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Smoking‐related emphysema is associated with idiopathic pulmonary fibrosis and rheumatoid lung
Author(s) -
Antoniou Katerina M.,
Walsh Simon L.,
Hansell David M.,
Rubens Michael R.,
Marten Katharina,
Tennant Rachel,
Hansel Trevor,
Desai Sujal R.,
Siafakas Nikolaos M.,
Bois Roland M,
Wells Athol U.
Publication year - 2013
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12154
Subject(s) - medicine , idiopathic pulmonary fibrosis , pulmonary fibrosis , copd , rheumatoid arthritis , odds ratio , gastroenterology , lung
Background and objective A combined pulmonary fibrosis/emphysema syndrome has been proposed, but the basis for this syndrome is currently uncertain. The aim was to evaluate the prevalence of emphysema in idiopathic pulmonary fibrosis ( IPF ) and rheumatoid lung (rheumatoid arthritis‐interstitial lung disease ( RA‐ILD )), and to compare the morphological features of lung fibrosis between smokers and non‐smokers. Methods Using high‐resolution computed tomography, the prevalence of emphysema and the pack‐year smoking histories associated with emphysema were compared between current/ex‐smokers with IPF ( n = 186) or RA‐ILD ( n = 46), and non‐chronic obstructive pulmonary disease ( COPD ) controls ( n = 103) and COPD controls ( n = 34). The coarseness of fibrosis was compared between smokers and non‐smokers. Results Emphysema, present in 66/186 (35%) patients with IPF and 22/46 (48%) smokers with RA‐ILD , was associated with lower pack‐year smoking histories than in control groups ( P < 0.05 for all comparisons). The presence of emphysema in IPF was positively linked to the pack‐year smoking history (odds ratio 1.04, 95% confidence interval ( CI ) 1.02–1.06, P < 0.0005). In IPF , fibrosis was coarser in smokers than in non‐smokers on univariate and multivariate analysis ( P < 0.01 for all comparisons). In RA‐ILD , fibrosis was coarser in patients with emphysema but did not differ significantly between smokers and non‐smokers. Conclusions In IPF and RA‐ILD , a high prevalence of concurrent emphysema, in association with low pack‐year smoking histories, and an association between coarser pulmonary fibrosis and a history of smoking in IPF together provide support for possible pathogenetic linkage to smoking in both diseases.