Chest
Original ResearchDiffuse Lung DiseaseClinical Features and Outcomes in Combined Pulmonary Fibrosis and Emphysema in Idiopathic Pulmonary Fibrosis
Section snippets
Study Patients
Patients were identified through the University of California San Francisco (UCSF) and Mayo Clinic Rochester (Mayo) interstitial lung disease (ILD) databases between January 2000 and July 2010. Patients were included if they had a diagnosis of IPF based on multidisciplinary review according to established criteria9, 10 and had a high-resolution CT (HRCT) scan within 1 year of their initial clinic consultation. Patients without a HRCT scan available for re-review were excluded (n = 71). A total
Prevalence of CPFE in IPF
Criteria for CPFE were met in 29 of 365 patients, representing 8.0% of the overall cohort (95% CI, 5.1%-10.6%) (Fig 1). There was no difference in the frequency of CPFE between cohorts (8.9% in UCSF and 6.9% in Mayo, P = .50). Forty-nine patients (13.4%) had ≥ 5% emphysema and 106 patients (29.0%) had at least some emphysema detectable on HRCT scan. In 17 patients, the extent of emphysema was greater than that of fibrosis; 15 of these patients met our definition of CPFE. When present, emphysema
Discussion
This is the first IPF-specific multicenter study of CPFE, and unlike previous studies, we used both a standardized definition of CPFE and rigorous statistical methods to determine differences in clinical features and outcomes. We restricted our analysis to patients with IPF to reduce potential bias that would be introduced by inclusion of other ILDs that have distinct natural histories and variable association with smoking. In addition, we chose a prespecified cutoff of ≥ 10% emphysema to
Acknowledgments
Author contributions: Drs Ryerson and Collard had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Ryerson: contributed to conception of the study design, performed the data analysis, produced the initial draft of the manuscript, approved the final manuscript, and served as principal author.
Dr Hartman: contributed to data interpretation and preparation and approval of the final manuscript.
Dr Elicker:
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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