Dear Doctor-reader of SW101,

In your case today, you are seeing a 58 year old woman with respiratory distress.  When you enter the exam room, she is lying on the table, sweatshirt over her head, coughing into a full sized towel.

Upon your entry, she emerges looking disheveled.  You can see that she’s sweating a bit and she is breathing a bit faster than normal (about 18 breaths per minute).  You could hear almost continual God-awful hacking well before you entered the room.

The woman is pleasant and communicative – although she constantly interrupts herself to cough so hard you think she will gag each time.  It takes her nearly 10 seconds to recover after each paroxysm of coughing.

Your patient says she has had the cough “forever”, but is has been really bad over the past 2 months.  She has taken all kinds of over the counter stuff, none working well or for long.  She uses an albuterol inhaler.  Someone somewhere said she had “asthma” once, but she doesn’t really know what that means or if it’s real.

She has a normal blood pressure.  Her pulse is around 100 (normal is 80) and respirations are already mentioned.  The O2 saturation is 97% on room air (normal is 98% or so).

What should you do, doc?