Skill Checkup: A 63-Year-Old Man With Persistent Cough and New Shortness of Breath

Zab Mosenifar, MD


January 27, 2023

A 63-year-old man presents with a cough that has persisted over the last several months. He initially suspected his symptoms were due to his gastroesophageal reflux until he developed shortness of breath. His height is 5 ft 10 in (1.78 m), his weight is 179 lb (81.19 kg), and his body mass index is 25.7. He smoked cigarettes for nearly 35 years but quit about 12 years ago, and he chews nicotine gum. He was also diagnosed with sleep apnea about 10 years ago. He takes a proton pump inhibitor, and although he has a continuous positive airway pressure (CPAP) machine, he reports that he does not use it regularly. The results of rheumatoid factor, C-reactive protein, hematology, and liver function tests are all unremarkable. Bilateral fibrosis is seen on chest radiography, and the physical examination is significant for bibasilar inspiratory crackles.


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