Interstitial lung disease and weight loss
A 52 year old man presented to the outpatients' department with dyspnoea, dry cough, and weight loss. The breathlessness had progressed over two years. Also 41 kg of weight loss in 12 months was concerning.
In seeking a cause for this, he underwent bronchoscopy two weeks before his outpatients' appointment, and since then his breathlessness had rapidly worsened. At the consultation he was unable to complete a sentence and was in a wheelchair.
Thorough history taking should include asking specifically about birds, as patients do not necessarily consider them as pets. A recent letter recommended asking about bird years, in the same way that smokers are assessed for pack years for judging exposure.3
The treatment is to avoid exposure to antigen. In acute situations, oxygen therapy is needed and sometimes steroids are used in severe cases.