A 58-year-old woman presents to the clinic complaining of progressive shortness of breath and a chronic cough. She states the breathlessness began about two years ago and has worsened to the point where she has difficulty carrying groceries up the stairs. She reports a daily morning cough productive of white sputum. She has experienced two episodes of “bronchitis” in the past year that required antibiotics and oral steroids from an urgent care center. Her medical history is significant for anxiety and osteoporosis. She has a 35-pack-year smoking history and currently smokes half a pack per day. She lives in a rural area and uses a wood-burning stove as her primary source of heat. She denies chest pain, palpitations, or lower extremity edema.

On general assessment, she appears thin and breathes through pursed lips while seated. She is afebrile. Her blood pressure is 138/82 mmHg with a regular heart rate of 92 bpm. Her respiratory rate is 20 breaths/min, and her oxygen saturation is 91% on room air.