What are the common comorbidities associated with COPD and how to deal with this overlap, diagnose and treat well?

2. • 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

3. What is your provisional diagnosis?

4. • CXR:

5. • HRCT:
Paraseptal
Emphysema
Interlobular
Reticulations
Honey
Combing
GGO

6. Combined Pulmonary Fibrosis
Emphysema Syndrome
(CPFE)

7. • 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?

8. • 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

11. Lung fibrosis
Cough/Aspiration
GERD, PU
+CS use
PHTN
Nutritional
Dyspnea
CKD