CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 34-year-old female
with 3?????? year history of asthma who presents to the Emergency
Room with 3-4 days of worsening asthma symptoms requiring
Albuterol MDI as much as 20 times per day, gives vague
history of recent URI-like symptoms, occasional white to
yellow sputum, no overnight stays in unfamiliar places, new
pets, new job, etc.  Has pets at home but no changes.  Had
pets all her life, unclear what precipitant is for this flare
or in the past.  Not on chronic oral steroids.  Last dose was
in [**2165-12-12**].  The flare required overnight MICU
observation.  Came to the Emergency Room from work, sent by
occupational health, had minimal improvement with first round
of nebs, ultimately improved approximately 1-2 hours later,
had increased shortness of breath 94% on four liters, heart
rate 130's, respiratory rate 30's.  Peak flow fell from 200
to 130 and then admitted to the MICU for observation.  Asthma
diagnosed in [**2162**], three times on steroids, last time in
[**2165-12-12**].  No PFTs on record, never been intubated.  L5
radiculopathy, positive EMG in [**12-12**], status post L4,5
laminectomy in [**2153**], L2,L3 and L5,S1 disc herniation status
post tubal ligation.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for asthma in mother, sister,
daughter, father with heart disease.

SOCIAL HISTORY: Divorced with three children, works in Human
Resources at [**Hospital3 1810**].  Quit smoking one year
prior to admission.  Smoked a pack a week, no alcohol, no
drugs.
Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site
Asthma NOS w (ac) exac,Acute uri NOS
Admission Date:  [**2166-3-10**]     Discharge Date:  [**2166-3-13**]

Date of Birth:                  Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This is a 34-year-old female
with 3?????? year history of asthma who presents to the Emergency
Room with 3-4 days of worsening asthma symptoms requiring
Albuterol MDI as much as 20 times per day, gives vague
history of recent URI-like symptoms, occasional white to
yellow sputum, no overnight stays in unfamiliar places, new
pets, new job, etc.  Has pets at home but no changes.  Had
pets all her life, unclear what precipitant is for this flare
or in the past.  Not on chronic oral steroids.  Last dose was
in [**2165-12-12**].  The flare required overnight MICU
observation.  Came to the Emergency Room from work, sent by
occupational health, had minimal improvement with first round
of nebs, ultimately improved approximately 1-2 hours later,
had increased shortness of breath 94% on four liters, heart
rate 130's, respiratory rate 30's.  Peak flow fell from 200
to 130 and then admitted to the MICU for observation.  Asthma
diagnosed in [**2162**], three times on steroids, last time in
[**2165-12-12**].  No PFTs on record, never been intubated.  L5
radiculopathy, positive EMG in [**12-12**], status post L4,5
laminectomy in [**2153**], L2,L3 and L5,S1 disc herniation status
post tubal ligation.

MEDICATIONS:  Flovent 220, 2 puffs [**Hospital1 **], Albuterol MDI 20
times per day in the past few days, no over the counter, no
herbals.  History of reaction to Cortisone and steroids in
the past but has taken them many times without trouble.

SOCIAL HISTORY:  Divorced with three children, works in Human
Resources at [**Hospital3 1810**].  Quit smoking one year
prior to admission.  Smoked a pack a week, no alcohol, no
drugs.

FAMILY HISTORY:  Positive for asthma in mother, sister,
daughter, father with heart disease.

PHYSICAL EXAMINATION:  Vitals, afebrile, 98.4, 131, 116/21,
respirations 25, 94% on room air.  General, in respiratory
distress, using accessory muscles, extraocular movements
intact, pupils equal, round and reactive to light and
accommodation, oropharynx clear without lesions.  Neck supple
without lymphadenopathy.  Lungs showed prolonged expiratory
phase, inspiratory and expiratory wheezes, poor air movement,
no focal areas of decreased breath sounds.  Cardiovascular is
tachycardic, regular.  Abdomen was soft, nontender, non
distended.  Extremities showed no clubbing, cyanosis or
edema, pulses times four.  Neuro, upper extremity and lower
extremity strength 5/5 bilaterally.  Alert and oriented times
three.

LABORATORY DATA:  White count was 10 with 90% neutrophils,
6.4% lymphs, hematocrit 41.4, MCV 91, platelet count 231,000,
BUN and creatinine 11 and 0.8.  Sugar 121.  ABG 7.45, 28, 60,
94% on four liters.  Chest x-ray showed no CHF, normal chest
x-ray.  EKG, sinus tachycardia at 150, normal axis, normal
intervals, questionable ST depression in V5 and V6 vs rate
related changes.

HOSPITAL COURSE:  The patient was admitted to the MICU
overnight for observation.  She was given 125 mg of
Solu-Medrol in the Emergency Room and she was started on 80
mg of IV tid as well as continuation of her inhaled steroids,
albuterol, Atrovent and nebs, prn Albuterol.  Outpatient ABG
was felt to demonstrate hypoxia but otherwise normal.  The
patient was called out of the unit on [**3-11**] after a 24 hour
stay.  The patient was started on Trimethoprim
Sulfamethoxazole to cover possible respiratory pathogens and
she was then changed to Zithromycin.  Her Solu-Medrol was
changed to Prednisone which was tapered as an outpatient.  On
the day of discharge her peak flow was still slightly low at
250, however, the patient was adamant about leaving and she
was discharged to home on [**2166-3-13**].

DISCHARGE MEDICATIONS:  5 day course of Azithromycin,
Prednisone 60 mg po q d to be tapered as an outpatient,
Albuterol MDI prn, Flovent 220 MDI, Protonix while on
steroids, Advair Disc inhaler which is Serevent and
Singulair.

DISCHARGE STATUS:  Good.

DISCHARGE DISPOSITION:  To home.






Dictated By:[**Last Name (NamePattern1) 2396**]

MEDQUIST36

D:  [**2166-8-19**]  08:34
T:  [**2166-8-20**]  21:04
JOB#:  [**Job Number 22759**]
{'Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site'}


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 34-year-old female
with 3?????? year history of asthma who presents to the Emergency
Room with 3-4 days of worsening asthma symptoms requiring
Albuterol MDI as much as 20 times per day, gives vague
history of recent URI-like symptoms, occasional white to
yellow sputum, no overnight stays in unfamiliar places, new
pets, new job, etc.  Has pets at home but no changes.  Had
pets all her life, unclear what precipitant is for this flare
or in the past.  Not on chronic oral steroids.  Last dose was
in [**2165-12-12**].  The flare required overnight MICU
observation.  Came to the Emergency Room from work, sent by
occupational health, had minimal improvement with first round
of nebs, ultimately improved approximately 1-2 hours later,
had increased shortness of breath 94% on four liters, heart
rate 130's, respiratory rate 30's.  Peak flow fell from 200
to 130 and then admitted to the MICU for observation.  Asthma
diagnosed in [**2162**], three times on steroids, last time in
[**2165-12-12**].  No PFTs on record, never been intubated.  L5
radiculopathy, positive EMG in [**12-12**], status post L4,5
laminectomy in [**2153**], L2,L3 and L5,S1 disc herniation status
post tubal ligation.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for asthma in mother, sister,
daughter, father with heart disease.

SOCIAL HISTORY: Divorced with three children, works in Human
Resources at [**Hospital3 1810**].  Quit smoking one year
prior to admission.  Smoked a pack a week, no alcohol, no
drugs. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Acute upper respiratory infections of unspecified site'}
