• A 63 year-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

What is your provisional diagnosis?

• CXR:

• HRCT:

ParaseptalEmphysema

Interlobular Reticulations

Honey Combing

GGO

Combined Pulmonary Fibrosis

Emphysema Syndrome

(CPFE)

• Patient received steroids 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?

• Echo: dilated right 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

Lung fibrosis

Cough/Aspiration

GERD, PU

+ CS use

PHTN

Nutritional

Dyspnea

CKD