Mrs. Williams is a 68-year-old woman who complains of a dry cough which she says is worse at night and upon arising in the morning. It has become more frequent over the last few winter months. Mrs. Williams explains she has moved to your area, brings her medical record, and a letter from her previous doctor.

She gives a history of a wheezy illness 2 years ago following a viral URTI, and last year she recalls having the “flu” which was her first attack for some years. Following the flu, she developed a heavy cough and a tight chest. The tightness and cough eased after she managed to cough up some dirty looking sputum. The symptoms continued on and off for around six weeks. Mrs. Williams was well during the next six months.