Description

P.W. is a 16-year-old female presenting with a 3-week history of dry, non-productive cough and shortness of breath x 3 days. Cough followed upper respiratory symptoms of congestion and runny nose 3 weeks ago. She reports that cough and shortness of breath are worse at night, and shortness of breath is exacerbated by walking and talking. She denies any relieving factors for the cough, but shortness of breath is improved with rest. She has not tried any treatments for these symptoms. Pertinent PMH includes episodes of reactive airway when she was younger, and eczema. She denies chest pain but describes chest tightness. She lives in an older apartment building with her parents and reports exposure to cockroaches and secondhand smoke daily. Physical exam reveals labored tachypneic respirations, SpO2 94% on RA, subcostal retractions, and bilateral expiratory wheezing. Exam is negative for fever, stridor, or cyanosis.