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Question 11 I am confused whether clubbing is a feature of chronic obstructive pulmonary disease (COPD) or not - you have mentioned that it is not a feature of COPD but some books do say that clubbing is a clinical feature of COPD. Question 12 A 70-year-old man with chronic obstructive pulmonary disease (COPD) and a past history of myocardial infarction with a left ventricular ejection fraction (LVEF) of 25% is dyspnoeic on slight exertion such as walking, bathing. He is not orthopnoeic and claims to have no paroxysmal nocturnal dyspnoea (PND). He has no wheezing or productive cough and his blood pressure is normal. He has had three episodes of ventricular tachycardia (VT) and has been on amiodarone for the past year. What is the best way to determine the exact cause of dyspnoea in this case? Question 13 In bronchiectasis, what is the reason for using a bronchodilator if the airways are already dilated? Question 14 Why is it that asthmatics having a severe attack can be seen clawing their hands?14 Respiratory disease 158 Question 15 Practical use of steroids: Which form of regimen is better (alternate-day, daily or in pulse form)? What should be the dose (once daily or three times daily or {2/3} in the morning)? For how long, especially when to give short courses as in asthmatics, when we don't need to taper it down? Question 16 In pregnancy, what is the recommended treatment for bronchial asthma? Is the use of the long-acting beta-adrenergic agonist Seretide, the corticosteroid Symbicort and leucotriene receptor antagonists (LTRAs) recommended? Question 17 In asthma patients, which is the safest analgesic to use? Question 18 Is the use of nebulized heparin in the treatment of asthmatic attacks recommended? Question 19 I would like to ask you about pneumonia and its classifications in particular; what are they? Question 20 What are the pathological differences in typical and atypical pneumonia? Question 21 Why, sometimes in cases of aspiration pneumonia, would the level of lymphocytes drop below normal range while the level of white blood cells (WBC) and neutrophils are above normal range?