ABSTRACT
Old Macdonald, a local farmer of pigs, cows, sheep, chickens and horses, presents to your GP practice. He was recently seen in the respiratory clinic for follow up for his pulmonary fibrosis. He recounts that years ago he was given a diagnosis of extrinsic allergic alveolitis and the nurse said this was caused by ‘farmer’s lung.’ He has been reading on the internet that this is due to inhaling mouldy hay. He was told in the recent clinic follow up that his spirometry showed a restrictive pattern and he wants to know what this means. On examination, his saturations are 95% in room air, he has clubbing of his fingers and fine inspiratory crackles can be heard throughout the chest.
