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

John J. Oppenheimer, MD; Zab Mosenifar, MD, FACP, FCCP


March 21, 2023

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 in the United States presents to the emergency department with severe shortness of breath; wheezing, and a persistent nonproductive cough. He first noticed the symptoms mid-morning yesterday prior to playing a round of golf with his work colleagues. He believed the onset of symptoms to be related to worsening of his allergies; however, symptoms continued to worsen through the afternoon and evening. He is an avid golfer and says that these symptoms are not unusual but tend to be worse upon awakening in the morning. He also reports frequent nasal obstruction, rhinorrhea, and episodes of sneezing that often wake him in the middle of the night. Use of antihistamine, decongestants, and nasal sprays do not provide significant relief of symptoms. He denies any sick contacts, chest pain, or myalgias. Body temperature is normal (98.2 °F; 36.8 °C); blood pressure is 125/75 mm Hg; height is 5 ft 11 in (1.80 m); weight is 177 lb (80.29 kg; BMI = 24.7). Rapid PCR for SARS-CoV-2 is negative. He has a medical history that is significant for eczema and 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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.