Cough

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A 50 year old man with a 40 pack year history presents with a cough and progressive shortness of breath over the past 2 years. His lung function tests show that his FEV1/FVC is less than 0.7.

What is the most likely diagnosis

• 0%COPD
• 0%Asthma
• 0%Pulmonary fibrosis
• 0%Sarcoidosis

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This patient has a significant smoking history and symptoms consistent with chronic obstructive pulmonary disease.

In COPD, the spirometry tests typically show a reduced ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). An FEV1/FVC ratio less than 0.70 is a key indicator of airflow obstruction.

Pulmonary fibroisis is a restrictive lung disease. Spirometry typically results in a reduced FEV1 and FVC but with a ratio of over 0.7.

Remember to think broadly about the differential diagnosis including the possibility of a malignancy in a smoker with a cough and progressive shortness of breath.