The hallmark symptoms of ILDs are the insidious onset of progressive shortness of breath and exertional dyspnea with paroxysmal dry cough. A careful history may elicit symptoms of an earlier viral prodrome in patients that may also include cough with varying sputum production and systemic symptoms such as fever or weight loss. On physical examination, most patients can have the typical dry, end-inspiratory ("Velcro") crackles most appreciable in the lung bases. The finding of cyanosis and accentuated second heart sound, right ventricular heave, and lower-extremity edema suggest late phases of the disease caused by chronic hypoxemia and pulmonary fibrosis.
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