ABSTRACT
Mr. W. is a 44-year-old male who presents to your office complaining of increasing shortness of breath and wheezing. He reports feeling wheezy during the day, and has several nocturnal awakenings per week due to wheezing. Upon further questioning, he denies changes in sputum production, fevers, or chills. He has past medical history of obesity, type II diabetes mellitus, tobacco use (quit 12 years ago, 30 pack years), and allergic rhinitis and asthma diagnosed as an adolescent. He takes both long- and short-acting insulin, an angiotensin-converting-enzyme inhibitor (ACEi), an albuterol metered-dose inhaler (MDI) daily. He reports significant relief with his albuterol inhaler.
