How do you frame a diagnosis? This is my case study and I am stuck on framing the diagnosis. Mr. W is a 65-year-old man presenting to the office reporting shortness of breath and cough. He has a PMH of Asthma, COPD and he is a smoker. Reports the DIB started about a week ago and has progressively been getting worse. The cough has been worsening and now nearly constant and is keeping him up at night. He reports clear sputum, denies bloody or green sputum. DIB worse with activity and sometimes chest feels tight. Attempts to treat have included his albuterol inhaler and warm steamy showers. Denies fever.Current medications: Albuterol inhaler PRNSocial: 35 pk year smokerPhysical exam: Vital signs: 98.6, 90, 22, 128/80, SPO2 93% on room air.Focused exam:HEENT: unremarkableNeck: No JVD, trachea midline.Respiratory exam: Respirations non-labored, decreased breath sounds and scattered wheezing.CV: S1/S2/RRR, no murmur, heave or lift. No dependent edema
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