Shortness of Breath Accompanied by Cough

SCENARIO 3 Shortness of breath accompanied by cough Scenario A 30 year old woman was taken to hospital with complaints of shortness of breath accompanied by coughing since three days ago. Previously, the patient and her husband cleaned the warehouse. The patient sneezed due to dust inhalation, while her husband did not experience similar complaints. The patient used the shortness of breath reliever inhaler that he had been using and took the medicine Salbutamol, complaints of shortness of breath decreased slightly. Patients also complain of coughing and difficulty expelling phlegm. Since one day, complaints of shortness of breath have become more severe, shortness of breath accompanied by 'wheezing' sounds and there has been no improvement with the medication he is using.For the past month, the patient has experienced recurring symptoms of shortness of breath, an average of twice a week. The shortness of breath recurs, especially when the air is cold and wakes up at night because of the tightness. The patient uses an inhaler to relieve congestion every day but does not use inhaler medication to prevent attacks. This shortness of breath interferes with the patient's daily activities.Six months ago the patient experienced shortness of breath and was taken to the emergency room, nebulized twice, the shortness of breath subsided, then went home and received oral medication (bronchodilator). Three days later he went to the polyclinic for treatment, had spirometry and received inhaler medication to relieve attacks and prevent attacks. One month later the patient had a routine check-up at the polyclinic, there were no complaints of shortness of breath, the patient's asthma control test score was 24 and spirometry was performed at that time.The patient began experiencing this history of shortness of breath since the age of 15 years. Apart from cold weather, patients will also experience shortness of breath if they inhale dust or if they are tired. The patient's mother also suffers from the same disease, while her aunt often gets itching when she eats sea fish. Physical examination: General condition looks seriously ill, short of breath when talking, can only speak a few words, restless. BP: 120/80 mmHg, pulse 102 x/', respiratory rate 30 x/', temperature 37.10C, oxygen saturation 90% Lung Examination: Inspection: visible retraction between the ribs Auscultation: normal vesicular, prolonged expiration,wheezingentire lung field Laboratory examination: Hb: 12.5 gr/dl, WBC 8000/mm3, Platelet Count 250000/mm3, count types: neutrophils 55%; eosinophils 12%, basophils 0%; lymphocytes 30%; monocytes 3% X-ray examination: hyperinflation was found. First spirometry examination Inspection Prediction Results % VEP1 2,505 1.68 67 KVP 3,121 2.81 95 VEP1/KVP 78 60 69 Second spirometry examination Inspection Prediction VEP1 2,505 KVP 3,121 Results 2,204 2.90 % 88 96 VEP1/KVP 78 82 91