Pulmonary fibrosis and emphysema.

A 58-year-old male presented with symptoms of progressive dyspnoea on exertion and predominantly dry cough of six months duration. He was a cigarette smoker with a smoking index of 10 pack years. He had no history of fever, exposure to dusts or drug therapy. There was no history of similar illness in the family members or any symptoms suggestive of connective tissue disease (CTD). On physical examination, clubbing was observed and there were bibasilar fine endinspiratory crackles on auscultation. Oxygen saturation by pulse oximetry showed significant exercise desaturation from 94% to 77%.