Dry cough with progressively increasing breathlessness in a 65-year old man
A 65-year old man presented to the chest clinic with historyof progressively increasing breathlessness since the past2 years. He was apparently alright 2 years ago when henoticed that he was getting breathless on climbing a flightof steps. The breathlessness has progressively increasedsince then and he now also gets breathless whileperforming his normal daily household activities. Since 10months he has developed a dry cough which is especiallyworse at night and disturbs his sleep. He is a non-smoker,non-alcoholic. He was an office worker but is now retiredsince 7 years.
He has been visiting his family physician since the past 6months for the breathlessness and cough. He is beingtreated with metered-dose inhalers and has also twice beengiven a course of antibiotics. He claims he has not gainedany significant relief from the treatment. The dry cough haspersisted and so has the breathlessness.
On general examination, the patient appears to be mildlydyspnoeic with a respiratory rate of 28 breaths per minute.He is afebrile with a pulse rate of 78 beats per minute. Hisfingernails reveal a ‘parrot-beaked’ appearance (grade IIIclubbing). On examination of his chest, there are coarserales heard bilaterally at both lung bases (left > right).These rales are akin to the sound heard on separating twopieces of velcro, hence termed “velcro” rales. A chestradiograph is taken (Figure 1). On reviewing the chest xray it is decided to further thoroughly investigate the patient. (copied from article)
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