ABSTRACT
The Caterpillar comes into your GP clinic accompanied by his friend the Hatter. He is a lifelong smoker and you suspect he also partakes in magic mushrooms. He reports that he smokes nearly constantly throughout the day with a pipe. He reports coughing up phlegm everyday; however, in the past 2 days he reports the phlegm has changed colour to a dark brown/yellow. He is also coughing up much more than normal and feels feverish and unwell. You note he has a previous diagnosis of chronic obstructive pulmonary disease (COPD) and depression. He has no allergies. He currently takes a salbutamol inhaler. On examination, his oxygen saturations are 87% in air, respiratory rate is 35, temperature 38.1°C, there are signs of clubbing on his hands and on examination of his chest he has widespread wheeze.
