Combined pulmonary fibrosis and emphysema in patients exposed to agrochemical compounds

Daniil, Zoi

doi:10.1183/09031936.06.00124505

Cited by 41 publications

(26 citation statements)

References 14 publications

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“…8 They concluded that among smokers with IPF, the presence and the extent of emphysema have a profound influence on physiologic function in terms of both further impairment and confounding effects to contribute to functional impairment and dyspnoea on exertion. Daniil et al reported nine of 21 IPF patients who met the imaging criteria for CPFE 9 as previously described by Cottin et al. 3 All nine patients were farmers and had significant exposure to agrochemical compounds.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics Of Combined Pulmonary Fibrosis And Emphysema

Kitaguchi¹,

Hanaoka²,

Kawakami³

et al. 2010

A42. Chronic Obstructive Pulmonary Disease Phenotypes

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Background and objective:We have sometimes seen patients with combined pulmonary fibrosis and emphysema (CPFE) and speculate that they have some different clinical characteristics to COPD patients. This study clarifies the clinical characteristics of CPFE patients. Methods: This was a retrospective study of 47 stable patients with concurrent emphysema and diffuse parenchymal lung disease with fibrosis, based on the findings of chest CT (CPFE patients). The clinical characteristics of CPFE patients were compared with those of emphysema dominant COPD patients without parenchymal lung disease (COPD patients).Results: Forty-six of the 47 CPFE patients were male. Paraseptal emphysema was particularly common in the CPFE group. Honeycombing, ground-glass opacities and reticular opacities were present in 75.6%, 62.2% and 84.4% of CPFE patients, respectively. Twenty-two of the 47 CPFE patients (46.8%) had lung cancer. Pulmonary function tests showed that the CPFE group had milder airflow limitation and lower diffusing capacity than the COPD group. Desaturation during 6-minute walking test in CPFE patients tended to be more severe than in COPD patients, if the level of FEV 1 or 6 minute-walking distance was equal. Conclusion: CPFE patients had some different clinical characteristics in comparison to COPD patients and may also have a high prevalence of lung cancer.4

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics Of Combined Pulmonary Fibrosis And Emphysema

Kitaguchi¹,

Hanaoka²,

Kawakami³

et al. 2010

A42. Chronic Obstructive Pulmonary Disease Phenotypes

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“…The vast majority of the patients in published series [7,8,9, 11, 31] are male (see table 2). The significance of this is unclear in our case series, since our population consisted of veterans.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in Combined Pulmonary Fibrosis and Emphysema

et al. 2007

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Background: Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder described in several case series of upper lobe emphysema associated with lower lobe fibrosis. Patients with this entity have relatively preserved lung volumes and spirometry but marked reductions in diffusing capacity on pulmonary function testing. Smoking appears to be the predominant risk factor for this disorder. Usual interstitial pneumonia has been the most common histological pattern of interstitial lung disease described on biopsy in the literature. Objectives: To characterize the clinical, imaging and pathological features of a cohort of patients with CPFE. Methods: Retrospective review of electronic medical record data, radiological imaging, and available lung biopsy specimens for a series of 10 patients with CPFE at the Providence VA Medical Center, Providence, R.I., USA. Results: We describe a series of 10 patients with CPFE. All had severe reductions in diffusing capacity out of proportion to their lung volumes and spirometry. All had predominantly upper lobe emphysema on computed tomography; 8/10 had lower lobe subpleural reticular abnormalities and honeycombing, while 2 had lower lobe ground glass changes on imaging. These 2 patients demonstrated a pattern of interstitial lung disease on biopsy characterized by intra-alveolar macrophage accumulation in association with marked alveolar septal fibrosis, consistent with a variant form of desquamative interstitial pneumonia with extensive fibrosis. Conclusions: The imaging findings and pathology in patients with CPFE are heterogeneous.

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“…Possible additional risk factors have been identified, such as exposure to agrochemical compounds [22]. It is also recognised that overexpression of tumour necrosis factor-a and platelet-derived growth factor-b in mouse lungs produces airspace dilatation and fibrosis [23,24].…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

The impact of emphysema in pulmonary fibrosis

Cottin¹

2013

Eur Respir Rev

131

115

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Several groups have described a syndrome in which idiopathic pulmonary fibrosis (IPF) coexists with pulmonary emphysema. This comes as no surprise since both diseases are associated with a history of exposure to cigarette smoke. The syndrome of combined pulmonary fibrosis and emphysema (CPFE) is characterised by upper lobe emphysema and lower lobe fibrosis. Physiological testing of these patients reveals preserved lung volume indices contrasted by markedly impaired diffusion capacity. The incidence of CPFE remains unknown but several case series suggest that this subgroup may comprise up to 35% of patients with IPF. CPFE is a strong determinant of associated pulmonary hypertension (PH). In addition, CPFE has major effects on measures of physiological function, exercise capacity and prognosis, and may affect the results of pulmonary fibrosis trials. Further studies are needed to ascertain the aetiology, morbidity, mortality and management of the CPFE syndrome, with or without PH, and to evaluate novel therapeutic options in CPFE.

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Combined pulmonary fibrosis and emphysema in patients exposed to agrochemical compounds

Cited by 41 publications

References 14 publications

Clinical Characteristics Of Combined Pulmonary Fibrosis And Emphysema

Clinical Characteristics Of Combined Pulmonary Fibrosis And Emphysema

Heterogeneity in Combined Pulmonary Fibrosis and Emphysema

The impact of emphysema in pulmonary fibrosis

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