Pulmonology · Model history
Wheezing during exercise: a model respiratory history
- Setting
- Pulmonology clinic
- Patient
- Ms. Chloe Bennett, 32, develops wheezing, cough, and shortness of breath when she runs outdoors.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“It's an albuterol inhaler. I shake it, breathe out, press once while I breathe in, and then hold my breath. I don't use a spacer.”
After hearing how the reliever is used, ask one question about ongoing anti-inflammatory or controller treatment.
Do you use any controller inhaler or take any other regular medicine?
Model interview
Full transcript
- Doctor
Ms. Bennett, I'm Dr. Lewis. What would you like us to focus on today?
- Patient
I wheeze and get short of breath when I run, especially outside in cold weather. I'm worried it could turn into a serious asthma attack.
- Doctor
Tell me what you notice first during a run.
- Patient
Usually a dry cough starts, then my chest feels tight and I hear a whistling sound when I breathe out.
- Doctor
How soon does that begin, and what do you do when it happens?
- Patient
It starts after about ten minutes in cold air. I stop, take my rescue inhaler, and the symptoms settle within ten or fifteen minutes.
- Doctor
How many days a week are you needing the inhaler for these symptoms?
- Patient
Usually two or three days a week, mostly on running days.
- Doctor
Do coughing or breathing symptoms ever wake you at night?
- Patient
No. I sleep through the night.
- Doctor
What is your breathing like at rest or during ordinary daily activities?
- Patient
It's normal. Walking and work don't bother me.
- Doctor
Have you had a recent cold or noticed another trigger besides running and cold air?
- Patient
No recent cold. I haven't found a clear trigger indoors.
- Doctor
Have you ever had an attack where you could not speak in full sentences or the inhaler did not help?
- Patient
No. I've always been able to speak, and the inhaler has worked.
- Doctor
Have you ever needed an emergency visit, hospital stay, or breathing tube because of asthma?
- Patient
No. Nothing that severe.
- Doctor
Which inhaler do you use now? Please walk me through how you use it.
- Patient
It's an albuterol inhaler. I shake it, breathe out, press once while I breathe in, and then hold my breath. I don't use a spacer.
- Doctor
Do you use any controller inhaler or take any other regular medicine?
- Patient
No controller and no other regular medicine.
- Doctor
Do you smoke or vape, or breathe smoke or fumes at home or work?
- Patient
No. I don't smoke or vape, my roommate doesn't smoke, and my office doesn't have fumes.
- Doctor
Do you have eczema, nasal allergies, or a family history of asthma?
- Patient
I had eczema as a child. I don't have nasal allergies, and no one else in my family has asthma.
- Doctor
Do you have any medication allergies?
- Patient
No known medication allergies.
- Doctor
How is this changing your exercise, and what would you like from today's visit?
- Patient
I've stopped running alone because I'm scared I won't get help. I want to know how well controlled this is, whether I need a controller, and whether my technique is right.
- Doctor
You have cough, chest tightness, wheezing, and shortness of breath after about ten minutes of outdoor running, especially in cold air, on two or three days a week. Albuterol settles it within fifteen minutes. You have no nighttime or resting symptoms and no history of a severe attack, but fear of an attack is limiting your running. Is that accurate, and is there anything else you want me to understand?
- Patient
That's accurate. Being able to run safely is the main thing.
- Doctor
Next I'll listen to your lungs, assess your breathing objectively, and watch you use the inhaler. Then we'll agree on an anti-inflammatory treatment and written action plan, including what to do if symptoms worsen or the reliever stops working.
- Patient
Good. I'd feel better having a clear plan.
Flow at a glance
The route through the history
- Invite the patient's description
- Define the exercise pattern and triggers
- Measure daytime, nighttime, and activity symptoms
- Check severe-attack history
- Review reliever response and inhaler technique
- Assess smoking, vaping, exposures, and atopy
- Explore safety concerns and goals
- Summarize and move to objective assessment and an action plan
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
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