Case history A 67-year-old male retired police officer pre- sented 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 practi- tioner 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-amoxi- clav 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 dis- charged in good condition and given a follow-up appointment at the asthma clinic. Investigations Lung function tests revealed a forced expiratory volume in one second (FEV1) of 33% predicted and a forced vital capacity (FVC) of 72% pred. The FEV1/FVC ratio was 46%. There was 15% reversibility in FEV1 post-bronchodilator therapy. The patient was unable to produce a flow–- volume loop suitable for interpretation. What lies behind this late-onset wheeze? Task 1 Interpret the spirometry data. 87 Breathe | September 2007 | Volume 4 | No 1 CASE PRESENTATION Correspondence: Dept of Medicine St Luke's Hospital Guardamangia Hill Guardamangia MSD 09 Malta E-mail: gabrielschembri@ gmail.com G. Schembri A. Vella M.V. Balzan Dept of Medicine, St Luke's Hospital, Guardamangia, Malta Figure 1. Chest radiograph taken during admission.