Case 1: 35 year old man with asthma.
- wheezy since birth with triggering agents including upper respiratory tract infections,
exercise, dog hair, and house dust mites.
- admitted to hospital today by his general medical practitioner because of worsening
symptoms and difficulty taking his medications.
- currently using two metered dose inhalers with a spacer for the delivery of his
medications - Salbutamol (Ventolin), a sympathomimetic (B2-agonist) and
beclomethasone dipropriate (Becotide)
- persistent, non-productive cough, expiratory wheezes and laboured breathing
- appears flushed and very anxious and is having difficulty completing sentences.
Arterial blood gases on admission
• SaO2 = 94 (FiO2 = 0.4)
• PaO2 (on O2) = 10 kPa (135mm Hg)
• PaCO2 (on O2) = 4.1 kPa (31mmHg)
• pH = 7.47
On examination
• Heart Rate (HR) = 100beats /min
• Temperature = 37.8 oC
• Respiratory Rate (RR) = 28 breaths/min (shallow, prolonged expiration; short, gasping
inspiration)
• FEV1/FVC ratio = 65%
• Auscultation – reduced breath sounds throughout the lung fields with widespread
expiratory wheeze
1. The patient’s chest X-ray is likely to show evidence of