Bipolar disorder

Patient comes in today for annual recheck. She has had moderate persistent asthma and is controlling it with Combivent two puffs three times daily as well as Advair 250/50 twice daily and she has her Ventolin inhaler as needed. She is currently out of her Advair. She has not had this for about eight weeks and also is running out of her Combivent. She really likes these medications to treat her asthma and she feels that they do a very good job in controlling her lung symptoms. Today, she states that she has recently been having more troubles due to sagebrush season as well as smoke in the air and has needed her Ventolin inhaler more frequently especially since she has been out of her Advair. Her peak flows today were at 200 at best. She has been previously up to 300 in the past, so a little bit low today.

ASSESSMENT:
1. Wheezing.
2. Moderate persistent asthma.
3. Allergic rhinitis.
4. Bipolar disorder.

PLAN:
1. Since patient has wheezing today in the clinic, I had her do DuoNeb nebulizer treatment and re-listened to her lung. She discontinued wheezing after this treatment. She did state that this made her feel better as well. I also have her use her Advair inhaler two puffs today before leaving and told her to begin that right away.
2. We also gave her a prescription for prednisone 30 mg for three days to help resolve any inflammation in the airways and just prevent wheezing from returning.
3. I also refilled her Combivent and Advair prescriptions today for the next year.
4. We also gave her flu shot today and we will follow up with her in one to two weeks to see if her wheezing has resolved.

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