A man with dyspnea, productive cough, and chest radiograph showing hyperinflation and a diffuse nodular pattern

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A Man With Dyspnea, Productive Cough, and Chest Radiograph Showing Hyperinflation and a Diffuse Nodular Pattern*

A 73-year-old man was in good health until 18 months ago, when he experienced progressive dyspnea and episodes of sinusitis, cough, and purulent sputum production. He denied fever, chills, or systemic symptoms. Several courses of antibiotics and corticosteroids produced improvement in symptoms, but symptoms returned following discontinuation of this therapy. He is currently receiving 7.5 mg of prednisone. He has not smoked for 25 years and has no identifiable environmental or occupational exposures. He is a retired (8 years) computer chip worker. He had a history of sinusitis for 10 years. Physical examination is normal except for decreased breath sounds bilaterally, coarse crackles, and a few expiratory wheezes. The complete blood cell count, liver function tests, and immunoglobulin levels are normal. The chest radiograph demonstrates hyperinflation and a diffuse fine nodular pattern.

Physiologic Test Results

FVC, 2.9 L (65%)

FEV1, 1.16 L (41%); 1.19 L (after bronchodilator)

FEV^sub 1^/FVC, 39%

Dco/VA,...