A 52-year-old man presented with purulent sputum production and progressive dyspnea. The patient was on tiotropium bromide and albuterol for chronic obstructive pulmonary disease.
He smoked nearly 40 packs in a year. Medical history included Type II diabetes mellitus Hyperlipidemia Coronary artery stenting Physical examination revealed Temperature: 100.5 F Pulse: 130 beats/min Blood pressure: 130/84 mmHg Oxygen saturation: 86% Respiratory rate: 28 breaths/min Barrel-shaped chest Hepatojugular reflux Inspiratory crackles Ventricular gallop Pulsus paradoxus
