Delayed Diagnosis of Lung Disease Leads To Respiratory Failure

This case involves a male patient in his mid-forties with a history of asthma and a persistent cough. A chest CT was ordered and an initial pulmonary consultation gave recommendations to add inhaled steroid treatment. The patient seemed fine immediately following the commencement of inhaled steroids. Several months later, however, the patient’s symptoms worsened. A CT Angio was done and the patient underwent a biopsy which showed pulmonary fibrosis. The next week, the patient suffered a collapsed lung and was admitted with air around his heart. The patient was transferred to another hospital for further management but he developed total respiratory failure and passed away. It was alleged that delayed treatment adversely affected the prognosis of the patient’s with autoimmune pulmonary fibrosis. An expert in pulmonology was sought to discuss how autoimmune lung disease be differentiated from other etiologies of a cough and difficulty breathing.

Question(s) For Expert Witness

1. How often do you order tests and treat patients with pulmonary disease and/or pulmonary fibrosis?

2. How can autoimmune lung disease be differentiated from other etiologies of a cough and difficulty breathing?

3. How does timely treatment affect the prognosis of patient's with autoimmune pulmonary fibrosis?

Expert Witness Response E-014746

I am a pulmonary critical care physician and order tests and treat patients with pulmonary disease on a weekly basis. Autoimmune lung diseases are usually associated with other systemic manifestations in the form of joint problems, skin rash, constitutional symptoms, and kidney disease. The cough and shortness of breath would also not be responsive to the usual treatments such as an inhaler or cough syrup. If there are systemic manifestations and the patient?s symptoms are not responding to the usual simple therapies, then a doctor should expect autoimmune disease. If there are any pulmonary test changes that are not consistent with simple asthma, then that is also a big indicator. The key point of this case is a doctor would want to try to treat the patient before they develop pulmonary fibrosis. Once there is pulmonary fibrosis the main aim is to avoid further worsening. Timely diagnosis is key to prevent long-term or permanent damage.