Skill Checkup: A 59-Year-Old Man With Dyspnea on Exertion and a Nonproductive Cough

Zab Mosenifar, MD


March 28, 2023

Monitoring patients with PF-ILD should involve regular assessment of physiology, symptoms, and high-resolution CT results. In doing so, disease progression can be effectively managed in this population. In the absence of worsening symptoms as seen in the present case, CT and pulmonary function testing would be reliable predictors of progression. Previous decline in forced vital capacity is typically not a reliable indicator of future decline, just as a period of stable measures does not predict future stability.

Diagnostic biomarkers for fibrotic lung disease have not been validated; however, increased circulating fibrocytes have been suggested in patients with IPF, though data regarding vascular endothelial growth factor are contradictory.

Functional parameters used to monitor and evaluate disease progression include the percentage value on the predicted forced vital capacity, the diffusion capacity of the lung for carbon monoxide, and 6-minute walk distance data. Worsening dyspnea is also a primary indicator of disease progression, as are acute exacerbations.

Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.


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