Patient is a 22 year old white man with asthma since age 5. He is here for a routine follow-up.

Past History: respiratory failure age 5, 10, and 17. Asthma has been complicated by subcutaneous emphysema (ages 10, 17) and by tension pneumothorax (age 17). No eczema. No food allergy.

Systems Review: is otherwise in apparent good health. Tolerates aspirin and other non-steroidal anti-inflammatory agents.

Social History: Non-smoker. No smokers at home. No pets. Occupation  air-conditioner technician;  Hobby - body-building.

Family History: mother has rhinitis with nasal polyposis and mild/moderate adult-onset asthma.

Current medications: Azmacort 4 puffs qid; Serevent 2 puffs bid; Albuterol inhaler 2 puffs q4h; Ipratroprium 4 puffs qid prn. The patient starts prednisone 60, 50, 40, 30, 20, … or 60 mg daily if needed.

Physical examination: Resp = 12/min  BP= 122/84 T=97 AP= 64
Chest clear. Air movement good. No wheezes rales or rhonchi. Nasal mucosa pale, boggy. Heart- RSR no murmurs.

Laboratory: IgE = 4 IU/ml   Allergy skin tests: negative

CBC = WBC = 6550  Polys = 50% Lymphs = 33% Monos= 10%  Eos = 5% Bas =2%
 

                                                       Pre-                           Post-
                                                  bronchodilator             bronchodilator
Peak Flow (9.5 L/sec)               12.0 (126%)              12.9 (136%)
Forced Vital Capacity (5.3 L)       4.9  (92%)                5.3 (100%)
FEV1 (4.3 L)                                 3.8 (88%)                3.9 (103%)
FEF25-75 (4.7 L/sec)                     0.7  (15%)              0.8  (17%)