1. Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity
- Author
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Cottin, V., Nunes, H., Brillet, P.-Y., Delaval, P., Devouassaoux, G., Tillie-Leblond, I., Israel-Biet, D., Court-Fortune, I., Valeyre, D., Cordier, J.-F., Carré, P., Chabot, F., Chatté, G., Coëtmeur, D., Crestani, B., Dalphin, J.C., Dietemann, A., Gentil, B., Humbert, M., Lacronique, J., Mairesse, M., Marchand, Eric, Reynaud-Gaubert, M., Rétrovirus et Pathologie Comparée (RPC), Institut National de la Recherche Agronomique (INRA)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Ecole Nationale Vétérinaire de Lyon (ENVL), Centre Hospitalier Universitaire de Lyon, Service de Pneumologie, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Lille (CHU de Lille), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Hospices Civils de Lyon (HCL), UCL - MD/MINT - Département de médecine interne, and UCL - (MGD) Service de pneumologie
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Hypertension, Pulmonary ,[SDV]Life Sciences [q-bio] ,Interstitial lung disease ,EMPHYSEMA ,030204 cardiovascular system & hematology ,Pulmonary arterial hypertension ,Pulmonary fibrosis ,Pulmonary function testing ,03 medical and health sciences ,FEV1/FVC ratio ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,PULMONARY ARTERIAL HYPERTENSION ,Aged ,Retrospective Studies ,Aged, 80 and over ,Emphysema ,INTERSTITIAL LUNG DISEASE ,Lung ,medicine.diagnostic_test ,business.industry ,Smoking ,Middle Aged ,respiratory system ,medicine.disease ,Survival Analysis ,Pulmonary hypertension ,Combined pulmonary fibrosis and emphysema ,Respiratory Function Tests ,respiratory tract diseases ,3. Good health ,Surgery ,PULMONARY FIBROSIS ,medicine.anatomical_structure ,Pulmonary Emphysema ,030228 respiratory system ,Cardiology ,Female ,Tomography, X-Ray Computed ,business - Abstract
The syndrome resulting from combined pulmonary fibrosis and emphysema has not been comprehensively described. The current authors conducted a retrospective study of 61 patients with both emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lungs on chest computed tomography. Patients (all smokers) included 60 males and one female, with a mean age of 65 yrs. Dyspnoea on exertion was present in all patients. Basal crackles were found in 87% and finger clubbing in 43%. Pulmonary function tests were as follows (mean ± SD): total lung capacity 88% ± 17, forced vital capacity (FVC) 88% ± 18, forced expiratory volume in one second (FEV1) 80% ± 21 (% predicted), FEV1/FVC 69% ± 13, carbon monoxide diffusion capacity of the lung 37% ± 16 (% predicted), carbon monoxide transfer coefficient 46% ± 19. Pulmonary hypertension was present in 47% of patients at diagnosis, and 55% during follow-up. Patients were followed for a mean of 2.1 ± 2.8 yrs from diagnosis. Survival was 87.5% at 2 yrs and 54.6% at 5 yrs, with a median of 6.1 yrs. The presence of pulmonary hypertension at diagnosis was a critical determinant of prognosis. The authors hereby individualise the computer tomography-defined syndrome of combined pulmonary fibrosis and emphysema characterised by subnormal spirometry, severe impairment of gas exchange, high prevalence of pulmonary hypertension, and poor survival. Copyright©ERS Journals Ltd 2005.
- Published
- 2005