الفهرس 
ACNOWLEDGMENTS
PrevalenceOnly 14 pages are availabe for public view
 |  | from | 165 |  |  |
| | | from | 165 | | |
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a recently defined syndrome, in which centrilobular and/or paraseptal emphysemas in upper lung zones coexist with pulmonary fibrosis in lower lobes in individuals. These patients have a characteristic lung function profile, with unexpected subnormal dynamic and static lung volumes, contrasting with a significant reduction of carbon monoxide transfer (DLCO) and exercise hypoxemia. Pulmonary hypertension is highly prevalent in CPFE and is the leading determinant of death. Tobacco smoking has been proposed as the main factor in its etiology. High-resolution computed axial tomography is the mandatory tool to confirm the diagnosis.
A total of 120 patients admitted to Chest department, Assiut University Hospital at the period from April 2015 to April 2016 were enrolled in this analytic cross- sectional study. They were divided to 3 groups according to their diagnosis (COPD, ILD, and CPFE). COPD group included 32 males and 8 females, ILD group included 16 males and 24 females, and CPFE group included 23 males and 17 females.
The primary goal aim of this study is to assess the clinical, functional and radiological characteristics of patients diagnosed with combined pulmonary fibrosis and emphysema syndrome. The secondary is to assess the prevalence of pulmonary arterial hypertension (PAH) among these patients.
All patients were subjected to the following:
1. Detailed medical history
2. Physical examination
3. Plain chest X-ray
4. Arterial blood gases (ABGs)
5. High resolution computed axial tomography (HRCT)
6. Echocardiography
7. Pulmonary function tests (were done whenever possible)
The following results were observed:
• The mean age was significantly higher in COPD patients (62.05 ± 8.1 years) in comparison to either CPFE (55.48+13.77 years) or ILD patients (48.33+10.04 years). Moreover, the mean age of CPFE group was significantly higher than ILD group (P < 0.01 for each).
• The percentage of males (80%) was statistically significantly higher in COPD group compared to either CPFE group (57.5%) or ILD group (40%) (P < 0.05, P<0.001 respectively).
• Regarding smoking history there was no statistical significant difference when comparing COPD or ILD group with CPFE group (P>0.05 for each).
• There was no statistical significant deference in the grade of dyspnea based on Modified Medical Research Council Dyspnea Scale among the study groups (P >0.05).
• All patients with COPD presented (100%) with productive cough. However, in patients with ILD 31 (77.5%) had dry cough, and 9 (22.5%) had productive cough; in patients with CPFE 26 patients (65%) had dry cough and 14 (35%) had productive cough. There was a statistical significant difference when comparing COPD group to either ILD group or CPFE group (P<0.001). However, there was no statistical significant difference between ILD group and CPFE group (P >0.05).
• In COPD group, 36 patients (90%) had chest wheeze which was significantly higher than either CPFE group (52.5%) or ILD group (2.5%). Also, the percentage of chest wheeze was significantly higher in CPFE group compared to ILD group (P <0.001 for each).
• The rate of exacerbation per year was 4.2+1.02 in CPFE group which was significantly higher compared to either COPD group (3.33+1.56) or ILD group (3.15+1.05)
• There was no statistical significant difference as regard the presence of central cyanosis among the study groups (P>0.05 for each).
• Finger clubbing was significantly higher in either CPFE group 18 patients (45%) or ILD group 12 patients (30%) compared to COPD group 1 patient (2.5%)( P <0.001, P <0.01 respectively).
• Signs of hyperinflation was present in 40 patients (100%) with COPD, in 38 patients (95%) with CPFE and in none of ILD group. The presence of signs of hyperinflation was significantly higher in either COPD group of CPFE group compared to ILD group) (P<0.001 for each).
• Dry crepitations (Velcro crackles) was found in 40 patients (100%) of the ILD group, in 31 (77.5^ %) of the CPFE group and in none of COPD group. The presence of Velcro crackles was significantly higher in either ILD group or CPFE group compared to COPD (P<0.001 for each). Also, the presence of Velcro crackles was significantly higher in ILD group in comparison to CPFE group (P<0.01).
