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A 60 year old male presented with cough, progressive breathlessness and hemoptysis. He is a current smoker, and worked as a mechanic. His mother had been treated for pulmonary TB a few years ago. Urinalysis shows blood +++, protein ++, numerous red cell casts. CXR was done (see below).

X-ray Shoulder Radiography Medical imaging Leg

click image to enlarge

This is his lung function-

FEV1 65% predicted
FVC 60% predicted
TLC 68% predicted
RV 66% predicted
TLCO 110% predicted

What is the management plan?

A. Steroid, brochodilators
B. Early plasmapharesis, methyprednisolone, cyclophosphamide
C. Anti-TB drug
D. Antibiotics for bacterial chest infection
E. Diuretics
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