Henry Levin, the 7th is a 67 year old male referred for further asthma management. Onset of asthma in his teens. He was hospitalized twice last year, and already twice this year. He has not been able to be weaned off steroids for the past several months.

• Asthma
• Hypertension
• Osteoarthritis, right knee

• Theodur 200mg BID
• Proventil inhaler 2puffs QID PRN
• Prednisone 20mg qd
• HCTZ 25mg qd

• Penicillin - Hives
• Aspirin - Wheezing

• Smoking :: 1 PPD between the ages of 20 and 55, and then he quit.
• Alcohol :: rare

• Vital Signs :: BP 118/78; Resp 16 and unlabored; T 98.6F; HR 86 and regular

• Skin :: Erythematous rash, palmar surface, left index finger.
  

• Lungs :: Clear with no wheeze. Good air flow.

• Cardiac :: RRR with no murmur, no S3, no S4.

• CXR 02/03/1999: Hyperinflated. Normal cardiac silhouette, clear lungs.
• Peak Flow today: 260 l/m

• Asthma, with prior smoking history. Difficulty weaning off steroids. Will try gradual taper.
• Hypertension, well-controlled.
• Contact dermatitis on finger.

• Complete PFTs with lung volumes.
• Chem-7
• Provide educational material on inhaler usage and peak flow self-monitoring.
• Decrease prednisone to 20qOD alternating with 18qOD.
• Hydrocortisone cream to finger BID.
• RTC 1 week.