John Franklin is a 35-year-old African American male who has a history of hypertension and asthma who smokes ½ ppd since the age of eighteen. He began to feel more short of breath after supper today and began to have a persistent non- productive cough. He ran out of his albuterol inhaler two months ago and has audible expiratory wheezing when he comes to the triage window of the emergency department (ED).


This case study presents John Franklin, a 35-year-old African American male with a medical history of hypertension and asthma. John is a smoker, consuming half a pack of cigarettes per day since the age of eighteen. He has recently experienced increased shortness of breath and a persistent non-productive cough. Upon arriving at the emergency department (ED), John is observed to have audible expiratory wheezing. This paper will analyze John’s symptoms, medical history, and provide a differential diagnosis, exploring the potential causes for his respiratory distress.

Background Information

Asthma is a chronic respiratory condition characterized by inflammation of the airways and reversible airflow obstruction. It affects approximately 300 million people worldwide, with its prevalence increasing in recent years (Masoli et al., 2004). The symptoms of asthma can range in severity, from mild intermittent to severe persistent, and can be triggered by various factors such as allergies, exercise, and tobacco smoke. In John’s case, his history of asthma, combined with his smoking habit, makes him particularly vulnerable to respiratory complications.

Clinical Presentation and Differential Diagnosis

John presents with several concerning symptoms, including increased shortness of breath and a persistent non-productive cough. These symptoms, along with the presence of audible expiratory wheezing, suggest an exacerbation of his asthma. However, it is important to consider other potential causes of his respiratory distress to form an accurate differential diagnosis.

1. Asthma Exacerbation: Given John’s history of asthma, the presentation of increased shortness of breath, cough, and wheezing is consistent with an asthma exacerbation. The absence of productive cough and the audible wheezing support this diagnosis.

2. Chronic Obstructive Pulmonary Disease (COPD): COPD is another common chronic respiratory condition often associated with smoking. While John’s symptoms align more closely with asthma, the possibility of COPD cannot be completely ruled out given his smoking history. Further investigations, such as pulmonary function testing, may be necessary to differentiate between the two conditions.

3. Respiratory Infection: Respiratory infections, such as bronchitis or pneumonia, can also present with similar symptoms to asthma exacerbations. Infection-induced inflammation can cause wheezing and coughing. An evaluation of John’s history, physical examination, and potentially performing a chest X-ray can help determine if an infection is present.

4. Allergic Reaction: An allergic reaction, triggered by exposure to allergens or irritants, can lead to respiratory symptoms similar to asthma exacerbations. This possibility should be considered, especially if there is a known exposure to a specific allergen or irritant.

5. Pulmonary Embolism: Although less likely, a pulmonary embolism, characterized by a blood clot in the pulmonary arteries, can cause shortness of breath and wheezing. This condition should be assessed more carefully if there are additional risk factors present, such as recent long-distance travel, immobilization, or a history of deep vein thrombosis.

6. Cardiac-related Causes: Certain cardiac conditions, such as congestive heart failure, can manifest as respiratory distress due to fluid accumulation in the lungs. Considering John’s hypertension history, cardiac causes should be cautiously considered.

To determine the most likely diagnosis, additional investigations such as thorough history-taking, physical examination, laboratory tests (e.g., complete blood count, C-reactive protein levels), and imaging studies (e.g., chest X-ray) may be required. Considering the potential risks associated with John’s condition, early medical intervention and appropriate treatment are crucial.

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