A 26-yr-old male with recurrent respiratory infections.

A 26-yr-old male patient was referred to the outpatient clinic with a history of recurrent respiratory infections since 8 yrs of age and a daily productive cough with purulent sputum. He related nasal sneezing, hoarseness and wheezing episodes to weather changes and exposure to dusts and chemicals. Dyspnoea on exertion was present during exacerbations. He had never smoked and denied any family history of respiratory disease. Physical examination was unremarkable. A chest radiograph (figs 1 and 2) and later a high-resolution computed tomography (HRCT) of the chest (figs 3 and 4) were ordered. Pulmonary function tests showed a forced vital capacity (FVC) of 3.16 L (66% of predicted), a forced expiratory volume in one second (FEV1) of 2.21 L (55% pred), a FEV1/FVC of 0.70 (83% pred) and a forced midexpiratory flow of 1.51 (33% pred). There was no response to bronchodilator.