Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: addendum: ms. hospital course was also complicated by diastolic heart failure for which she was treated empirically with several doses of lasix during her hospitalization. while there were no signs of pulmonary edema or heart failure on physical exam or radiographic evidence, clinical response to diuretic supported this diagnosis. secondary diagnosis: acute on chronic diastolic heart failure chief complaint: shortness of breath major surgical or invasive procedure: bronchoscopy x 2 history of present illness: ms. is a 74 year old woman with history of tbm, s/p silicone y-stent placement on and therapeutic bronch w/ clearance of secretions who presents with cough and shortness of breath for 5 days. she states that she feels similar to her prior occlusion . she has trouble bringing secretions up, but when she does expectorate it is mostly yellow/white mucus. she saw her pcp last week who started a "penicillin-based antibiotic" without much improvement. she has been on steroids in the past for copd flares and notes that they make her feel very agitated and requires sedation with them. she initially presented to hospital ed and was afebrile, satting 94% on ra. she had had decreased appetite and eating mostly soup. . in the ed, initial vitals were t 98, p 60, rr 20, bp 133/60, 95% on 4l. the patient underwent cxr which showed no evidence of pneumonia on prelim read. . ros: negative for fevers, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea. . past medical history: tbm s/p y stenting in copd obesity hypoventilation syndrome h/o c. diff colitis anxiety depression hypothyroidism cad, diastolic heart failure seizure disorder r colon cancer s/p hemicolectomy in s/p tonsillectomy s/p thyroid lobectomy s/p cholecystectomy s/p appendectomy social history: tobacco: >25 pack years, denies any active smoking alcohol: denies widow, lives by her self family history: mother and father with cad no lung cancer or congenital lung diseases physical exam: on admission: vitals: t 98.0 p 84 rr 28 bp 117/68 o2 97% on 2l gen: uncomfortable elderly female with moderate respiratory distress and audible upper airway rhonchi heent: eomi. mmm. op clear. conjunctiva well pigmented. neck: supple, without adenopathy or jvd. chest: lungs - coarse rhonchi in all lung fields, no wheezes appreciated. cor: normal s1, s2. rrr. no murmurs appreciated. abdomen: soft, non-tender and non-distended. +bs, no hsm. extremity: warm, without edema. 2+ dp pulses bilaterally. neuro: alert and oriented. cn 2-12 intact. motor strength intact in all extremities. sensation intact grossly. pertinent results: wbc-12.9*# rbc-4.54 hgb-12.7 hct-39.8 plt ct-278 glucose-113* urean-10 creat-1.1 na-141 k-4.5 cl-113* hco3-19* angap-14 calcium-8.7 phos-3.4 mg-1.9 ck-mb-notdone ctropnt-<0.01 08:15am blood type-art po2-59* pco2-30* ph-7.42 caltco2-20* base xs--3 07:39am blood type- po2-189* pco2-36 ph-7.43 caltco2-25 cxr : emphysema, no evidence of acute superimposed process. tracheal stent in place. : the heart size is normal. mediastinal position, contour and width are unremarkable. bibasal linear opacities have slightly improved and might represent interval improvement in bronchiectasis or bronchial wall inflammation/infection brief hospital course: 74 y/o f with pmhx of copd, and tbm s/p silicone y-stent on , followed by therapeutic bronch on , preseted on with cough and shortness of breath for five days. . on arrival to the floor, pt was c/o shortness of breath and having difficultly clearing secretions. despite additional nebs, and humidified o2, she triggered for increased rr. she was also desatting to high 80s and complaining of tiring out. abg was 7.42/30/59. she was tranferred to the icu. . on , she received theapeutic bronchoscopy. on , ip removed the y stent, given lack of improvement. patient reported subjective improvement in breathing and ability to cough up secretions. she was maintained on albuterol/atrovent nebs, advair, and morphine for anxiety component. she was started on azithromycin for presumed copd exacerbation. patient was not started on steroids in the icu given previous history of psychosis with prednisone. upon transfer out of the micu, she was saturating at 95% on 5l of oxygen. . on the floor, pt had increased dyspnea, although she was on four liters o2 and on q4h standing nebulizers. she was started on prednisone 40mg. after two days and no improvement, prednisone was increased to 60mg daily. the pulmonary team was also consultued and had no further recommendations. she was also given several empiric doses of lasix. within two days she had significant improvement. she was tachypneic, though did not desaturate when she would walk and climb stairs with physical therapy. she was discharged when stable on 2l, with