A 67-year-old male patient, lifelong smoker, with a background of asthma since childhood and recurrent ethmoid polyps attended for a routine clinical review. He was only prescribed a salbutamol inhaler, to be used when required. He reported intermittent episodes of shortness of breath with wheezing at night and a progressive deterioration of his symptoms over the previous two years. He was also complaining of cough productive of yellow phlegm, almost every morning. On examination, he was tachypneic at rest, with an oxygen saturation of 92% on room air. He was severely hyperinflated and a bit wheezy on auscultation.
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