Case presentation A 38-year-old man presented to the emergency department with complaints of shortness of breath and wheezing. On arrival, he was struggling to speak. He is a regular smoker. Medical history One week ago, he was discharged from the hospital after acute severe exacerbation of chronic obstructive pulmonary disease (COPD), first diagnosed three years ago. This is his third casualty attendance over the past 12 months.
He is now awaiting investigation for deranged liver function tests. He is taking salbutamol inhaler p.r.n.; tiotropium, 18 mg once daily; Symbicort 6/200, 2 puffs daily; carbocisteine, 375 mg thrice daily; Uniphyllin Continus, 400 mg twice daily. Examination His trachea is central, expansion of the chest poor but equal, and auscultation reveals widespread expiratory wheeze but no clinical sign of consolidation. A chest X-ray shows hyperinflated lung fields.…
