Difficulty in breathing

Male patient of age 24 Unmarried Smoking often once daily Drink alcohol twice a week Chief Complaints Breathlessness Cough dry Symptoms increased during night Patient feel something in chest History History of taking medication for same problem from nearby chemist Afebrile Vitals Bp:140/86 Pulse:86 Spo2 95 Temp:96.8 f Physical Examination Palor (+) Cynosis (-) Weight :75 Bilateral wheezing +++ App:Normal Bowel Normal Bladder normal Sleep : disturb Investigations Hb:16.8 Plateltes:2.8 Crp: 6 Lft kft normal Xray chest NAD Diagnosis Asthma? P.Eosinophilia?? Management My concern Is Ct chest advice?? Any other investigation should done?? What treatment should started??

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Need to rule out causes of Wheezes... it can be overlapping of Asthma and COPD... or smoking related bronchitis... HRCT is useful for structural changes... can go after stabilising acute symptoms. Needs Absolute Eosinophils count, IGE, PFT for further work up. Till you get Diagnosis... give LABA+Steroid as inhaled therapy.. acebrophylline... and supportive care...

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Adv absolute eosinophillic count. Sputum eosinophillic count, PFT to rule out reversible obstructive airways disease, Consider ICS LABA combination.

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Advice AEC AND PFT MAY BE ANXIETY INDUCED ASTHMA REVERSIBLE OBSTRUCTIVE AIRWAY DISEASE PLZ UPLOAD IMAGES

Thanks sir For opinion Images not available with me yet but try to arrange in follow up
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Kindly upload CXR PA

Not available yet But will arrange in next follow up with patient
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ICS LABA WITH ANXIOLYTIC

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