Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

Lee, Seung Hoo; Park, J. S.; Kim, S. Y.; Kim, D. S.; Kim, Y. W.; Chung, Man Pyo; Uh, Soo‐Taek; Park, C. S.; Park, S. W.; Jeong, Sung Hwan; Park, Y. B.; Lee, H. L.; Shin, Jong Wook; Lee, J. H.; Jegal, Yangin; Lee, H. K.; Kim, Y. H.; Song, Jin Woo; Park, M. S.

doi:10.5588/ijtld.18.0194

“…A pooled prevalence of CTD-ILD associated with systemic sclerosis in three previous studies was reported to be 13.4% [12][13][14][15] . The prevalence of emphysema (> 5% in high-resolution computed tomography (HRCT) was reportedly 13.4-25.4% and COPD was evident in 9.2% of patients with idiopathic pulmonary fibrosis (IPF) [16][17][18] . Furthermore, among patients with rheumatoid arthritis-related ILD, emphysema was found in 27% of non-smokers and 76% of smokers 19 .…”

Section: Prevalencementioning

confidence: 99%

“…50 . However, there are conflicting results regarding mortality in patients with CPFE and patients with IPF alone: some studies reported no significant difference in mortality 16,17,[62][63][64] , while others reported that mortality was higher in CPFE groups 56,[65][66][67][68] or lower in CPFE groups 69,70 . In a metaanalysis performed by Koo et al, higher mortality was noted in patients with CTD-CPFE, compared to those without CTD-ILD with emphysema 12 .…”

Section: Prognosis Of Cpfementioning

confidence: 99%

Chronic obstructive pulmonary disease combined with interstitial lung disease

Choi¹,

Song²,

Rhee³

2022

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Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension.The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.Additional comparisons of biomarkers between groups revealed four clear categories: biomarkers elevated in emphysema alone (interleukin [IL]-6, CXCL10, CCL2, IL-10, and interferon-γ); biomarkers reduced in emphysema alone (IL-17A, IL-13, matrix metalloproteinase [MMP] 1, MMP13, MMP2, CCL24, and lysyl oxidase); biomarkers that were similar among emphysema, IPF, and CPFE, but different from the healthy control group (sCD14, CCL5, tumor necrosis factor [TNF] RII, SP-D, ST2, IL-1β, IL-4, IL-5, CXCL8, and TNFα); and biomarkers with a mixed pattern that did not fit any other categories. These results suggest that the levels of inflammatory proteins are generally comparable between IPF and CPFE, but distinct features are present in emphysema. These results were also consistent with the findings of previous studies [38][39][40][41] . Therefore, the immunological pathogenesis of CPFE may be more closely associated with IPF development.Klebs von den Lungen-6 (KL-6) is a high-molecular-weight glycoprotein that is strongly expressed on type II alveolar pneumocytes and bronchiolar epithelial cells. It is an important marker of ILD and is associated with disease severity, progression, and survival; notably, it promotes pulmonary fibroblast migration and proliferation [42][43][44][45] . Because of this association with ILD, some studies have investigated relationships with fibrotic changes in patients with COPD. In asthma-COPD overlap, patients with a history of smoking and older age have more frequent ILA 46 . These patients with asthma-COPD overlap and ILA showed higher levels of KL-6, compared with patients with asthma-COPD overlap who lacked ILA.The clinical significance of KL-6 has also bee...

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“…A pooled prevalence of CTD-ILD associated with systemic sclerosis in three previous studies was reported to be 13.4% [ 12 - 15 ]. The prevalence of emphysema (>5%) in high-resolution computed tomography (HRCT) was reportedly 13.4%–25.4% and COPD was evident in 9.2% of patients with idiopathic pulmonary fibrosis (IPF) [ 16 - 18 ]. Furthermore, among patients with RA-related ILD, emphysema was found in 27% of non-smokers and 76% of smokers [ 19 ].…”

Section: Prevalencementioning

confidence: 99%

“…Notably, accompanying pulmonary fibrosis in patients with emphysema resulted in five-fold greater mortality risk, compared with nonmalignant patients who did not have pulmonary fibrosis ( Figure 3 ) [ 50 ]. However, there are conflicting results regarding mortality in patients with CPFE and patients with IPF alone: some studies reported no significant difference in mortality [ 16 , 17 , 62 - 64 ], while others reported that mortality was higher in CPFE groups [ 56 , 65 - 68 ] or lower in CPFE groups [ 69 , 70 ]. In a meta-analysis performed by Koo et al [ 12 ], higher mortality was noted in patients with CTD-CPFE, compared to those without CTD-ILD with emphysema [ 12 ].…”

Section: Prognosismentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Choi

¹

,

Song

²

,

Rhee

³

2022

View full text Add to dashboard Cite

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

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“…Interstitial changes vary in patients with CPFE, such that most are unclassifiable, one-third have the usual interstitial pneumonia pattern, and one-fifth constituted identifiable or secondary lung fibrosis [11]. The prevalence of emphysema (> 5% in high-resolution CT) was reportedly 13.4-25.4% and COPD was evident in 9.2% of patients with idiopathic pulmonary fibrosis (IPF) [12][13][14]. Furthermore, among patients with rheumatoid arthritis-related ILD, emphysema was found in 27% of non-smokers and 76% of smokers [15].…”

Section: Prevalencementioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Combined With Interstitial Lung Disease

Choi¹,

Song²,

Rhee³

2021

Preprint

0

View full text Add to dashboard Cite

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents may be beneficial in patients with CPFE, but further studies are needed.

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Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

Cited by 9 publications

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Chronic obstructive pulmonary disease combined with interstitial lung disease

Chronic obstructive pulmonary disease combined with interstitial lung disease

Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Chronic Obstructive Pulmonary Disease Combined With Interstitial Lung Disease

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