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Open Access 01-12-2024 | Idiopathic Pulmonary Fibrosis | Research

A formula for predicting emphysema extent in combined idiopathic pulmonary fibrosis and emphysema

Authors: Athol U. Wells, Joseph Jacob, Nicola Sverzellati, Gary Cross, Joseph Barnett, Angelo De Lauretis, Katerina Antoniou, Derek Weycker, Mark Atwood, Klaus-Uwe Kirchgaessler, Vincent Cottin

Published in: Respiratory Research | Issue 1/2024

Abstract

Background

No single pulmonary function test captures the functional effect of emphysema in idiopathic pulmonary fibrosis (IPF). Without experienced radiologists, other methods are needed to determine emphysema extent. Here, we report the development and validation of a formula to predict emphysema extent in patients with IPF and emphysema.

Methods

The development cohort included 76 patients with combined IPF and emphysema at the Royal Brompton Hospital, London, United Kingdom. The formula was derived using stepwise regression to generate the weighted combination of pulmonary function data that fitted best with emphysema extent on high-resolution computed tomography. Test cohorts included patients from two clinical trials (n = 455 [n = 174 with emphysema]; NCT00047645, NCT00075998) and a real-world cohort from the Royal Brompton Hospital (n = 191 [n = 110 with emphysema]). The formula is only applicable for patients with IPF and concomitant emphysema and accordingly was not used to detect the presence or absence of emphysema.

Results

The formula was: predicted emphysema extent = 12.67 + (0.92 x percent predicted forced vital capacity) – (0.65 x percent predicted forced expiratory volume in 1 second) – (0.52 x percent predicted carbon monoxide diffusing capacity). A significant relationship between the formula and observed emphysema extent was found in both cohorts (R² = 0.25, P < 0.0001; R² = 0.47, P < 0.0001, respectively). In both, the formula better predicted observed emphysema extent versus individual pulmonary function tests. A 15% emphysema extent threshold, calculated using the formula, identified a significant difference in absolute changes from baseline in forced vital capacity at Week 48 in patients with baseline-predicted emphysema extent < 15% versus ≥ 15% (P = 0.0105).

Conclusion

The formula, designed for use in patients with IPF and emphysema, demonstrated enhanced ability to predict emphysema extent versus individual pulmonary function tests.

Trial registration

NCT00047645; NCT00075998.

Available only for authorised users

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Title: A formula for predicting emphysema extent in combined idiopathic pulmonary fibrosis and emphysema
Authors: Athol U. Wells
Joseph Jacob
Nicola Sverzellati
Gary Cross
Joseph Barnett
Angelo De Lauretis
Katerina Antoniou
Derek Weycker
Mark Atwood
Klaus-Uwe Kirchgaessler
Vincent Cottin
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Idiopathic Pulmonary Fibrosis
Pulmonary-Function Tests
Published in: Respiratory Research / Issue 1/2024
Electronic ISSN: 1465-993X
DOI: https://doi.org/10.1186/s12931-023-02589-x

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