lives with huband and brother
[**Name (NI) **] Health student at BU
Asthma, unspecified type, with status asthmaticus,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Long-term (current) use of steroids,Eosinophilia,Anemia, unspecified,Obesity, unspecified,Esophageal reflux,Other diseases of pharynx, not elsewhere classified,Unspecified sleep apnea
Asthma w status asthmat,Pancreatic disorder NEC,Adv eff corticosteroids,Long-term use steroids,Eosinophilia,Anemia NOS,Obesity NOS,Esophageal reflux,Disease of pharynx NEC,Sleep apnea NOS
Admission Date:  [**2122-10-21**]              Discharge Date:   [**2122-10-22**]

Date of Birth:  [**2092-9-22**]             Sex:   F

Service: MED

Allergies:
Aspirin

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Shortness of Breath
Asthma Attack

Major Surgical or Invasive Procedure:
none

History of Present Illness:
30 yo woman with severe asthma since childhood required multiple
intubations (>10x, with last one in [**7-28**]) was admitted due to
another episode of asthma attack. Pt reported that she has been
maintained on prednisone 20mg po qod since [**7-29**], she is
followed by Dr. [**Last Name (STitle) 50575**] of pulmonary and her most recent PFT
([**2122-10-4**]) showed worsening dz (FEV1/FVC=45(56% pred). Pt
reported that around 11pm last night she had an asthma attack(
she has on avg 3 attacks per wk). She feels this was
precipitated by here walking between the heat of her home and
the cold outside mult times.  She took nebs and went to bed at
1am and woke up at 6am wheezing, nebs didn't help, called EMS.
She them collapsed and doesnot remember anything until she woke
up in the ED.
By report of the family and ambulance, the pt given CPR by
brother when she stopped breathing.  The EMS gave her O2, nebs
a, and .3 sc epi which brought her sats to 95%.  In the ED
(arrived ~7am) she was given solumedrol 125mg x 1, heliox mask
vent at 10L, and cont nebs to maintain sats.  Her symptoms
slowly improved as the morning progressed.  By the time she
arrived at the ICU (12pm) she no longer required nebs to
maintain sats or avoid SOB.

In the past, pt had been on high dose steroid for [**1-27**] yrs (~80
mg prednisone daily then decadron 4mg daily) which ended [**2-26**]
due to pt developed cushingnoid syndrome. After her last
hospitalization [**7-29**], her outpt pulmonogist started her on
prednisone 20 mg qod.


Past Medical History:
Asthma
eczema
Fe Def Anemia
Nasal Polyps

Social History:
No ETOH, No Tob, No drugs.
Married, lives with huband and brother
[**Name (NI) **] Health student at BU

Family History:
Distant relatives have DM, asthma

Physical Exam:
Admission exam:
T 98.8 P 99 RR 11 BP 129/86 O2  91 on 10L heliox
Gen - A+Ox3, [**Last Name (un) 1425**] young woman, spleaking in full sentances,
no accessory muscles when breathing,
HEENT: EOMI, PERRL, OP clear, no icterus, moon face
Neck: supple, posterior hump, acanthosis nigricans, no LAD
Cor: RRR no m/r/g
Chest: diffuse expiratory wheezes, no rales, no ronchi
Abd: obese with striae, NT/ND, +BS, no HSM
Ext: nl bulk and tone, +2 DP bilat, thickened toenails b/l, no
c/c/e

Pertinent Results:
[**2122-10-21**] 07:10AM   GLUCOSE-192* UREA N-11 CREAT-1.0 SODIUM-140
POTASSIUM-4.7 CHLORIDE-100 TOTAL CO2-28 ANION GAP-17
[**2122-10-21**] 07:10AM   ALT(SGPT)-16 AST(SGOT)-15 CK(CPK)-103 ALK
PHOS-136* AMYLASE-107* TOT BILI-0.3
[**2122-10-21**] 07:10AM   cTropnT-<0.01
[**2122-10-21**] 07:10AM   CK-MB-3
[**2122-10-21**] 07:10AM   ALBUMIN-3.7 CALCIUM-8.8 PHOSPHATE-6.8*#
MAGNESIUM-2.2
[**2122-10-21**] 07:10AM   WBC-20.1* RBC-4.85 HGB-14.1 HCT-43.0 MCV-89
MCH-29.0 MCHC-32.7 RDW-14.9
[**2122-10-21**] 07:10AM   NEUTS-52.7 LYMPHS-32.8 MONOS-2.9 EOS-10.6*
BASOS-1.0
[**2122-10-21**] 07:10AM   PLT COUNT-372
[**2122-10-21**] 07:10AM   PT-13.8* PTT-26.9 INR(PT)-1.2

CXR - no CHF< or focal consolidation

PFT [**2122-10-4**] (after albuterol)
FVC 2.10 / 71% pred
FEV1 0.94 / 40% pred
Fev1/FVC 45 / 56% pred
imp: marked obstructive vent def
since [**7-29**] FVC decreased 17%, FEV1 decreased 27%)


Brief Hospital Course:
30 yo F with a hx of severe asthma who presents with an attack.

