Case Report with Review of Literature: Combined Pulmonary Fibrosis with Emphysema (CPFE)- Case Report

Abstract

Commonly described smoker’s lung disease are emphysema, chronic bronchitis, lung cancer, and interstitial lung disease (ILD). CPFE is heterogenous lung disease documented in smokers which includes emphysema in upper lobes and pulmonary fibrosis in lower lobes. In this case report, we have reported a 80-year male presented with progressive shortness of breath with fatigability and hypoxia treated as emphysema with inhaled bronchodilators. Response to medical treatment was not satisfactory with worsening of shortness of breath and fatigability. Clinical examination revealed bilateral basal Velcro crepitation’s with resting oxygen saturation was 88% at room air. High resolution computerized imaging documented emphysema in upper lobes with honeycombing and tractional bronchiectasis in lower lobes. Echocardiography documented pulmonary hypertension with dilated right atrium and ventricle. We have treated with oxygen supplementation during rest and ambulation, long-acting inhaled bronchodilator medicines and antifibrotic Nintedanib with strict counselling for avoidance of tobacco exposure. Cardiopulmonary parameters improvement including in 6-minute walk distance was significant with bronchodilators and antifibrotics.