Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis

Joseph Jacob, Brian Jack Bartholmai, Srinivasan Rajagopalan, Maria Kokosi, Toby M. Maher, Arjun Nair, Ronald Karwoski, Elisabetta Renzoni, Simon L.F. Walsh, David M. Hansell, Athol U. Wells

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

This study aimed to investigate whether the combination of fibrosis and emphysema has a greater effect than the sum of its parts on functional indices and outcome in idiopathic pulmonary fibrosis (IPF), using visual and computer-based (CALIPER) computed tomography (CT) analysis. Consecutive patients (n=272) with a multidisciplinary IPF diagnosis had the extent of interstitial lung disease (ILD) scored visually and by CALIPER. Visually scored emphysema was subcategorised as isolated or mixed with fibrotic lung. The CT scores were evaluated against functional indices forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO), transfer coefficient of the lung for carbon monoxide (KCO), composite physiologic index (CPI)) and mortality. The presence and extent of emphysema had no impact on survival. Results were maintained following correction for age, gender, smoking status and baseline severity using DLCO, and combined visual emphysema and ILD extent. Visual emphysema quantitation indicated that relative preservation of lung volumes (FVC) resulted from tractionally dilated airways within fibrotic lung, ventilating areas of admixed emphysema (p<0.0001), with no independent effect on FVC from isolated emphysema. Conversely, only isolated emphysema (p<0.0001) reduced gas transfer (DLCO). There is no prognostic impact of emphysema in IPF, beyond that explained by the additive extents of both fibrosis and emphysema. With respect to the location of pulmonary fibrosis, emphysema distribution determines the functional effects of emphysema.

Original languageEnglish (US)
Article number1700379
JournalEuropean Respiratory Journal
Volume50
Issue number1
DOIs
StatePublished - Jul 1 2017

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Idiopathic Pulmonary Fibrosis
Emphysema
Vital Capacity
Lung
Interstitial Lung Diseases
Carbon Monoxide
Fibrosis
Tomography
Lung Volume Measurements
Pulmonary Emphysema
Pulmonary Fibrosis
Gases
Smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis. / Jacob, Joseph; Bartholmai, Brian Jack; Rajagopalan, Srinivasan; Kokosi, Maria; Maher, Toby M.; Nair, Arjun; Karwoski, Ronald; Renzoni, Elisabetta; Walsh, Simon L.F.; Hansell, David M.; Wells, Athol U.

In: European Respiratory Journal, Vol. 50, No. 1, 1700379, 01.07.2017.

Research output: Contribution to journalArticle

Jacob, J, Bartholmai, BJ, Rajagopalan, S, Kokosi, M, Maher, TM, Nair, A, Karwoski, R, Renzoni, E, Walsh, SLF, Hansell, DM & Wells, AU 2017, 'Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis', European Respiratory Journal, vol. 50, no. 1, 1700379. https://doi.org/10.1183/13993003.00379-2017
Jacob, Joseph ; Bartholmai, Brian Jack ; Rajagopalan, Srinivasan ; Kokosi, Maria ; Maher, Toby M. ; Nair, Arjun ; Karwoski, Ronald ; Renzoni, Elisabetta ; Walsh, Simon L.F. ; Hansell, David M. ; Wells, Athol U. / Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis. In: European Respiratory Journal. 2017 ; Vol. 50, No. 1.
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