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JAMA Clinical Challenge
July 5, 2019

A Woman With Dyspnea and Bronchiectasis

Author Affiliations
  • 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Florida, Gainesville
JAMA. 2019;322(6):571-572. doi:10.1001/jama.2019.8606

A 41-year-old woman with an 8–pack-year history of tobacco use presented for progressive cough and dyspnea of 4 years’ duration. Her cough was productive of yellow-green sputum and treated with antibiotics on multiple occasions, which provided some alleviation of her symptoms. She had no history of neonatal respiratory distress, nasal congestion, persistent urticaria, joint laxity, or illicit drug use. She denied a family history of liver cirrhosis, chronic obstructive pulmonary disease (COPD), or cystic fibrosis. Examination revealed scattered wheezes and rhonchi on auscultation. Pulmonary function testing demonstrated a severe obstruction with a forced expiratory volume at 1 second (FEV1) of 0.79 L (28% of predicted), forced vital capacity (FVC) of 1.64 L (47% of predicted), FEV1:FVC ratio of 48%, and a reduced diffusing capacity for carbon monoxide of 8.74 mL/min per mm Hg (23.75% of predicted), which was consistent with emphysema. Chest radiography followed by computed tomography (CT) of the chest showed lower lobe predominant emphysema and bronchiectasis (Figure).