Good Health Clinic Consultation Note

Henry Levin, the 7^th is a 67 year old male referred for further asthma management. Onset of asthma in his teens. He was hospitalized twice last year, and already twice this year. He has not been able to be weaned off steroids for the past several months.

• Asthma
• Hypertension (see HTN.cda for details)
• Osteoarthritis, right knee

• Theodur 200mg BID
• Proventil inhaler 2puffs QID PRN
• Prednisone 20mg qd
• HCTZ 25mg qd

• Penicillin - Hives
• Aspirin - Wheezing
• Codeine - Itching and nausea

• Father had fatal MI in his early 50's.
• No cancer or diabetes.

• Smoking :: 1 PPD between the ages of 20 and 55, and then he quit.
• Alcohol :: rare

Vital Signs
Date / Time	April 7, 2000 14:30	April 7, 2000 15:30
Height	177 cm (69.7 in)
Weight	194.0 lbs (88.0 kg)
BMI	28.1 kg/m2
BSA	2.05 m2
Temperature	36.9 C (98.5 F)	36.9 C (98.5 F)
Pulse	86 / minute	84 / minute
Rhythm	Regular	Regular
Respirations	16 / minute, unlabored	14 / minute
Systolic	132 mmHg	135 mmHg
Diastolic	86 mmHg	88 mmHg
Position / Cuff	Left Arm	Left Arm
Skin Exam
Erythematous rash, palmar surface, left index finger.

Lungs
Clear with no wheeze. Good air flow.
Cardiac
RRR with no murmur, no S3, no S4.

• CXR 02/03/1999: Hyperinflated. Normal cardiac silhouette, clear lungs.
• Peak Flow today: 260 l/m

• Suture removal, left forearm.

• Asthma, with prior smoking history. Difficulty weaning off steroids. Will try gradual taper.
• Hypertension, well-controlled.
• Contact dermatitis on finger.

• Complete PFTs with lung volumes.
• Chem-7 tomorrow.
• Teach peak flow rate measurement.
• Decrease prednisone to 20qOD alternating with 18qOD.
• Hydrocortisone cream to finger BID.
• RTC 1 week.