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Scene 1: Meet Malcolm.

Malcolm retired nine years ago after forty years working in various engineering jobs, including factories and boilermakers. He had been exposed to many substances and chemicals during this time, working before health and safety rules made wearing protective equipment at work compulsory. He is an ex-smoker and stopped 15 years ago. He smoked around a pack a day from the age of 20.

Scene 2: Malcolm visits his GP.

He has been seeing his GP over the past year as he’s been feeling breathless when doing things and he has an irritating dry cough. At first it’s thought he may have COPD, but his spirometry doesn’t show this and he finds no benefit from inhalers. A chest x-ray is clear.  On examination, his GP finds he has distinctive inspiratory crackles on auscultation, his fingers are clubbed and his oxygen saturation is lower than expected at 90%.

Scene 3: Malcolm is referred to the respiratory consultant.

His GP refers him  to a respiratory consultant.  He takes Pulmonary Function tests which show his gas transfer factor (tLco) is reduced. Due to his clinical examination and history, a High Resolution CT scan of his chest is ordered. The results of this are discussed at a Multidisciplinary team meeting, with a radiologist, consultant and nurse specialist.  His HRCT shows a distinctive honeycombing pattern at the bases of both lungs.  This occurs when there is damage to the alveoli caused by fibrosis. The team agree that Malcolm has a diagnosis of Idiopathic Pulmonary Fibrosis.