264
Clinical851596012894133172242280343405443
Case1330596012893156210272
Patient:851939012878140179219281351389428
Iblev1314939012847117156218287
Georgy16379390128101163233280349420
Sergeyevich2090939012878141187258320390451521561623693
(Date2819939012846148209247310
of3164939012870116
Birth:3314939012894133179218289327
27.09.1989)3676939012870140175246315350421490560630676
Presenting8511281012878125187242305374412452521592
Complaint:147712810128132201310378418480520589628667
Attacks218112810128101140178241303372426
of264312810128107154
breathlessness283212810128107154217279317388426488543598667730784839
with370512810128139178216287
expiratory402712810128100170240278325388426495542613
difficulty,467312810128108148195241279342411451489560593
dry530112810128108155225
paroxysmal8511522012870133180249319390443552612651
cough.153815220128118189258329398434
Daytime200715220128156218288325365476536
attacks257815220128118157196259322391445
occur305815220128125188249319367
4-5346015220128125175244
times37401522012894133243303357
per413315220128125188235
week,440315220128156218280350386
with482415220128157195234304
noted516315220128125196234296365
limitations851176301283978188225264327366404474545599
in14851763012869139
physical16591763012899169240293332395456495
activity21901763012892154192231301339379450
(sports26731763012876131201271318356411
-31201763012880
swimming,32351763012883185223333441478548619654
running,39241763012876147216287325396466501
tennis).44601763012867130200270308363411446
Nocturnal494117630128131199262301370418487548586
attacks8512004012862101141203265335389
occur12742004012871133196265312
1-216212004012870118187
times1844200401283777186247302
per21822004012870131178
week.239520040128102163226296331
Current8512346012894164211258320389428
Medication:132023460128125187256296358420459497568637676
Uses203123460128101155218273
salbutamol23392346012859122161231300340402511579618
to29932346012844115
relieve31432346012853115153192255324387
attacks,35652346012868106144207270339394429
4-540292346012875125195
times4260234601284383192252307
per46032346012875137184
week482923460128101163225295
during51602346012874144191230300370
the8512588012839110172
day10572588012870133203
and12942588012862132202
1-215312588012870118188
times1755258801283777187247301
per20912588012870132179
week230525880128101163226295
at26352588012863102
night.27712588012870109179249288324
History85129300128101140195233304351421
of13062930012888135
Present14762930012895142204259322391430
Illness:19422930012864102141211274327382421
Two24002930012886187257
years26922930012888148211258312
ago,30402930012880150220254
during33292930012888158205245314384
a37482930012880
trip38632930012857104143213
to41112930012857127
the42732930012857126189
forest,44962930012864135182244299337373
the49042930012856126189
patient51282930012888150188228290360398
experienced8513171012862133202265312351412483544607677
lacrimation,15633171012884146208255293402462501541612681717
runny23153171012891161230301371
nose,272031710128115185240302337
non-productive309231710128114184254303374420490560629692731770839902
cough,402931710128107177246316387422
and448531710128107177247
shortness47683171012898168238285324393456510565
of536731710128116162
breath8513412012870117180242280351
with124334120128101140178249
a15263412012870
feeling16313412012853114177216254324395
of20603412012876123
difficult22183412012876115162208247310379418457
expiration.27103412012869138209247294357395436506576610
Similar33553412012885124234270310372419
attacks38093412012870107147209271341395
occurred42403412012876139201270316363425495
3-447703412012877126195
times5000341201284584194254309
per53443412012876139186
year8513653012870131193240
after11263653012899146185248295
psychoemotional145636530128106161231292362432494604673712751821891954991
stress24833653012890130176238293347
and28653653012899169238
visits313936530128105145199238277332
to35053653012876146
the36863653012875146207
countryside.392836530128100169238309347395465518557627690725
Used468836530128138192253324
inhalers50463653012876146216278317380425479
(Salbutamol).8513896012847125187226296366405468577645684731766
Over165338960128122191253300
the19883896012859129192
past22153896012890153206246
year,24953896012892152214261296
began28263896012892154225286357
noticing32173896012890161199239301340409479
similar37313896012876115224261300363410
symptoms41763896012875145254323362432542594
during48063896012891162208247316387
URI.522838960128122215262297
Current8514137012894164211258320389428
deterioration13144137012875138176238285323394441502541579650720
began20694137012874136206268338
324434137012874
days25524137012875137208261
