CASE 96: SHORTNESS OF BREATH
History
A 35-year-old woman presents with a 6-month history of increasing shortness of breath.
This has progressed so that she is now short of breath on walking up one flight of stairs and
walks more slowly on the flat than other people her age. In addition she has developed a
dry cough over the last 3 months.
In her previous medical history she had mild asthma as a child. She thinks that her father
died of a chest problem in his 40s. She takes occasional paracetamol and has taken ‘slim-
ming pills’ in the past.
She is a lifetime non-smoker and drinks less than 10 units of alcohol per week. She has
worked in the printing trade since she left school. She has two children aged 8 and 10 years
and they have a cat and a rabbit at home.
Examination
There is no clubbing, anaemia or cyanosis. Examination of the cardiovascular system is
normal. In the respiratory system expansion of the lungs seems to be reduced but sym-
metrical. The percussion note is normal as is tactile vocal fremitus. On auscultation there
are fine late inspiratory crackles at both lung bases.
Respiratory function tests revealed the following:
Actual PredictedFEV 1 (L) 3.0 3.6–4.2
FVC (L) 3.6 4.5–5.3
FER (FEV 1 /FVC) (%) 83 75–80
PEF (L/min) 470 450–550FEV 1 : forced expiratory volume in 1 s; FVC, forced vital capacity; FER, forced expiratory
ratio; PEF, peak expiratory flow.
Her chest X-ray is shown in Fig. 96.1 and a high-resolution computed tomography (CT)
scan in Fig. 96.2.