CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: 45yo M with PMHx of refractory asthma with > 100 hospitalization
and 17 past intubations now presenting with wheezing, SOB,
worsening over the past 2 days.
Patient developed cough and shortness of breath for the past
week that he attributes to the hot weather. Over the past 2
days, patient has had worsening SOB and wheezing, not managed
with home nebulizers. Prior to presentation in the ED, the
patient used his nebulizers 6 times on the AM of presentation
with no changes in symptoms. He reports that he increased his
prednisone dose from 30mg daily to 80mg daily 3 days ago. His
cough is productive of sputum, described as clear, thick and
yellow. He reports that he had fever of 99.2 1 week ago. He has
also noticed DOE, which the patient does not experience at
baseline.
Of note, he reports that his wife has been ill with coughing and
runny nose.
Initial vitals upon arrival to the ED: 98.0 103 153/98 22 97%
RA. In the [**Last Name (LF) **], [**First Name3 (LF) **] verbal report, the patient is speaking in
full sentences though having difficulty completing full
sentences, but with no accessory muscle use and no tachypnea.
The patient had a CXR which showed no effusions or
consolidations concerning for PNA. The patient was given 2
Duo-Neb treatments, IV magnesium, and IV solumedrol 125mg ONCE.

MEDICAL HISTORY: - Severe asthma with greater than 100 hospitalizations, multiple
intubations (17), followed by Dr. [**Last Name (STitle) **] in pulm, plan to refer

MEDICATION ON ADMISSION: 1. DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL
Inhalation Q4H:PRN shortness of breath or wheezing
2. fluticasone 220 mcg/actuation Inhalation [**Hospital1 **] 6 puffs twice a
day
3. Fluticasone Propionate NASAL 1 SPRY NU [**Hospital1 **]
4. Montelukast Sodium 10 mg PO DAILY
5. Loratadine 10 mg Oral Daily
6. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H
7. Omeprazole 20 mg PO BID
8. Tiotropium Bromide 1 CAP IH DAILY RX *Spiriva with HandiHaler
18 mcg 1 cap IH daily
9. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation Q4H:PRN shortness of breath or wheezing
10. Nicotine Lozenge 4 mg PO Q1H:PRN craving
11. PredniSONE 30mg PO daily

ALLERGIES: Fish Product Derivatives / Shellfish Derived / Peanut / Grass
Pollen-Bermuda, Standard / Mold Extracts / Cat Hair Std Extract

PHYSICAL EXAM: Admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: bilateral wheezes, no rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Two children with asthma as well as mother with asthma.

SOCIAL HISTORY: Works as school bus driver. Lives with wife and one of his three
children. Still smoking 1ppd. Has on average a bottle of
wine/week when he can afford it. Denies ilicits.
Chronic obstructive asthma with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Other diseases of lung, not elsewhere classified,Esophageal reflux,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Hip joint replacement
Ch obst asth w (ac) exac,Obstructive sleep apnea,Tobacco use disorder,Other lung disease NEC,Esophageal reflux,Leukocytosis NOS,Adv eff corticosteroids,Sec DM wo cmp nt st uncn,Joint replaced hip
Admission Date:  [**2178-6-29**]              Discharge Date:   [**2178-6-30**]

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

Service: MEDICINE

Allergies:
Fish Product Derivatives / Shellfish Derived / Peanut / Grass
Pollen-Bermuda, Standard / Mold Extracts / Cat Hair Std Extract

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None


History of Present Illness:
45yo M with PMHx of refractory asthma with > 100 hospitalization
and 17 past intubations now presenting with wheezing, SOB,
worsening over the past 2 days.
Patient developed cough and shortness of breath for the past
week that he attributes to the hot weather. Over the past 2
days, patient has had worsening SOB and wheezing, not managed
with home nebulizers. Prior to presentation in the ED, the
patient used his nebulizers 6 times on the AM of presentation
with no changes in symptoms. He reports that he increased his
prednisone dose from 30mg daily to 80mg daily 3 days ago. His
cough is productive of sputum, described as clear, thick and
yellow. He reports that he had fever of 99.2 1 week ago. He has
also noticed DOE, which the patient does not experience at
baseline.
Of note, he reports that his wife has been ill with coughing and
runny nose.
Initial vitals upon arrival to the ED: 98.0 103 153/98 22 97%
RA. In the [**Last Name (LF) **], [**First Name3 (LF) **] verbal report, the patient is speaking in
full sentences though having difficulty completing full
sentences, but with no accessory muscle use and no tachypnea.
The patient had a CXR which showed no effusions or
consolidations concerning for PNA. The patient was given 2
Duo-Neb treatments, IV magnesium, and IV solumedrol 125mg ONCE.


On arrival to the MICU, the patient is feeling tired, but denies
chest pain, chest tightness, shortness of breath, abdominal
pain, nausea, or vomiting.


