ABSTRACT
A 42-year-old male was referred by his primary care physician to a hospital respiratory clinic because of increased symptoms of wheezing and dyspnea. The patient had previously received short courses of broad-spectrum antibiotics and oral corticosteroids, which had only partially resolved his symptoms. His current drug treatment was an inhaled corticosteroid (400 mcg, once daily) in combination with a long-acting β2-agonist and an inhaled short-acting β2-agonist (taken as required). The patient had a more than 25-year history of episodic wheezing. His respiratory symptoms were not precipitated by exposure to allergens and there was no seasonal variability in his symptoms. Furthermore, the patient gave a 10-year history of a chronic cough associated with daily expectoration of mucoid sputum. He had been smoking for approximately 20 years, currently around 15 cigarettes per day. His occupation was a shopkeeper. There was no family history of asthma. Both of his parents were lifelong cigarette smokers, and his wife was also a smoker. On examination of the chest, there was mild bilateral wheeze.
