17th January 2024

A 58-year-old patient presents to respiratory clinic after having been referred by the GP due to ongoing shortness of breath, dry cough and reduced exercise tolerance for approximately 2 years, although she feels this has worsened recently.

A 58-year-old patient presents to respiratory clinic after having been referred by the GP due to ongoing shortness of breath, dry cough and reduced exercise tolerance for approximately 2 years, although she feels this has worsened recently. Her symptoms are not worse at any particular time of day and do not vary throughout the year, regardless of whether she is at home or on holiday. She has no prior past medical history other than two C-sections (aged 35 and 37). She takes no regular medication but recently completed a course of antibiotics for a suspected LRTI. She is a current smoker, although she has tried to quit several times without success – she currently smokes about 10 cigarettes a day. She worked as a secretary in a busy office in the city but recently retired. She lives with her brother, who bought a tropical parrot three years ago which lives in the home with them. Her ESR is moderately raised; however her liver, renal and full blood count screen are otherwise normal. She had a chest x-ray performed prior to attending clinic, which was hyperinflated. Her lung function shows an obstructive picture. 

Based on the information above, which of the diagnoses below is the MOST likely primary differential?

Select the SINGLE most appropriate option from the list below. Select ONE option only.