A 69-year-old man smoked 20 cigarettes a day for over 40 years but then gave up 9 months ago. He has had a cough with daily sputum production for the last 20 years and has become short of breath over the last 3 years. He coughs up a little white or yellow sputum every morning. He has put on weight recently and now weighs 100 kg. His ankles have become swollen recently and his exercise tolerance has decreased. He is not able to look after his grandchild because he feels too short of breath. There is no other relevant medical or family history.
His general practitioner (GP) gave him a salbutamol metered-dose inhaler which produced no improvement in his symptoms. Examination He is overweight. He appears to be centrally and peripherally cyanosed and has some pitting edema of his ankles. His jugular venous pressure is raised 3 cm. He has poor chest expansion. There are some early inspiratory…