• The presence of rhonchi was significantly higher in either COPD group or CPFE group in comparison with ILD group (0%) (P <0.001 for each).
• As regard the plain chest X- ray in COPD, hyperinflation in 40 patients (100%) , low flat diaphragm in 28 (70%) , hyperlucent lung in 9 (22.5%) , and increased retrosternal space in 29 (72.5%). In CPFE group, hyperinflation was found in 38 patients (95%), low flat diaphragm in 11 (27.5%), hyperlucent lung in 1 (2.5%), increased retrosternal space in 5 (12.5%). The difference was statistically significant (P<0.01). While, emphysematous chang<As regard fibrotic changes, in ILD group, reticulonodular opacity was found in 30 patients (75%), reticular opacity in 8 (20%), and nodular opacity in 2 (5%). In CPFE group, reticulonodular opacity in 31 (77.5%), honeycombing in 1 (2.5%), reticular opacity in 4 (10%), nodular opacity in 1 (2.5%), and no fibrotic changes in 3 (7.5%). While, fibrotic changes were not found in COPD group. The presence of fibrotic changes was significantly higher in CPFE group or ILD group in comparison to COPD group (P<0.001 for each). However, there was no statistical significant difference regarding the presence of fibrotic changes in ILD group when compared to CPFE (P>0.05).
• The HRCT findings of the COPD group were as follow: centrilobular emphysema in 6 patients (15%), paraseptal emphysema in 1 (2.5%), panlobular emphysema in 1 (2.5%) , bulla in 3 (7.5%), hyperinflation in 40 (100%) , and architectural or bronchial distortion in 1 (2.5%). In CPFE group, centrilobular emphysema was found in 24 patients (60%), paraseptal emphysema in 6 (15%), panlobular emphysema in 9 (22.5%), bulla in 5 (12.5%), hyperinflation in 38 (95%). The difference was statistically significant (P<0.05). While, emphysematous changes were not found in ILD group.
• As regard fibrotic changes in CPFE group, ground glass opacity was found in 24 (60%), honeycombing opacity in 19 (47.5%), reticular opacity in 28 (70%), traction bronchiactasis in 3 (7.5%), and architectural or bronchial distortion in 4 (10%). In ILD group, ground glass opacity was found in 32 patients (80%), honey combing opacity in 23 (57.5), reticular opacity in 21 (52.5%), and traction bronchiectasis in 1 (2.5%). There was no statistical significant difference between ILD group and CPFE group (P>0.05). However, the fibrotic changes was significantly higher in CPFE group or ILD group when compared to COPD group (P<0.01, P<0.001 respectively).
• The mean PaCO2 was significantly higher in COPD group and CPFE group in comparison with ILD group (P <0.001). Also, the mean PaCO2 was higher in COPD group than CPFE group but not reach the statistical significant (P= 0.061).
• The mean PaO2 was significantly lower in CPFE group compared to COPD group or ILD group (P<0.05, P<0.01 respectively). The mean HCO3- was significantly higher in COPD group when compared to either CPFE group or ILD group (P< 0.05, P<0.001 respectively). Also, the mean HCO3- was higher in CPFE group than ILD group but not reach the statistical significant (P= 0.064).The mean SaO2 was significantly lower in CPFE group when compared to either COPD group or ILD group (P<0.05) for each.As regard PASP, the mean PASP was significantly higher in CPFE group in comparison to either COPD group or ILD group
• The mean FVC% was significantly lower in ILD group in comparison to either COPD or CPFE groups (P <0.001, P <0.05 respectively), and significantly lower in CPFE group than COPD group (P < 0.001). The mean FEV1/FVC% was significantly lower in COPD group compared to either CPFE group or ILD group, and significantly lower in CPFE group compared to ILD group (P< 0.001 for each).The mean DLCO% was significantly lower in CPFE group when compared to either COPD group or ILD group, and significantly lower in ILD group in comparison with COPD group (P< 0.001 for each). The mean TLC %, mean RV%, mean RV/TLC %, and mean FRC were significantly higher in COPD group when compared to either CPFE group or ILD group, and were significantly higher in CPFE group in comparison with ILD group (P 0.01 for each).