Past Medical History:
- Severe asthma with greater than 100 hospitalizations, multiple
intubations (17), followed by Dr. [**Last Name (STitle) **] in pulm, plan to refer

to Dr. [**First Name (STitle) **] at [**Hospital1 112**]
- OSA on CPAP at night
- Avascular necrosis of the hip and shoulder from prolonged
steroid use, status post hip replacement ([**2173**])
- GERD
- H/o L Achilles tendon rupture s/p repair


Social History:
Works as school bus driver. Lives with wife and one of his three
children. Still smoking 1ppd. Has on average a bottle of
wine/week when he can afford it. Denies ilicits.

Family History:
Two children with asthma as well as mother with asthma.


Physical Exam:
Admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: bilateral wheezes, no rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

Discharge: same as above except:
VS: 97% RA with ambulation
Lungs: CTAB

Pertinent Results:
[**2178-6-29**] 12:00PM BLOOD WBC-12.9*# RBC-5.20 Hgb-15.6 Hct-47.5
MCV-91 MCH-30.1 MCHC-32.9 RDW-13.5 Plt Ct-310
[**2178-6-29**] 12:00PM BLOOD Neuts-66.4 Lymphs-23.8 Monos-7.9 Eos-1.4
Baso-0.6
[**2178-6-29**] 12:00PM BLOOD Glucose-91 UreaN-15 Creat-1.0 Na-140
K-5.1 Cl-109* HCO3-21* AnGap-15
[**2178-6-29**] 01:40PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.027
[**2178-6-29**] 01:40PM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG
[**2178-6-29**] 01:40PM URINE RBC-1 WBC-1 Bacteri-NONE Yeast-NONE Epi-0
TransE-<1
[**2178-6-29**] 01:40PM URINE CastHy-5*
[**2178-6-29**] 01:40PM URINE Mucous-MANY07/02/12 1:40 pm URINE

                            **FINAL REPORT [**2178-6-30**]**

   URINE CULTURE (Final [**2178-6-30**]):    NO GROWTH.

CXR: FINDINGS:  Frontal and lateral views of the chest were
obtained.  The heart is of normal size with normal
cardiomediastinal contours.  Bilateral streaky linear perihilar
opacities are compatible with reactive airway disease,
progressed since [**2175**] and similar to [**2178-5-16**].  The lungs
are otherwise clear.  No lobar consolidation, pleural effusion,
or pneumothorax.  The osseous structures are unremarkable.  No
radiopaque foreign bodies.
IMPRESSION:  Bilateral streaky perihilar opacities, compatible
with reactive airway disease, similar to [**2178-5-16**] though
progressed since [**2176-9-13**].


Brief Hospital Course:
Mr. [**Known lastname **] was admitted to [**Hospital1 18**] with an exacerbation of his
reactive airway disease, asthma vs COPD vs bronchiectasis. He
was started on standing bronchodilator nebs and prednisone 60mg
daily and admitted to the ICU. His CXR showed no PNA. His
respiratory status improved dramatically in the next 24h and his
oxygen sat was 97% RA with ambulation. He was encouraged to quit
smoking again and provided script for nicotine lozenges. He was
discharged with a plan to taper prednisone in the following
manner: take 60mg x 4 days, 50mg x 4 days, 40mg x 4 days, then
return to usual dose of 30mg daily. He should likely have a high
res CT chest as an outpatient to eval for bronchiectasis. He may
also have an element of COPD contributing to this picture. He
will follow up with PCP in next few days, pulmonary next month.

Medications on Admission:
1. DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL
Inhalation Q4H:PRN shortness of breath or wheezing
2. fluticasone 220 mcg/actuation Inhalation [**Hospital1 **] 6 puffs twice a
day
3. Fluticasone Propionate NASAL 1 SPRY NU [**Hospital1 **]
4. Montelukast Sodium 10 mg PO DAILY
5. Loratadine 10 mg Oral Daily
6. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H
7. Omeprazole 20 mg PO BID
8. Tiotropium Bromide 1 CAP IH DAILY RX *Spiriva with HandiHaler
18 mcg 1 cap IH daily
9. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation Q4H:PRN shortness of breath or wheezing
10. Nicotine Lozenge 4 mg PO Q1H:PRN craving
11. PredniSONE 30mg PO daily

Discharge Medications:
1. DuoNeb *NF* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg
base)/3 mL Inhalation Q4H:PRN shortness of breath or wheezing
RX *DuoNeb 0.5 mg-3 mg (2.5 mg base)/3 mL 1 nebulizer IH every
four (4) hours Disp #*60 Vial Refills:*0
2. fluticasone *NF* 220 mcg/actuation Inhalation [**Hospital1 **]
6 puffs twice a day
RX *Flovent HFA 220 mcg 6 puffs IH twice a day Disp #*1 Inhaler
Refills:*0
3. Fluticasone Propionate NASAL 1 SPRY NU [**Hospital1 **]
4. Montelukast Sodium 10 mg PO DAILY
RX *Singulair 10 mg 1 Tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
5. Loratadine *NF* 10 mg Oral Daily Reason for Ordering: Wish to
maintain preadmission medication while hospitalized, as there is
no acceptable substitute drug product available on formulary.
6. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H
RX *Serevent Diskus 50 mcg 1 discus IH every twelve (12) hours
Disp #*1 Inhaler Refills:*0
7. Omeprazole 20 mg PO BID
8. Tiotropium Bromide 1 CAP IH DAILY
RX *Spiriva with HandiHaler 18 mcg 1 cap IH daily Disp #*1
Inhaler Refills:*0
9. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation Q4H:PRN shortness of breath or wheezing
RX *albuterol sulfate 90 mcg 2 puffs IH every four (4) hours
Disp #*1 Inhaler Refills:*0
10. Nicotine Lozenge 4 mg PO Q1H:PRN craving
RX *nicotine (polacrilex) 4 mg 1 lozenge by mouth every hour
Disp #*120 Lozenge Refills:*0
11. PredniSONE 60 mg PO DAILY
RX *prednisone 10 mg 1 Tablet(s) by mouth as directed Disp #*91
Tablet Refills:*0
RX *prednisone 10 mg 1 Tablet(s) by mouth as directed Disp #*100
Tablet Refills:*0


