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Restrictive ventilatory defect — SCE Respiratory MCQ

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EasyRespiratory PhysiologyRestrictive ventilatory defectSCE Respiratory

A 58-year-old woman has progressive dyspnoea and spirometry showing FEV1 1.82 L (76% predicted), FVC 1.86 L (64% predicted) and FEV1/FVC 0.98. TLCO is 38% predicted and KCO is 62% predicted. Chest radiograph shows low lung volumes and basal reticulation. What is the most appropriate investigation?

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Correct answer: A — High-resolution CT chest

This patient has a probable restrictive ventilatory pattern: FVC is reduced, the FEV1/FVC ratio is preserved/high, gas transfer is markedly reduced, and the chest radiograph shows low lung volumes with basal reticulation. Together these findings strongly suggest interstitial lung disease, such as idiopathic pulmonary fibrosis. In current UK practice, suspected pulmonary fibrosis/interstitial lung disease should be assessed with CT thorax including high-resolution images, which can define the pattern and distribution of fibrosis and may show a usual interstitial pneumonia pattern. Methacholine challenge and serial peak flows assess asthma, cardiopulmonary exercise testing is not the first diagnostic test when ILD is suggested by spirometry and CXR, and polysomnography is for suspected sleep-disordered breathing.

Reference: NICE Clinical Guideline CG163: Idiopathic pulmonary fibrosis in adults: diagnosis and management. Published 2013, last updated 2017. Recommendation 1.2.1: assess suspected IPF with lung function testing, chest X-ray review and CT thorax including high-resolution images. https://www.nice.org.uk/guidance/cg163/chapter/recommendations