CHEST Guidelines-A-54-Year-Old-Man-Presenting-With-Progressive-Dysp

A-54-Year-Old-Man-Presenting-With-Progressive-Dysp

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A 54-year-old man presented with a 6-month history of progressive dyspnea at rest and with minimal exertion. His medical history included hypertension, non-insulin-dependent diabetes, coronary artery disease, and factor V Leiden heterozygosity. He had a significant smoking history of 43 pack-years. Initial examination and tests, including a chest radiograph and CT scan, revealed bilateral reticular opacities and ground glass opacities, suggestive of interstitial lung abnormalities. Spirometry indicated a restrictive ventilatory defect consistent with diffusion impairment. <br /><br />Bronchoscopy and subsequent tests excluded infection. A video-assisted thoracoscopic wedge resection of the left upper lobe showed fibrotic interstitial lung disease with respiratory bronchiolitis-like areas and significant peribronchiolar and alveolar septal fibrosis, indicating smoking-related interstitial fibrosis (SRIF).<br /><br />SRIF is a condition increasingly recognized among smokers, characterized by uniform fibrotic patterns and emphysematous changes in lung biopsies. Unlike other forms of respiratory bronchiolitis, SRIF involves pronounced fibrosis not typically present in its less severe form. The patient was diagnosed with SRIF due to his extensive smoking history, with imaging changes and histological evidence supporting the diagnosis.<br /><br />The primary treatment for SRIF is smoking cessation, which the patient was counseled to do. He successfully quit smoking after four months, resulting in significant improvement in symptoms and CT scans. SRIF has a more favorable prognosis compared to similar lung conditions, with an 85% five-year survival rate. However, ongoing management typically involves monitoring through repeated lung function tests, and there is no specific pharmacological treatment beyond smoking cessation.<br /><br />References to detailed studies and contributions from multiple authors support the case findings and conclusions.

Keywords

progressive dyspnea

interstitial lung disease

smoking-related fibrosis

factor V Leiden

restrictive ventilatory defect

ground glass opacities

respiratory bronchiolitis

smoking cessation

fibrotic interstitial lung disease

CT scan improvements