C10015198 / invoice 10000

Reason: BreathingO has abnormal breathing episodes for a while at homeKnown asthma PE unremarkable no dypsnea lung auscultation WNL, SPO2 98 on room airIs on flixotide, may benefit from bronchodilator alsoO is a worrier - just wants to know when she needs to come in Red flag signs include; cyanosis, open mouth breathing, abdominal effort, syncopeIntermittent self resolving phases of mildly increased resp rate/sneezing is okayAny non resolving dyspnea must be investigatedZP to speak to Viv re rads and investigations done prior and will call O--------------------------Presenting Complaint:- Owner reports intermittent abnormal breathing episodes observed at home over an extended period.History:- Known history of likely feline asthma, diagnosed on radiograph- Currently managed with inhaled fluticasone propionate (Flixotide).- Bronchoalveolar lavage has not been performed to date.Physical Examination:** CARE **- Bright, alert and responsive.- No evidence of respiratory distress.- Respiratory rate and effort within normal limits.- No dyspnoea observed.- Thoracic auscultation unremarkable with normal bronchovesicular sounds.- Peripheral mucous membranes pink with normal capillary refill time.- SpO2 98% on room air.Assessment:Stable patient with a history of feline asthma. No abnormalities detected on examination today. Intermittent episodes described may represent mild transient bronchoconstriction or airway irritation. Current therapy appropriate, however patient may benefit from the addition of a bronchodilator to improve control of clinical signs. Definitive airway sampling has not been performed.Plan:- Continue inhaled fluticasone therapy- Consider introduction of a bronchodilator (e.g. salbutamol inhaler)- Review previous thoracic imaging and diagnostic investigations performed- Consider bronchoalveolar lavage in future if clinical signs worsen or diagnosis becomes uncertainWill discuss prior radiographs and investigations with Dr Viv and will contact the owner following review.Client Communication:Owner reassured that patient is stable at present.Discussed red flag signs requiring immediate veterinary attention:- Cyanosis- Open-mouth breathing- Marked abdominal respiratory effort- Collapse or syncope- Any respiratory distress that does not self-resolve- Advised that occasional mild, self-limiting increases in respiratory rate or brief sneezing episodes may occur and can be monitored at home.- Owner understands monitoring advice and when to seek urgent care.    Vital Signs