COPD and Co-Morbidities

COPD and Co-Morbidities

• 2.
  • A 63year-old male, ex-smoker, presented with progressing dyspnea on moderate exertion, previously admitted for acute exacerbation of COPD without icu admission. • Clinical examination: demonstrated fine ’Velcro‘-like crackles on the lung bases, with no finger clubbing, and the absence of clinical signs of connective tissue disease. The patient’s body mass index was 25 kg/m². • Past history: adenocarcinoma prostate & hyper- cholestrolinemia on treatment. • Spirometry: FEV1/FVC = 71%, FVC = 91%, FEV1 = 85% • DLCo: 72% , TLC: 79%, So2: 92%  86% on exertion • Echocardiography: NAD
• 3.
  What is yourprovisional diagnosis?
• 4.
  • CXR:
• 5.
  • HRCT: Paraseptal Emphysema Interlobular Reticulations Honey Combing GGO
• 6.
  Combined Pulmonary Fibrosis EmphysemaSyndrome (CPFE)
• 7.
  • Patient receivedsteroids and was improved partially • 2 years later  dyspnea progressed to be on mild exertion despite treatment • Associated with hypoxia, episodes of syncope on exertion & easy fatigability • Loss of weight  >10 % in 6 Ms, BMI 17 What investigations u need to do?
• 8.
  • Echo: dilatedright side, RVSP 45 mmHg • FEV1: 66% (>10% worsening), FVC: 67%, Ratio: 75%, • TLC: 52%, DLCo: 21% • HRCT: No much change (no cancer) CPFE with PHTN
• 11.
  Lung fibrosis Cough/Aspiration GERD, PU +CSuse PHTN Nutritional Dyspnea CKD