Discharge Disposition:
Home

Discharge Diagnosis:
1. Asthma/COPD exacerbation


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with difficulty breathing.
This was likely due to an exacerbation of your asthma. You may
also have COPD, another chronic lung disease. It is important
you take all of your breathing medications every day. You should
stop smoking to avoid having more of these episodes.
.
Some of your medications were changed during this admission:
START prednisone taper, take 60mg daily for one week, then 40mg
daily for one week, then 20mg daily for one week, then 10mg
daily for one week.
.
You should continue to take all of your other medications as
prescribed.

Followup Instructions:
You should have a follow up appointment with Dr. [**Last Name (STitle) **] within
the next 3 days. Please call [**Telephone/Fax (1) 2010**] to schedule this
appointment when you get home today.

Department: PULMONARY FUNCTION LAB
When: WEDNESDAY [**2178-8-5**] at 10:20 AM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: WEDNESDAY [**2178-8-5**] at 10:40 AM
With: [**Known firstname **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: PFT
When: WEDNESDAY [**2178-8-5**] at 10:40 AM


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Chronic obstructive asthma with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Other diseases of lung, not elsewhere classified,Esophageal reflux,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Hip joint replacement'}


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: Dyspnea

PRESENT ILLNESS: 45yo M with PMHx of refractory asthma with > 100 hospitalization
and 17 past intubations now presenting with wheezing, SOB,
worsening over the past 2 days.
Patient developed cough and shortness of breath for the past
week that he attributes to the hot weather. Over the past 2
days, patient has had worsening SOB and wheezing, not managed
with home nebulizers. Prior to presentation in the ED, the
patient used his nebulizers 6 times on the AM of presentation
with no changes in symptoms. He reports that he increased his
prednisone dose from 30mg daily to 80mg daily 3 days ago. His
cough is productive of sputum, described as clear, thick and
yellow. He reports that he had fever of 99.2 1 week ago. He has
also noticed DOE, which the patient does not experience at
baseline.
Of note, he reports that his wife has been ill with coughing and
runny nose.
Initial vitals upon arrival to the ED: 98.0 103 153/98 22 97%
RA. In the [**Last Name (LF) **], [**First Name3 (LF) **] verbal report, the patient is speaking in
full sentences though having difficulty completing full
sentences, but with no accessory muscle use and no tachypnea.
The patient had a CXR which showed no effusions or
consolidations concerning for PNA. The patient was given 2
Duo-Neb treatments, IV magnesium, and IV solumedrol 125mg ONCE.

MEDICAL HISTORY: - Severe asthma with greater than 100 hospitalizations, multiple
intubations (17), followed by Dr. [**Last Name (STitle) **] in pulm, plan to refer

MEDICATION ON ADMISSION: 1. DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL
Inhalation Q4H:PRN shortness of breath or wheezing
2. fluticasone 220 mcg/actuation Inhalation [**Hospital1 **] 6 puffs twice a
day
3. Fluticasone Propionate NASAL 1 SPRY NU [**Hospital1 **]
4. Montelukast Sodium 10 mg PO DAILY
5. Loratadine 10 mg Oral Daily
6. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H
7. Omeprazole 20 mg PO BID
8. Tiotropium Bromide 1 CAP IH DAILY RX *Spiriva with HandiHaler
18 mcg 1 cap IH daily
9. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation Q4H:PRN shortness of breath or wheezing
10. Nicotine Lozenge 4 mg PO Q1H:PRN craving
11. PredniSONE 30mg PO daily

ALLERGIES: Fish Product Derivatives / Shellfish Derived / Peanut / Grass
Pollen-Bermuda, Standard / Mold Extracts / Cat Hair Std Extract

PHYSICAL EXAM: Admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: bilateral wheezes, no rales, ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Two children with asthma as well as mother with asthma.

SOCIAL HISTORY: Works as school bus driver. Lives with wife and one of his three
children. Still smoking 1ppd. Has on average a bottle of
wine/week when he can afford it. Denies ilicits. 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Other diseases of lung, not elsewhere classified,Esophageal reflux,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Hip joint replacement'}
