Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a progressive, insidious onset of exertional dyspnea and non-productive cough. History significant for heavy tobacco use. Denies fever, night sweats, or significant weight loss. Symptoms have persisted for [Duration], with no reported response to empiric antibiotics or bronchodilators.
Clinical Examination Findings
General: Patient is in no acute distress, resting comfortably. Respiratory: Auscultation reveals bilateral fine end-inspiratory crackles (Velcro-like) at the lung bases. No wheezing or rhonchi. Cardiovascular: Regular rate and rhythm, no murmurs or S3/S4. Extremities: No digital clubbing or peripheral edema noted.
Treatment Protocol
1. Smoking cessation counseling and nicotine replacement therapy (mandatory). 2. Initiation of systemic corticosteroids (e.g., Prednisone 0.5-1 mg/kg/day) with a tapering schedule. 3. Consider steroid-sparing agents (e.g., Azathioprine or Mycophenolate Mofetil) if refractory to initial therapy. 4. Pulmonary rehabilitation and supplemental oxygen if resting SpO2 <88%.