20th February 2025

A 71-year-old gentleman is referred to respiratory clinic after lung function tests showing the following:

A 71-year-old gentleman is referred to respiratory clinic after lung function tests showing the following:

FVC 76% of predicted, FEV1 73% of predicted, DLCO 60% of predicted 

He tells you he has been increasingly short of breath over the last year. This has been accompanied by a cough. 

His past medical history consists of atrial fibrillation and NAFLD (non-alcoholic fatty liver disease). His medication list includes apixaban and bisoprolol. He has no allergies. He is an ex-smoker and worked as a plumber prior to retirement. He is unsure of his asbestos exposure.

On examination, you note reduced muscle mass. Clubbing is present and chest examination reveals bibasal crackles.

CXR shows bilateral reticular shadowing, worse in the bases, with reduced lung volume and left-sided calcified pleural plaques.

What is the most likely diagnosis?

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