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Mixed Pattern (CPFE) — RACP Adult Medicine MCQ

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HardRespiratoryMixed Pattern (CPFE)RACP Adult Medicine

A 65-year-old man with both COPD and pulmonary fibrosis (combined pulmonary fibrosis-emphysema) presents with severe exercise limitation. Spirometry: FEV₁ 55% predicted, FVC 58% predicted, FEV₁/FVC 0.62. TLC is 75% predicted. DLCO is 28% predicted (severely reduced). What is the spirometry pattern?

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Correct answer: D — Mixed obstructive and restrictive pattern

Both FEV₁/FVC ratio reduced (<0.70) AND FVC reduced with TLC reduced suggests a mixed obstructive and restrictive pattern. The disproportionately severe DLCO reduction (much worse than FEV₁ or FVC) is characteristic of combined pulmonary fibrosis-emphysema (CPFE) syndrome. These patients have high risk of pulmonary hypertension.

Reference: eTG Respiratory – 2024 – CPFE; ATS/ERS 2022