History A 72-year-old man was admitted last night with increasing shortness of breath. His breathing has been getting worse for many years now, especially in the winter. His general practitioner (GP) has diagnosed asthma. Several courses of antibiotics were given over the last few years. The patient’s recent problems started 3 days ago with a cough productive of green sputum. He has been keeping unwell. Now he cannot climb the stairs and sleep properly.
His GP saw him this morning and referred him to hospital as an infective exacerbation of asthma. He continues to smoke despite advice and has a 50 pack-year history. There is no other relevant medical history. He takes a salbutamol inhaler when needed but today this was of little help. Examination Some blood tests were performed and a chest radiograph was requested. His white cell count is 16.3 × 10 9 /L, neutrophil count is 89 percent…
