She developed a sudden onset of fever one day prior to admission which she denied of having chills and rigor, not associated with sweating and she was not taking any medication to relieve the fever. No temperature recorded at home. On further questioning, she claim not complete the antibiotic that was prescribed to her before.

On the same day, she had shortness of breath that was preceded by cough with greenish sputum and no blood noted. Her shortness of breath was associated with wheezing and sensation of chest tightness. She was unable to speak in a complete sentence and complaint of difficult to sleep as she cannot even lie flat due to the symptom.  She needs 2 or 3 pillows to sleep. Her symptom becomes worse on exertion as she walks or climbs up the stairs. However, it improved in sitting and lean forward position. She claims that her shortness of breath was not triggered by cold weather or any certain food. She also had cat at home. She denied PND, chest pain, pedal edema.

She was treated with Salbutamol and Fluticasone inhaler. However she claims not compliance to her inhalers. She had stopped using the inhalers since a long time already and she was not remembering the steps to use the inhaler.

She claims that since diagnosed with Asthma, she had been admitted to hospital at least once a year due to asthma attack.

She had no known 🤬 of food allergy.

She denied smoking, taking alcohol or 🤬 for pleasure.

Upon physical examination, she was tachypnea with evidence of respiratory rate of 24 breaths per minute and rapid shallow breathing pattern, presence of audible wheezing noted. On auscultation, there was bronchial breath sound and generalized rhonchi heard. Other systemic examinations were unsignificant.

 

 

He was previously well until the night before the admission at 11pm, where he suddenly develop shortness of breath which wakes him up from sleep. He described it as a chest tightness associated with wheezing. He was unable to complete sentences. His wife also noticed presence of chest recession (subcostal recession). It was also associated with cough and sweating. It was a productive cough with whitish sputum. No haemoptysis. No cyanosis.

 

He then used an inhaler for a few puffs but it was not relieved. He tried to continue to sleep, but was awake the next 15 minutes. He took another few puffs and the cycle continues until the third time, at 2am, he could not tolerate any longer as the symptoms got worse. He was then brought to the ED of H. Selayang. 

 

Otherwise, no fever, no reduce in effort tolerance. No haemoptysis. No chest pain and no pleuritic chest pain. No pedal oedema, no palpitation. No loss of appetite or loss of weight.

 

His triggering factors include dusts, exercise and cold weather. However, he denied being exposed to the allergens on the day of admission. Despite that, he did went for fishing with his friends on that evening. He claimed that it was not far to walk and the weather was not cold. He also has allergic rhinitis and has a family history of asthma(his mom). His house was near to a construction area, and he has carpets in his house but no pets. 

 

He was diagnosed to have asthma 5 years ago in H. Selayang & hospitalized for 4 days. He was given Blue inhaler(salbutamol) and chocolate colour inhaler(budesonide). However, he was not compliant to the medications. He also defaulted follow up in H. Selayang. He only uses the blue inhaler(salbutamol) whenever needed. The other inhaler was only used for the first few months then he stopped using them. 

 

This is his third hospitalization. His second admission was in February 2018(7 months ago) with the same presentation. However, this year, his symptoms has become worse as he needs to use the (blue)reliever inhaler 3 times everyday. Since the admission, he required 5 nebs (throughout 7 months). 

 

His mother passed away at age of 48 due to asthma. 

His father passed away last year due to heart problem.

He has 3 children. His 3^rd child has asthma.

 

He is a smoker. He smokes 5 pack years. 

On physical examination, no findings was relevant. His symptoms has fully resolved.

Past medical/ surgical hx: not significant

Family hx: not significant

Social hx: He works as technician in UiTM Puncak Alam with 13 pax year of smoking. He’s living a sedentary lifestyle.

Physical examination: there’s no significant finding.

 

The fever was preceded by episode of cough for 1 week of duration. The cough was described as dry in nature however it became productive of whitish sputum since the last 3 days. Blood streak was also noted in the sputum. His cough was aggravated by cold. It was associated with sore throat and pleuritic chest pain on the right side. There was history of contact with sick people when he was visiting Kelantan with Jemaah Tabligh last month. However, there is no loss of weight, loss of appetite or night sweat and he denies any contact with TB patient. 

 

MN also complained of having episodes of shortness of breath since he had the fever. He claimed that he had asthma since he was 18 years old, diagnosed in Pusat Rawatan Islam and go for regular follow up in Klinik Kesihatan Sg Buloh. He was on metered dose inhaler of budesonide, berodual (Fenoterol and ipratropium bromide) and oral theophylline. His asthma was poorly controlled. During the fever, the episode of shortness of breath became worsen as it is increasing in frequency and prolonged in duration and he discovered himself at his worst condition 2 days before the admission. He complained of having disturbed sleep almost every night and his daily activity was restricted. His shortness of breath was associated with chest thightness. However, he denied having orthopnoea and no wheezing.

 

Otherwise, there is no headache, dizziness, nausea and vomiting, abdominal pain, diarrhea or constipation. 

Mr. MN has underlying asthma, hypertension, gout and benign prostate hyperplasia. He was diagnosed with asthma and hypertension since he was 18 years old. He was also diagnosed with gout and benign prostate hyperplasia since 10 years ago. He got medication and follow regular medical checked up in Klinik Kesihatan Sg Buloh. He also had history of having pneumonia in April 2016 and was admitted to Hospital Sg Buloh for 5 days.

- aspirin

- allopurinol

- amlodipine
- glyceryl trinitrate
- telmisartan
- simvastatin 

- budesonide

- ipratropium bromide

- theophylline

ALLERGY

He had no known allergy towards food or any medication

FAMILY HISTORY

His parent is healthy and died in old age. His first sister had hypertension and died in her 50^th with unknown cause. His second sister died in her 30^th with unknown cause and his last brother is healthy. His children also healthy.

 

Mr. MN is married and live with his wife staying at semi-D house in Desa Moccis in Sungai Buloh. He is a pensioner since 2006 who previously worked as director in FAMA. He was an ex-smoker since 15 to 25 years old with 10 pack years. He denies any alcohol intake and drug usage.

PHYSICAL EXAMINATION
On examination of the chest, he was tachypneic with respiratory rate of 22 breath per minute and there are signs of consolidation on his right lower zone up to mid zone as there are increased vocal fremitus, dullness on percussion, reduce air entry, bronchial breath sound and increased vocal resonance.