Use the following patient vignette to answer questions 11 –…
Use the following patient vignette to answer questions 11 – 13. A 35-year-old man presents with sputum producing cough and dyspnea at rest. Past medical history is significant for a previous diagnosis of premature emphysema at age 28. The patient denies smoking and excessive alcohol intake or exposure to dust and mold. Family history is significant for coronary artery disease and pulmonary disease in the patient’s father and only brother. Vital signs are within normal limits except for blood pressure of 160/120 mmHg on three readings. Physical examination reveals an ill-appearing man with prolonged expiratory time. Auscultation of the lungs reveals end-expiratory wheezing. ECG is within normal limits. 13. What is the next best diagnostic approach for this patient?