14th February 2025

An 88-year-old has a background of recurrent depressive disorder.

An 88-year-old has a background of recurrent depressive disorder. As she has become older, she has become frailer and now requires a Zimmer frame to mobilise. She has COPD and becomes breathless walking more than 50 metres, meaning that she is becoming more and more frightened of leaving the house. She uses her reliever inhalers 3-4 times per day on average and sometimes feels breathless even when lying in bed.

She is now no longer able to shop for herself, despite her shop being only 30 metres away. She has also stopped visiting her grandchildren, which she used to do on a weekly basis. This upset her daughter as she offered to take her there and back in the car but she still declined.

Her GP performs spirometry with her and organises some blood tests:

Spirometry: FEV1 – 60% predicted; FVC – 130% predicted; FEV1/FVC ratio – low

Haemoglobin 110 g/L (130-180)

Mean Cell Volume 105 fL (80-100)

White Cell Count 8.6 x109/L (3.6-11)

Neutrophils 7.4 x10⁹/L (1.8-7.5)

Platelet Count 397 x10⁹/L (140-400)

Bicarbonate 25 mEq/L (22-29)

TSH 3.9 mU/L² (0.4-4)

Free T4 9.1 pmol/L (9-24)

What is the most likely diagnosis?

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