Sample 2
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petermaguire-2649-78985- 279557-3024.WAV <BODY> Re-eval longstanding AR, IT, mild intermittent asthma, who has been very stable on Intal2 p b.i.d. Unfortunately, Tilade, Intal discontinued. Reviewed previous records back to 2003, which included my note wanting to avoid IOP, so we wanted to avoid nasal steroids and potentially inhaled steroids. Discussed low relative risk of side effects with low dosing of corticosteroids. Used ProAir for the first time in about a year as her Intal was running low; she felt potentially one mild need. Has minimal congestion, rhinorrhea in the morning. Tolerating IT well on ROS 14point. O: Appears VSS, NAD. SaO2 on room air is 96 percent. SKIN: Nonfocal. HEENT: NC, AT. PERRLA. EOMI. TMs clear. NP 1-2. OP WNL. NECK: WNL. LUNGS: CTA without focality. Without focal wheezes, rales, or rhonchi. EXT/NEURO: Stable. Mild intermittent asthma that may become more symptomatic off her controller. She tried Singulair a long time ago and in hindsight felt that it did not have much or any effect. For that reason, we are trying Alvesco 80 mcg lowest therapeutic dose at 1 p daily; new spacer device, dispensed 2 Alvesco. Followup in 2 months clinically if there are any issues, side effects. Recommend that she check her IOPs in 2 months and periodically, at least annually. Cont IT, AR. Counseling greater than 50 percent, time 15 min. </BODY>
