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A 60-year-old man is evaluated for progressive exertional dyspnea. For the past year, he has been unable to walk three blocks without stopping twice because of shortness of breath. He has a daily cough productive of a small amount of white sputum. He has smoked 1 pack per day since the age of 20 years. On physical examination, he is comfortable at rest. Vital signs are normal. Oxygen saturation by pulse oximetry is 90% on ambient air. Estimated central venous pressure is normal and no murmurs or extra cardiac sounds are heard. His lung examination reveals decreased air movement without wheezes or crackles. The remainder of the examination is normal. Chest x-ray shows increased radiolucency and low-lying diaphragms. Pulmonary function studies following administration of a bronchodilator:
FEV1 : 65% of predicted
FVC : 75% of predicted
FEV1/FVC ratio : 0.60
Total lung capacity (TLC) : 105% of predicted
Diffusing capacity of lung for carbon dioxide (DLCO) : 44% of predicted
Which of the following is the most likely diagnosis?
(A) Asthma
(B) Chronic obstructive pulmonary disease
(C) Heart failure
(D) Interstitial lung disease
A 60-year-old man is evaluated for progressive exertional dyspnea. For the past year, he has been unable to walk three blocks without stopping twice because of shortness of breath. He has a daily cough productive of a small amount of white sputum. He has smoked 1 pack per day since the age of 20 years. On physical examination, he is comfortable at rest. Vital signs are normal. Oxygen saturation by pulse oximetry is 90% on ambient air. Estimated central venous pressure is normal and no murmurs or extra cardiac sounds are heard. His lung examination reveals decreased air movement without wheezes or crackles. The remainder of the examination is normal. Chest x-ray shows increased radiolucency and low-lying diaphragms. Pulmonary function studies following administration of a bronchodilator:
FEV1 : 65% of predicted
FVC : 75% of predicted
FEV1/FVC ratio : 0.60
Total lung capacity (TLC) : 105% of predicted
Diffusing capacity of lung for carbon dioxide (DLCO) : 44% of predicted
Which of the following is the most likely diagnosis?
(A) Asthma
(B) Chronic obstructive pulmonary disease
(C) Heart failure
(D) Interstitial lung disease
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