Case Study: 66-year-old white male referred for a lung transplant evaluation

CLINICAL INFORMATION

History

  • 66-year-old white male referred for lung transplant evaluation
  • First started experiencing shortness of breath approximately 5 years ago while walking up inclines and steps
  • The patient was diagnosed with idiopathic pulmonary fibrosis approximately 3 years ago based on a high-resolution CAT scan and open lung biopsy analysis (November 2003)
  • The patient was treated with interferon gamma for 3 years
  • The patient is currently on 4 liters of oxygen and increases this to 6L/min with exercise
  • PMH–GERD, Wolff-Parkinson-White Syndrome (WPW), hyperlipidemia

Activity Level

  • Currently, the patient states that his shortness of breath is stable. He does get dyspneic walking approximately 1 block with inclines. However, he does not get dyspneic when walking on level surfaces.

Habits

  • The patient is a former smoker (1-1.5 packs per day for 30 years). He stopped 16 years ago.

Occupation

  • He currently works at a desk job, but previously worked in a steel factory. There were no other relevant exposures.

Family History

  • Noncontributory

Medications

  • The patient is currently taking interferon-gamma 1b, atorvastatin, sucralfate, fluticasone, and loratadine.

Physical Exam and Work-up

  • Temp: 95.8
  • BP: 141/82
  • Pulse: 89 BPM
  • RR: 12 breaths/minute
  • O2: 93% on RA
  • Weight: 171.3 lbs, height is 73 inches
  • Cardiovascular: Regular rate and rhythm. Loud S2
  • Lungs: Dry crackles at the bases bilaterally
  • Extremities: warm, nontender, no edema

Physiologic Studies

  • PFTs:
    • FVC of 4.09 L (83%)
    • FEV1 of 3.19 L (83%)
    • FEV1/FVC ratio of 78%
    • TLC of 6.85 L (94%)
    • RV of 2.76 L (103%)
    • DLCO of 6.1 (27%)
  • 6-minute walk test on room air: The patient was able to walk 3 minutes 50 seconds and 303.3 meters. His oxygen saturation decreased from 96% to 79% and his heart rate increased from 87 to 132. His Borg scale value increased from 0 to 3.
  • 6-minute walk test on 6 liters: The patient was able to walk 457.2 meters with a decrease in his oxygen saturation from 100 to 86%.

PFT Interpretation

  • Lung volumes are in the normal range
  • The diffusing capacity (DLCO) is markedly reduced
   
 
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