What lies behind this late-onset wheeze?

Abstract

A 67-year-old male retired police officer presented to the casualty department in May 2005 with worsening dyspnoea on exertion and cough productive of yellowish sputum. He was being treated for hypertension and had been diagnosed with asthma by his general practitioner in March 2005. He had a 15 pack-year smoking history, until the age of 35 years. On examination, pulse rate was 110 beats per min, temperature 37.5°C and blood pressure 130/80 mmHg. A diffuse wheeze across both lung fields was noted on chest examination. Chest radiography was unremarkable (figure 1). The patient was diagnosed with an infective exacerbation of asthma and received: co-amoxiclav 1.2 g i.v. 8-hourly; hydrocortisone 100 mg i.v. 8-hourly; and salbutamol and ipratropium by nebuliser 6-hourly with good effect. He was discharged in good condition and given a follow-up appointment at the asthma clinic.