54 y/o M w/IPF, called today with worsening dyspnea x 3 days. He had
   been in unusal state of health at baseline resp status (using 4L NC at
   rest and 6L NC with exertion) when 3 days PTA, he hugged his cousin who
   has rats for pets and also the heat came up from the basement of his
   house. He feels that with these two events, he breathing became acutely
   worse and is concerned for allergen exposure. He denies any sick
   contacts, fevers, chills, worsening [** 2169**]/productive [** 2169**], rhinorrhea.
   He did receive flu and pneumovax.
   .
   He has had a recent admissions in [**11-26**] with progressive DOE. CT
   revealed increased ground glass opacity in LL superimposed on pulmonary
   fibrosis with elevated eosinophils peripherally (12%). A BAL was also
   positive for eosinophils. He was started on high dose steroids
   (prednisone 60mg) [**2739-2-16**] with plan for close outpatient follow up for
   eosinophilic lung disease. He was discharged on [**2-20**] on 2-3L NC. He then
   represented to [**Hospital1 1**] on [**12-12**] for spontaneous pneumomediastinum of
   unclear etiology.
   .
   On day of admission, Pt called pulmonologist (Dr. [**First Name (STitle) **] c/o worsening
   shortness of breath since Saturday [**3-23**]. Yesterday he was at pulmonary
   rehab and desaturated to the 70s on 6L with minimal exertion, and he is
   currently on 4L NC at rest.  No sick
   contacts recently and [**Name2 (NI) 2169**] has not changed. He was asked to go to ED
   given concern for either acute exacerbation of underlying IPF vs
   superimposed infection vs pneumothorax.
   .
   In the ED, initial vs were: 98.3, 96, 144/97, 24, 97% 6L NC.