ago28484137012867137207
after30904137012867114153214261
hypothermia:33864137012875146214285324394456503612649716756
developed41774137012875137206269307378447510579
a47924137012866
cough48944137012866136206277346
with528041370128102140178248
difficult-to-expectorate8514378012870110157202241304373412451499537607654716785856919980101910891136119812361299
sputum.21854378012875144214253323433465
Last268543780128107169224263
night,29844378012890128198269307343
a33624378012882
dry34794378012890137207
cough37204378012882152223293363
suddenly41194378012873143213283346415454525
worsened,467743780128122191238293356425488557592
and53044378012882151221
shortness8514619012855125195242280351412467521
of14084619012870116
breath15584619012871118180243281350
appeared;19444619012862132202264327373436505544
use25234619012870124187
of27454619012870116
inhalers28964619012839108179241280343388442
provided33734619012870117187256296365428497
no39064619012870139
relief.40814619012847109146186249294329
Past8514961012878140195233
Medical112049610128160223293331394456494
History165049610128137175230269338386455
/21394961012875
Allergies:224949610128137176215278325395433496550589
Allergy287649610128101138178241286356426
to33374961012874145
flower35174961012883122191293355402
pollen,395449610128106175215253316385420
trees,44104961012874121183246299335
citrus47804961012898137175222292346
fruits,51624961012882129198238276331366
raspberries,8515203012847109164233304367412459498560615650
B153652030128114
vitamins,16855203012890129168231340376447502538
and22585203012882152222
penicillin25155203012890153222261323362401439479548
drugs30995203012890137206277331
-34655203012872
presenting35715203012890137200254316386425463534604
as42105203012884137
cough,43835203012882151222291361396
shortness48155203012875145214261299370433486540
of53915203012890137
breath,8515444012870117180242280351386
urticaria.12715444012870117155194257318365404467502
Smokes18085444012878187255325388443
for22865444012847116163
1024835444012870140
years,26595444012870130193239294330
3-530235444012870119189
cigarettes32485444012861100170232279341379419482535
per38175444012870133180
day.40325444012870132202235
Objective85157860128101171210272335374412483545
Examination:143057860128110179242351388459521559599668739778
Condition22445786012894163234303343381420490560
of28395786012893140
moderate301457860128133201272334381443481544
severity.35935786012877140209272319357396467500
The412857860128109179242
patient44055786012892155194233295364403
is48435786012863117
standing,49965786012877116178248318356427496531
leaning8516027012839102164233273342412
on12986027012895166
their15006027012863133196235281
hands18166027012895158228298353
in22036027012865135
front23736027012873120189259298
of27066027012898146
them.28866027012865134197306339
Skin326160270128104174212283
is35786027012865120
moist.373360270128135203243298336372
Respiratory414060270128119181235305344391453491562609679
rate48536027012872135174237
2051246027012896166
per53256027012895157202
minute,85162690128109146216287327389424
expiration131162690128140211280319366428466506575645
is199162690128118173
markedly220062690128188248294365427498536607
prolonged.284062690128149196266306376446516579648683
Pulmonary355862690128157227267376444515577624694
percussion428662690128149211257319390444499537608678
note499962690128148218257320
is535462690128116170
hyperresonant8516511012870141209272319365428482553622685754793
("boxy"16806511012860116187257326397454
sound).21696511012869138209278348395430
Auscultation264865110128102171225288357397435498536575645714
reveals33986511012861123192255317355410
harsh38436511012884147192247316
breathing41956511012883130192255293362402472541
with478665110128101139178248
buzzing50706511012883153215278316385455
and8516752012862133202
wheezing109967520128101171234296359397467537
sounds.16716752012865135205275345400434
Heart215167520128101163225272311
rate24986752012857119158221
8927546752012881150
bpm,29406752012880150260292
heart32686752012882145207254292
sounds35956752012865135206275345400
are40306752012873120182
muffled,426267520128109177224271310373442478
first4775675201285796143197236
sound50466752012865135205275345
is54266752012849103
weakened85169930128101163225296359428490559
at14466993012862101
the15826993012838109171
base17886993012870132186249
of20716993012870117
the22236993012839109171
xiphoid24286993012870110179250320358429
process.28916993012870117186249311365419454
Spirometry8517335012878148188234304414474513560630
Data:151573350128101163202264303
FEV118547335012879164265335
72%,22247335012870140257292
FEV1/FVC25507335012878164265334374452554647
-32327335012846
0.78.33137335012870105176245280