CC is a 45-year-old man who complains of increasingly short breath. He had been healthy till 7 years ago when "bronchopneumonia"developed,featuring fever and respiratory distress. At that time, he was hospitalized for about a week and recalls that,over the subsequent month.short breath, wheezing and cough developed. He visited his physician and was told that he had "asthma". He then stopped smoking, having a smoking history of 3 packs a day for 25 years. Since then, he has suffered recurrent "asthma attack",usually occurring after respiratory tract infections. He has no history of eczema or childhood asthma. Recently, CC has been feeling well after using the bronchodilator medications and doing heavy work without dyspnea. Four days before this visit,he developed a "runny nose", mild throat pain and a nonproductive cough. He then noted increasingly short breath and began to use his inhaler three to five times a day. The night before this visit, he was unable to sleep lying down caused by short breath, so he comes to our hospital today.

Physical examination reveals a well-nourished man in moderate respiratory distress using his accessory muscles to breathe. Vital signs: heart rate 92 beats min; blood pressure 130/80mmHg: respiratory rate 32 breaths/min: oral temperature 36.5°C. Chest:clear to percussion,diffuse expiratory wheezes, no rales. Heart: no JVD (jugular venous distention),PMI (point of maximum impulse)not palpable and heart tones distant. S1 and S2 are normal, and no additional sounds are present. Others: no abnormal signs are noted. Other findings from physical examination are normal.

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