Skill Checkup: A 32-Year-Old Man With Unusual Severe Shortness of Breath, Wheezing, and Nonproductive Cough

John J. Oppenheimer, MD


January 12, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 32-year-old man and avid golfer presents to the emergency department with severe shortness of breath; wheezing, and persistent; nonproductive cough. He says that these symptoms are not unusual and are worse upon awakening in the morning. He awakens in the middle of the night several times a month with symptoms, including nasal obstruction, rhinorrhea, and paroxysms of sneezing. He has a medical history that is significant for allergies to pet dander and dust mites since childhood. He is a nonsmoker and works as an insurance agent. He recently started dating a woman who has a cat.

He assumes that the recent exacerbation of symptoms reflects worsening of his allergies and seeks relief because the symptoms now interfere with his quality of life. Use of antihistamines; decongestants; and, occasionally, nasal steroid sprays do not provide significant relief.


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