A 45 year old female daily wage labourer by occupation came to the opd with chief complaint of shortness of breath since 2 days. Patient was apparantly asymptomatic 2 days ago then she developed shortness of breath which is insidious in onset gradually progressive from grade 1 to grade 3.It is aggrevating on supine position and reliwved on sitting position . Sob is not associated with chest pain , chest tightness, palpitations ,fever , cold , cough , nausea, vomitings , loose stools , PND , sore throat , decreased urine output. H/o exposure to smoke from fossil fules since 30 years and patient husband is a known smoker who smoker 4-5 beedis per day. PAST HISTORY - No similar complaints in the past . - Not a k/c/o DM, HTN, TB, ASTHMA, EPILEPSY,CAD, CVA. - Tubectomy was done 20 years ago. MENSTRUAL HISTORY PAST MENSTRUAL HISTORY - Age of menarche - 11 years . - Regular cycles 5-6 days / 30 days. - No pain , No clots - Uses 2-3 pads per day. PRESENT MENSTRUAL HISTORY - LMP - 4/1/