Patient case: Pulmonary Fibrosis in Sub-Saharan Africa
K.D, a 62-year-old retired miner, presents to the local clinic with complaints of worsening shortness of breath and a persistent, dry cough over the past six months.
K D’s symptoms started gradually about six months ago with mild exertional dyspnoea, which has progressively worsened. He now experiences shortness of breath even at rest, accompanied by a chronic dry cough. He denies any fever, chest pain, or haemoptysis. His symptoms have significantly impacted his daily activities and quality of life.
K.D worked as a miner for over 30 years, exposed to dust, silica, and other occupational hazards. He lives in a densely populated urban area with his wife and two adult children. Access to healthcare facilities is limited, and he has not had regular medical check-ups in recent years.
- General: Appears fatigued and dyspnoea at rest
- Vitals: BP 140/85 mmHg, HR 90 bpm, RR 28 breaths/min, SpO2 88% on room air, temperature 37.0°C
- Respiratory: Bilateral fine end-inspiratory crackles throughout lung fields, decreased breath sounds at lung bases
- Cardiovascular: Regular rhythm, no murmurs
- Abdomen: Soft, non-tender, no hepatosplenomegaly
- Chest X-ray: Shows bilateral reticular opacities and lower lung field honeycombing
- High-Resolution CT (HRCT) Scan: Confirms extensive fibrotic changes predominantly in the lower lung zones
- Pulmonary Function Tests: Demonstrates a restrictive pattern with reduced lung volumes and decreased diffusion capacity (DLCO)
- Blood Tests: Normal CBC, elevated erythrocyte sedimentation rate (ESR)
Idiopathic Pulmonary Fibrosis (IPF)
1. Medications:
- Initiation of antifibrotic therapy with pirfenidone or nintedanib to slow disease progression.
- Symptomatic management with bronchodilators and corticosteroids as needed.
- Oxygen Therapy: Prescribed to maintain oxygen saturation above 90%.
- Pulmonary Rehabilitation: Exercise training and breathing techniques to improve respiratory function and quality of life.
- Patient Education: Counselling on the nature of IPF, management strategies, and the importance of avoiding respiratory irritants.
- Follow-Up: Scheduled regular visits to monitor disease progression, adjust therapy, and address any new symptoms or complications.
The prognosis for IPF is guarded, and K.D will require ongoing support and management to optimize his quality of life and respiratory function.
This case illustrates the typical presentation and challenges of managing pulmonary fibrosis in a patient from an urban area in sub-Saharan Africa, highlighting the impact of occupational exposure on respiratory health.
A). Farmer
B). Teacher
C). Miner
D). Doctor
A). Abdominal pain
B). Persistent dry cough and worsening shortness of breath
C). Headache
D). Joint pain
A). Echocardiogram
B). Chest X-ray showing bilateral reticular opacities
C). Electroencephalogram (EEG)
D). Blood glucose test
A). Pain relief
B). Slowing disease progression
C). Treating infection
D). Improving lung function
