A 10-year-old boy appears at your office with a chief complaint of shortness of breath. Exertional dyspnea has been present for the previous month and is associated with intermittent dry cough. The patient has no associated fever, chills, or chest pain. Chart review indicates no history of asthma or other pulmonary disease, although the patient has been seen several times for “hay fever.”

The patient is accompanied by his mother, who appears quite anxious. The mother emotionally relates that her 65-year-old cousin has recently been diagnosed with mesothelioma and is dying. Furthermore, he had been a custodian at the patient’s school for the previous 3 years, after retiring from his career as a longshoreman. His work at the school involved general cleanup and boiler room maintenance. The mother is afraid that her son’s dyspnea and cough are related to asbestos exposure at the school and that he might be developing mesothelioma, because he often helped her cousin after school. Recent asbestos removal in the school boiler room has increased the mother’s concern.

On physical examination, the patient is in no acute distress. Respirations are unlabored. Lung auscultation reveals a diffuse, expiratory wheeze. Spirometry performed in the office shows a forced vital capacity (FVC) of 95% of predicted value and a forced expiratory volume in 1 second (FEV1) of 88% of predicted value, with an FEV1/FVC of 70%. The remainder of the examination is within normal limits. A chest radiograph is normal.