20th February 2025

A 63-year-old man is referred to respiratory clinic for management of a chronic cough.

A 63-year-old man is referred to respiratory clinic for management of a chronic cough. His symptoms have been ongoing for 3 years but are now getting worse. The cough is often dry but he sometimes notices some black pigmentation to his sputum. He does feel wheezy, particularly on exertion but this improves when he takes his salbutamol inhaler.

Past medical history includes asthma and ischaemic heart disease. His medications include bisoprolol, ramipril, atorvastatin, salbutamol and Fostair inhalers. He is a previous smoker and currently works as a plumber although he previously worked in the coal industry.

His physical examination is unremarkable.

CXR shows multiple nodules in the upper zones, the largest of which measures 8 mm in diameter. You request an HRCT, which again shows nodules, predominantly affecting the upper zones, the largest of which measures 9 mm in diameter.

What is the most likely diagnosis?

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