title: The effect of emphysema on lung function and survival in patients with idiopathic pulmonary fibrosis.
abstract: OBJECTIVE
  In this study the prevalence, lung function and prognosis of IPF combined with emphysema were evaluated.
  
  
  METHODS
  Consecutive patients with usual interstitial pneumonia (UIP) on high-resolution computed tomography (HRCT), with or without emphysema, were assessed retrospectively. The area of fibrosis in the base of the lungs was assessed by HRCT as minimal (<2 cm from the subpleura), moderate (>or=2 cm from the subpleura, <1/3 of the area of the base of the lungs) or severe (>or=1/3 of the area of the base of the lungs).
  
  
  RESULTS
  Among 660 patients with UIP on HRCT, 221 showed upper-lobe emphysema. Pulmonary function results for patients with UIP and UIP/emphysema, respectively, were: FVC, 71.8% and 87.1%; FEV1%, 86.7% and 87.9%; and DL(CO), 74.3% and 65.2% of predicted. The relationship between FVC, the extent of fibrosis and survival was investigated in 362 patients with records of pulmonary function tests and no lung cancer at the time of entry into the study. Although the extent of fibrosis was similar between the groups, 71.3% of UIP patients met the lung volume criteria for IPF (FVC <80% of predicted), whereas only 26.5% of UIP/emphysema patients met the lung volume criteria for IPF. Median survival was 7.5 years in the UIP group and 8.5 years in the UIP/emphysema group.
  
  
  CONCLUSIONS
  Emphysema was a common finding in patients with UIP. Patients with UIP and emphysema had greater lung volumes and better survival compared with those with UIP alone.
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Japan. kurashima.kazuyoshi@pref.saitama.lg.jp
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kurashima
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Noriko
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kanauchi
authors.forename: Miyuki
authors.initials: M
authors.lastname: Ueda
authors.forename: Toshiko
authors.initials: T
authors.lastname: Hoshi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyahara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed