Combined Pulmonary Fibrosis & Emphysema Case Study Reveals Need For Comprehensive Patient Evaluation


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PH and sclerodermaA case study confirmed the need for a combined diagnosis approach in patients with pulmonary fibrosis and emphysema (CPFE) in contrast to a simplistic approach to lung function examination in symptomatic smokers.

The study, entitled “Lung function testing in COPD: when everything is not so simple” was recently published in the journal Respirology Case Reports. 

Combined pulmonary fibrosis and emphysema (CPFE) is a condition that usually affects male smokers. The diagnosis of CPFE is difficult because effects observed in lung function tests widely vary. CPEC has a higher morbidity and mortality than pulmonary fibrosis and emphysema alone: evidence has shown that the mortality of CPFE is significantly higher than in idiopathic pulmonary fibrosis alonee, with a median survival ranging from 2.1 to 8.5 years after the diagnosis. As a result, CPFE is condition that relies on early identification and diagnosis.

In this regard, Giovanni Barisione and colleagues from the U.O. Fisiopatologia Respiratoria, Dipartimento di Medicina Interna e Specialità Mediche, IRCCS Azienda Ospedaliera Universitaria San Martino, Genoa, Italy, reported the case of a heavy smoker, overweight man aged 70 years, with a history of arterial hypertension and coronary disease and progressive exertional dyspnea for 1 year. Additionaly, the patient had a history of indirect exposure to asbestos.

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The researchers report than when observed and properly tested for lung function, the patient showed normal spirometry and lung volumes. However, there was a reduction of diffusing capacity for carbon monoxide and even more nitric oxide. The arterial partial pressure of oxygen was reduced with a markedly increased alveolar-to-arterial difference. In this regard, the patient was found to have an abnormal lung function. Subsequently, using high-resolution computed tomography (HRCT), the patient revealed lobe emphysema and lower lobe pulmonary fibrosis.

Based on this case study, the researchers indicate that a simplistic approach based on spirometry is not sufficient for the evaluation of smokers with suspected COPD. This is mainly because of the progressive exertional dyspnea. The researchers suggest that because of environmental risk factors such as smoking and exposure to fibrogenic dust, these symptomatic patients present wide lung function spectrum defects that should be evaluated comprehensively in order to make an appropriate diagnosis.

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