1) Asthma - The patient is now recovering from her asthma
attack.  She is no longer requiring freq nebs and was able to
avoid intubation.
Home asthma meds including theophylline, montelukast,
fluticasone, salumedrol, and were continued.  Also the patient
was given 125 methylprednisolone q8h. She remained stable
overnight without any SOB.  Pt placed on insulin SS w/ steroids.
 In the morning of the day after abmission the pt was felt
stable to go home with pulm follow-up.  She was switched to a
prednisone taper starting at 60mg qday and going to 30mg qday.
Also she will be started on protonix to avoid GERD which may
exacerbate her asthma.  As an outpt she should be worked up for
OSA

2) FEN - house diet

3) Access - PIV

4) Comm - with pt

Full Code

Medications on Admission:
Theophylline 300mg SR [**Hospital1 **]
Montelukast 10mg qday
Albuterol 1-2 puffs q4h
Fluticasone 2 puffs [**Hospital1 **]
salmeterol 1 puff qday
albuterol nebs [**Hospital1 **]
prednisone 20mg qod

Discharge Medications:
1. Montelukast Sodium 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Theophylline 300 mg Capsule, Sust. Release 12HR Sig: One (1)
Capsule, Sust. Release 12HR PO BID (2 times a day). Capsule,
Sust. Release 12HR(s)
3. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
4. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours).
5. Ipratropium Bromide 0.02 % Solution Sig: Five Hundred (500)
mcg Inhalation every six (6) hours as needed for shortness of
breath or wheezing.
Disp:*60 vials* Refills:*6*
6. Prednisone 20 mg Tablet Sig: see comments Tablet PO once a
day: Take 3 tabs a day for 2 days.  Then take 2 tabs a day for 2
days.  Then take 1 and a half tablets a day until your
appointment with Dr. [**Last Name (STitle) **].
Disp:*30 Tablet(s)* Refills:*2*
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma Exacerbation

Discharge Condition:
stable

Discharge Instructions:
PLease [**Name8 (MD) 138**] MD or return to hospital if you have another attack
that is not responsive to your nebulizers.

Followup Instructions:
Primary Care: Please follow up with your PCP or NP as soon as
you are discharged.  At the time please mention your prolonged
steroid use and possible questions regarding diabetes care.

Pulmonary: Please f/u with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 5091**]
Thursday [**2122-10-29**] 2:30pm

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Asthma, unspecified type, with status asthmaticus,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Long-term (current) use of steroids,Eosinophilia,Anemia, unspecified,Obesity, unspecified,Esophageal reflux,Other diseases of pharynx, not elsewhere classified,Unspecified sleep apnea'}


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: Shortness of Breath
Asthma Attack

PRESENT ILLNESS: 30 yo woman with severe asthma since childhood required multiple
intubations (>10x, with last one in [**7-28**]) was admitted due to
another episode of asthma attack. Pt reported that she has been
maintained on prednisone 20mg po qod since [**7-29**], she is
followed by Dr. [**Last Name (STitle) 50575**] of pulmonary and her most recent PFT
([**2122-10-4**]) showed worsening dz (FEV1/FVC=45(56% pred). Pt
reported that around 11pm last night she had an asthma attack(
she has on avg 3 attacks per wk). She feels this was
precipitated by here walking between the heat of her home and
the cold outside mult times.  She took nebs and went to bed at
1am and woke up at 6am wheezing, nebs didn't help, called EMS.
She them collapsed and doesnot remember anything until she woke
up in the ED.
By report of the family and ambulance, the pt given CPR by
brother when she stopped breathing.  The EMS gave her O2, nebs
a, and .3 sc epi which brought her sats to 95%.  In the ED
(arrived ~7am) she was given solumedrol 125mg x 1, heliox mask
vent at 10L, and cont nebs to maintain sats.  Her symptoms
slowly improved as the morning progressed.  By the time she
arrived at the ICU (12pm) she no longer required nebs to
maintain sats or avoid SOB.

MEDICAL HISTORY: Asthma
eczema
Fe Def Anemia
Nasal Polyps

MEDICATION ON ADMISSION: Theophylline 300mg SR [**Hospital1 **]
Montelukast 10mg qday
Albuterol 1-2 puffs q4h
Fluticasone 2 puffs [**Hospital1 **]
salmeterol 1 puff qday
albuterol nebs [**Hospital1 **]
prednisone 20mg qod

ALLERGIES: Aspirin

PHYSICAL EXAM: Admission exam:
T 98.8 P 99 RR 11 BP 129/86 O2  91 on 10L heliox
Gen - A+Ox3, [**Last Name (un) 1425**] young woman, spleaking in full sentances,
no accessory muscles when breathing,
HEENT: EOMI, PERRL, OP clear, no icterus, moon face
Neck: supple, posterior hump, acanthosis nigricans, no LAD
Cor: RRR no m/r/g
Chest: diffuse expiratory wheezes, no rales, no ronchi
Abd: obese with striae, NT/ND, +BS, no HSM
Ext: nl bulk and tone, +2 DP bilat, thickened toenails b/l, no
c/c/e

FAMILY HISTORY: Distant relatives have DM, asthma

SOCIAL HISTORY: No ETOH, No Tob, No drugs.
Married, lives with huband and brother
[**Name (NI) **] Health student at BU 

### Response:
{'Asthma, unspecified type, with status asthmaticus,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Long-term (current) use of steroids,Eosinophilia,Anemia, unspecified,Obesity, unspecified,Esophageal reflux,Other diseases of pharynx, not elsewhere classified,Unspecified sleep apnea'}
