61 year old male with 80 pack yr smoking with bronchiectasis ? pulmonary fibrosis.

61 year old male with Chief complaints of grade 2 SOB and cough with expectoration since one week. 
HOPI:patient was apparently asymptomatic week back then he had fever, cold, cough, shortness of breath for which taken to the local hospital in motkur and symptomatic treatment was given. history of fever which was intermittent low-grade decreased with medication present for 5 days.cough with expectoration- white in colour, minimal amount, non foul smelling, non blood stained. no history of chest pain, palpitations, orthopnea, PND. No h/o coronary artery disease, tuberculosis,thyroid disorders.
addictions like toddy since 25 years of age one bottle per day and alcohol since 30 years of age 90ml per day. Beedi 2 packets per day since 50 years of age.
O/E :
 patient is conscious, coherent, cooperative.
Grade -4 Clubbing present.

no signs of pallor, icterus,cyanosis, lymphadenopathy, pedal edema.
Vitals :
temperature- 98.4F 
pulse rate: 60 Bpm regular 
respiratory rate :16 cpm
BP :110/ 90 mm of Hg
Head to toe Examination: temporal wasting +

Oral cavity tobacco stains on tooth. 

Leukoplakia on soft palate.
 Mallam Patti grade -1. Locomotor brachi - present.
Respiratory examination
Inspection :
flat alar chest, pectus excavatum.reduced chest movements on right side.
Palpation- trachea appears to be cental. apex beat not palpable.
chest expansion - 1.25 cm.reduced chest expansions in infraclavicular, supraclavicular, mammary, infra mammary, supra scapular on right side.
Percussion - dull note in right suprascapular area. 
Auscultation-
Bilateral air entry present.
Mid inspiratory coarse crepitus present all over the areas of the lung ( more on left).
LFT-
TB- 0.64 mg/dl
DB- 0.2mg/dl
AST-20U/L
ALT-12IU/L
ALP-125 IU/L
TP-6.5 g/dl
Alb-3.6 g/dl
A/G-1.27
RFT-
Ecg-

Chest X ray
Day2 
no fresh complaints
Vitals
Temp-98.6F
PR- 80bpm
Bp-110/80 mm of hg
RR-24 cpm
RVS-
BAE+, decreased air entry in right side.
Reduced chest expansion in SCA,SMA.
Investigations-
Sputum- 
              AFB-
              CBNAAT-
 treatment:
Neb. With IPRAVENT 1 respule 6 th hourly.
Tab. MVT PO/OD

 On day 3
no fresh complaints.
SOB resolved
Vitals
Temp-98.2F
PR- 86bpm
Bp-110/80 mm of hg
RR-22 cpm
RVS-
BAE+, decreased air entry in right side.
Reduced chest expansion in SCA,SMA.
 Treatment:
Neb. With IPRAVENT 1 respule 6 th hourly.
Tab. ZINCOVIT PO/OD.

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