home o2, and outpatient pulmonary rehab. she was instructed to call her pulmonologist immediately upon reaching home and set an appointment within one week. . chronic diastolic heart failure: pt is not maintained on any chf ppx meds at baseline and appeared euvolemic to dry on exam. she had no crackles on lung exam or lower extremity edema, cxr without signs of edema. i/os were net even throughout her hospitalization. she was given several doses of lasix, empirically given no improvement in pulmonary symptoms and her respiratory status improved to some degree, and it was thought that she might have had some of fluid retention affecting her respiratory status. . smoking cessation: smoking cessation was highly encouraged on a daily basis by multiple teams. she stated that boredome was the most significant component to not quitting. after this experience, she stated she was encouraged and make every effort to quit. medications on admission: effexor extended release 150mg po daily atrovent mdi 2 puffs qid lamictal 150mg po daily seroquel 25mg po qhs synthroid 150 mcg po daily tylenol 650mg po q6h prn pain/fever mucinex 1200 mg po bid mucomyst nebs q8hrs advair 250/50 discharge medications: 1. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*90 capsule(s)* refills:*0* 2. lamotrigine 150 mg tablet sig: one (1) tablet po once a day. tablet(s) 3. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime). 4. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 5. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). disp:*2 disks* refills:*2* 7. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours): please take with daily prednisone to prevent stomach pain. disp:*30 tablet(s)* refills:*2* 8. outpatient physical therapy pt: evaluate and treat, pulmonary rehab dx: tracheobronchomalacia 9. prednisone 10 mg tablet sig: as directed tablet po once a day: prednisone, take 60mg x1 day, then 40mg for 5 days, then 20mg x 5 days, then 10mg x 5 days, then 5mg x 5 days. please take 40mg if symptoms increase and call your pcp to evaluate symptoms. please discuss your prednisone dosing at your pulmonology visit. . disp:*200 tablet(s)* refills:*0* 10. lorazepam 0.5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for anxiety. disp:*30 tablet(s)* refills:*0* 11. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q4h (every 4 hours). disp:*180 nebulizer* refills:*2* 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours). disp:*180 nebulizer* refills:*2* discharge disposition: home discharge diagnosis: primary: tracheobronchomalaica and copd secondary: diastolic heart failure, tobacco abuse discharge condition: stable, rr, 22, o2sat 91% 2l discharge instructions: you were admitted for treatment of shortness of breath caused by tracheobonchomalacia and copd exacerbation. during your hospitalization you were transferred to the icu given increasing effort required to breath. you underwent bronchoscopy twice, once for suction of secretions, and once for stent removal. you were transferred to the floor, where you were treated for a copd exacerbation with steroids and nebulizers. your respiratory status improved and you were discharged. . medications changed on this admission: --> prednisone, take 60mg x1 day, then 40mg for 5 days, then 20mg x 5 days, then 10mg x 5 days, then 5mg x 5 days. please go back to 40mg if symptoms increase and call your pcp. discuss your prednisone dosing at your pulmonology visit. --> nicotine patch - apply daily for 7 days then quit. --> tesselon pearls for cough --> famotidine - to protect the stomach while on prednisone . please call your doctor or return to the ed if you experience worsening shortness of breath, chest pain, or any other concerning symptom. please take 40 mg of prednisone if you feel you are about to experience a copd exacerbation. followup instructions: please follow up with your pulmonologist dr - ( within one week of when you get home. no appointments are available at this time, but they should be able to schedule you when you call them. md procedure: closed [endoscopic] biopsy of bronchus removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure dysthymic disorder chronic kidney disease, stage iii (moderate) other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of malignant neoplasm of large intestine mechanical complication due to other implant and internal device, not elsewhere classified epilepsy, unspecified, without mention of intractable epilepsy other postprocedural status personal history of noncompliance with medical treatment, presenting hazards to health obesity, unspecified foreign body accidentally entering other orifice chronic respiratory failure other diseases of trachea and bronchus foreign body in larynx dysphagia, unspecified 

Answer: The patient is high likely exposed to