16th February 2025

An 80-year-old lady is seen for follow up in a Care of the Elderly clinic.

An 80-year-old lady is seen for follow up in a Care of the Elderly clinic. She is complaining of difficulty in breathing. Her background includes ischaemic heart disease with coronary artery bypass graft (CABG), osteoporosis and hypothyroidism. She is an ex-smoker with a 40-pack-year history.

Her respiratory rate is 20, her saturations 98% on air. She has marked scoliosis and kyphosis, with a kyphotic angle of approximately 65 degrees. Auscultation is normal. She has a BMI of 30.

Echocardiography shows a left ventricular ejection fraction of 60% and an estimated pulmonary artery systolic pressure (PASP) of 31 mmHg.

Pulmonary function tests are as follows:

FEV1 0.7 L (52% predicted), FVC 0.9 L (53% predicted), FEV1/FVC ratio 81%

TL_ᴄᴏ 56% of predicted

K_ᴄᴏ 102% of predicted

What is likely to be the major cause of her symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.