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Diaphragm Ultrasound in Respiratory Disorders and Diaphragm Paralysis
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Pauliane Vieira Santana, Leticia Zumpano Cardenas, Andre Luis Pereira de Albuquerque
The respiratory muscles were poorly explored in ILD (30), and few studies employed DUS. He et al. (31) studied the diaphragmatic motion of combined pulmonary fibrosis and emphysema patients (n = 25), idiopathic pulmonary fibrosis (IPF; n = 18), and COPD (n = 60) in comparison with healthy controls (n = 21). Diaphragmatic mobility was similar between IPF patients and healthy controls.
The association of the nicotine metabolite ratio with lung cancer among smokers
Published in Cut Adeya Adella, Stem Cell Oncology, 2018
D. Afiani, N.N. Soeroso, E. Mutiara, B.Y.M. Sinaga
In this study, the heaviest Brinkman index is the most common category of lung cancer (46.7%). Zhang et al. (2001) reported that most of the patients with Lung Cancer-Combined Pulmonary Fibrosis and Emphysema (LC-CPFE) were smokers and had an average Brinkman index of 1131.7 ± 490.8.
Smoking and interstitial lung disease
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
Joshua J Solomon, Kevin K Brown
Ever-smoking is a known risk factor for the development of IPF. Studies looking at environmental and occupational exposures in patients with IPF have found that when compared to never-smokers, ever-smokers have an increased risk of disease development (odds ratio ranging from 1.57 to 2.9) (116–118). A meta-analysis has provided additional support for a relationship (119), as have studies of subjects genetically at risk for the development of fibrosis (120). More recently, patients with IPF accompanied by severe breathlessness and a marked reduction in DLCO in spite of normal or near-normal lung volumes on pulmonary function testing have been described (121). HRCT scanning revealed a combination of upper-lobe emphysema and lower-lobe UIP patterns, and all patients were former or current smokers. This was an early description of ‘combined pulmonary fibrosis and emphysema’ (CPFE) (122–127), a syndrome reported almost exclusively in smokers. It has been estimated that it may account for 5%–10% of diffuse ILDs (123).
Clinical significance of microscopic polyangiitis with interstitial lung disease and bronchiectasis: probability of preexisting comorbidities
Published in Annals of Medicine, 2023
Yun Zhang, Qunli Ding, Chengna Lv, Yanan Ying, Zekai Cen, Haijun Zhou, Tingting Wu
Chest CT and high-resolution CT (HRCT) scans were evaluated by two pulmonologists, and the dominant pulmonary involvement was classified as either ILD, BE or diffuse alveolar haemorrhage (DAH). The criteria of the 2013 ATS/ESR classification of idiopathic interstitial pneumonia (IIP) were used to classify the ILD patterns [18], and the criteria of the 2018 ATS/ERS/JRS/ALAT guidelines were used to classify UIP patterns [19]. A combined pulmonary fibrosis and emphysema (CPFE) diagnosis was based on the 2022 ATS/ERS/JRS/ALAT guidelines [20]. Pulmonary fibrosis (PF) with traction BE was not included as a BE type. A UIP-like pattern was defined as findings coinciding with a UIP or probable UIP pattern according to the modified diagnostic guidelines for the HRCT classification of IPF proposed by the Fleischner Society [21]. Acute exacerbation of ILD (AE-ILD) was defined as an acute worsening or development of dyspnoea with a duration of <1 month, chest CT with new bilateral ground-glass opacity and/or consolidation superimposed on PF, and deterioration not fully explained by heart failure or fluid overload [22,23]. The remission induction treatment regimens were recorded. The last follow-up was in October 2022, and the outcomes were defined as death from all causes. The study was approved by the Ethics Committee of the First Affiliated Hospital of Ningbo University (IRB no.: KS202211015).
Clinical, radiologic, and physiologic features of idiopathic pulmonary fibrosis (IPF) with and without emphysema
Published in Expert Review of Respiratory Medicine, 2022
Chenfei Li, Yan Wang, Qi Liu, Hai Zhang, Fei Xu, Zhenyun Gao, Xiaohui Wang, Guangyu Tao, Yuqing Chen, Wenwen Rong, Hong Yu, Feng Li
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial lung disease (ILD) of unexplained causes, occurring mostly in the elderly. The major histopathological feature and/or thoracic imaging is usual interstitial pneumonia (UIP) localized to the lung [1]. The incidence and prevalence of IPF are reported to be 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively [2]. Moreover, patients with IPF are prone to developing pulmonary complications including pulmonary hypertension (PH) and lung cancer, resulting in a poor prognosis [3]. Combined pulmonary fibrosis and emphysema (CPFE), first proposed in 2005, is a distinct entity defined by the coexistence of emphysema and/or multiple pulmonary bullae (primarily in the upper lobes) and pulmonary fibrosis (primarily in the lower lobes and subpleural region) [4]. However, there is no consensus on the precise definition of CPFE. High resolution computed tomography (HRCT) imaging of the lungs of CPFE provides a very heterogeneous picture of the pulmonary fibrosis that can be divided into UIP type and non-UIP type. The former includes IPF [5], whereas the latter includes nonspecific interstitial pneumonia (NSIP), alveolar enlargement with fibrosis (AEF), and smoking-related interstitial fibrosis (SRIF) [6].
Pharmacological management of Idiopathic Pulmonary Fibrosis: current and emerging options
Published in Expert Opinion on Pharmacotherapy, 2021
Athina Trachalaki, Mujammil Irfan, Athol U Wells
Chronic Obstructive Disease (COPD) often coexists with IPF and when concurrent emphysema is a major radiological feature, the term ‘Combined Pulmonary Fibrosis and Emphysema’ (CPFE) is used. The impact of CPFE on survival, over and above the overall increase in disease severity due to the presence of coexisting disease processes, is debatable as conflicting data [56,57]. However, there is no evidence that anti-fibrotic therapy is less efficacious in IPF patients with CPFE. In a post-hoc analysis of an RCT, the efficacy of Nintedanib was similar in patients with and without emphysema [58]. Thus, it is not believed that IPF pharmaceutical management should not differ in patients with CPFE. However, if there is significant airflow obstruction in CPFE, empirical bronchodilator therapy is often appropriate [59].