Mr. L is a 54-year-old white man currently employed as a machinist. He was seen in the pulmonary outpatient clinic for the first

Mr. L is a 54-year-old white man currently employed as a machinist. He was seen in the pulmonary outpatient clinic for the first time complaining of shortness of breath with exertion and a productive cough. Mr. L stated that his coughing had recently increased and was producing thick, yellow sputum. He stated that his cough had been present for several years but was “usually not a problem”. His cough has usually been productive of clear to white sputum in the morning. He had recently noticed more shortness of breath than usual and was now dyspneic at rest. Mr. L did admit to feeling warm at times during the past few days but had not taken his temperature. He denied chest pain, hemoptysis, sinusitis, weight loss, allergies, night sweats, or chills. Mr. L admitted to smoking 2.5 packs of cigarettes per day for the past 30 years. He had attempted to stop on several occasions but was successful for no longer than 3 or 4 months. His machinist work had exposed him to many toxic fumes. His family history was positive for lung disease, as his father died of emphysema at age 64. His mother is alive and well at 75,