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The impact of emphysema in pulmonary fibrosis

Vincent Cottin
European Respiratory Review 2013 22: 153-157; DOI: 10.1183/09059180.00000813
Vincent Cottin
*Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Pneumologie – Centre de référence national des maladies pulmonaires rares, et centre de compétences de l’hypertension artérielle pulmonaire, Lyon, and #Université Claude Bernard Lyon 1, INRA, UMR754 INR-Vetagroup EPHR IFR 128, Lyon, France.
*Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Pneumologie – Centre de référence national des maladies pulmonaires rares, et centre de compétences de l’hypertension artérielle pulmonaire, Lyon, and #Université Claude Bernard Lyon 1, INRA, UMR754 INR-Vetagroup EPHR IFR 128, Lyon, France.
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  • For correspondence: vincent.cottin@chu-lyon.fr
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    Figure 1.

    Cox model survival estimates for relevant 12-month longitudinal changes in pulmonary function tests in patients with combined idiopathic pulmonary fibrosis and moderate/severe emphysema. A relative decline in forced expiratory volume in 1 s (FEV1) of >10% predicted versus <10% is shown. Physiological cut-off points were chosen based on prior literature and the best prognostic fit according to index of concordance. All Cox models are adjusted for the baseline average pulmonary function test, average age at diagnosis of 62 years, male sex and positive smoking history. Reproduced from [35].

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  • Table 1. Characteristics and clinical manifestations at diagnosis in 61 patients with combined pulmonary fibrosis and emphysema
    Patient characteristics
    Sex
        Male60
        Female1
    Age years65.2±10.2 (36–84)
    Body mass index kg·m−226±3 (19–32)
    Smoking status
        Current smoker19
        Ex-smoker42
        Never-smoker0
    Pack-years smoking46±27 (5–120)
    Current smokers57±27 (8–120)
    Ex-smokers41±25 (5–110)
    Asthenia14 (23)
    NYHA grade of dyspnoea
        Grade 110 (16)
        Grade 223 (38)
        Grade 323 (38)
        Grade 45 (8)
    Cough29 (48)
    Sputum production22 (36)
    Chest pain10 (17)
    Finger clubbing26 (43)
    Basal crackles53 (87)
    Wheezes8 (13)
    • Data are presented as n, mean±sd (range) or n (%). NYHA: New York Heart Association. Reproduced from [4].

  • Table 2. Pulmonary function tests in 61 patients with combined pulmonary fibrosis and emphysema
    TestPatients tested n
    FVC % pred6190±18 (47–125)
    FEV1 % pred6180±21 (33–123)
    Post-bronchodilator improvement in FEV1 L360.06±0.13 (-0.35–0.3)
    FEV1/FVC %6169±13 (30–94)
    FEF25–75% % pred5751±26 (15–118)
    TLC % pred5688±17 (44–132)
    RV % pred5690±32 (35–188)
    DLCO % pred5737±16 (10–80)
    KCO % pred5746±19 (8–84)
    PaO2 at rest (surpine position) kPa618.4±1.9 (4.6–13.3)
    PaCO2 at rest (surpine position) kPa614.9±0.7 (3.0–7.3)
    Alveolar–arterial PaO2 difference (room air) kPa615.5±2.1 (0.1–11.7)
    PaO2 at exercise–PaO2 at rest (surpine position) kPa22-1.5±1.6 (-4.4–1.7)
    6-min walking distance m23336±139 (50–548)
    Decrease in SpO2 during 6-min walk test %23-8.9±5.7 (-20–0)
    • Data are presented as mean±sd (range), unless otherwise stated. FVC: forced vital capacity; % pred: % predicted; FEV1: forced expiratory volume in 1 s; FEF25–75%: mean forced expiratory flow between 25% and 75% of FVC; TLC: total lung capacity; RV: residual volume; DLCO: diffusing capacity of the lung for carbon monoxide; KCO: transfer coefficient of the lung for carbon monoxide; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; SpO2: arterial oxygen saturation measured by pulse oximetry. Reproduced from [4].

  • Table 3. Imaging features of combined pulmonary fibrosis and emphysema
    Feature
    Emphysema100
        Centrolobular97
        Paraseptal93
        Bullae54
    Fibrosis100
        Honeycombing95
        Reticulation87
        Traction bronchiectasis69
        Ground-glass opacities66
        Consolidation15
    • Data are presented as %. Reproduced with modification from [4].

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The impact of emphysema in pulmonary fibrosis
Vincent Cottin
European Respiratory Review Jun 2013, 22 (128) 153-157; DOI: 10.1183/09059180.00000813

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The impact of emphysema in pulmonary fibrosis
Vincent Cottin
European Respiratory Review Jun 2013, 22 (128) 153-157; DOI: 10.1183/09059180.00000813
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