11-20-2006, 05:33 PM
A 51-year-old man presents complaining of shortness of breath. The patient describes a slowly progressive inability to perform physical activities over the past 2 years. He reports being able to start an activity, such as golf or tennis, but within a few minutes he feels like "he has lost his breath." There is no associated chest pain, pressure, or discomfort. More recently, he has had significant shortness of breath even at rest. The clinical picture, with the addition of a restrictive pattern on pulmonary function tests and interstitial infiltrates on the chest x-ray film, suggests the diagnosis of interstitial lung disease. Which of the following is the most appropriate next step in management?
A. Follow-up in the clinic in 2 months, as most interstitial lung diseases are untreatable
B. Referral to a pulmonologist for further evaluation and possible transbronchial biopsy
C. An empiric course of prednisone for 6 weeks
D. Immunosuppressive therapy with azathioprine
E. Referral to a thoracic surgeon for further evaluation and possible open lung biopsy
A. Follow-up in the clinic in 2 months, as most interstitial lung diseases are untreatable
B. Referral to a pulmonologist for further evaluation and possible transbronchial biopsy
C. An empiric course of prednisone for 6 weeks
D. Immunosuppressive therapy with azathioprine
E. Referral to a thoracic surgeon for further evaluation and possible open lung biopsy