TY - JOUR T1 - Pulmonary function measures predict mortality differently in idiopathic pulmonary fibrosis <em>versus</em> combined pulmonary fibrosis and emphysema JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/09031936.00114010 SP - erj01140-2010 AU - S.L. Schmidt AU - A.M. Nambiar AU - N. Tayob AU - B. Sundaram AU - M.K. Han AU - B.H. Gross AU - E.A. Kazerooni AU - A.R. Chughtai AU - A. Lagstein AU - J.L. Myers AU - S. Murray AU - G.B. Toews AU - F.J. Martinez AU - K.R. Flaherty Y1 - 2010/01/01 UR - http://erj.ersjournals.com/content/early/2010/12/09/09031936.00114010.abstract N2 - The composite physiologic index(CPI) was derived to represent the extent of fibrosis on high resolution computed tomography, adjusting for emphysema in patients with idiopathic pulmonary fibrosis(IPF). We hypothesized longitudinal change in CPI would better predict mortality than forced expiratory volume in 1 second(FEV1), forced vital capacity(FVC), or diffusing capacity for carbon monoxide(DL,CO) in all patients with IPF, and especially in those with combined pulmonary fibrosis and emphysema(CPFE).Cox proportional hazard models were performed on pulmonary function data from IPF patients at baseline (n=321), 6 months (n=211) and 12 months (n=144). Presence of CPFE was determined by high resolution computed tomography.A 5 point increase in CPI over 12 months predicted subsequent mortality (HR 2.1, p=0.004). At 12 months, a 10% relative decline in FVC, a 15% relative decline in DL,CO or an absolute increase in CPI of 5 points all discriminated median survival by 2.1 to 2.2 years versus patients with lesser change. Half our cohort had CPFE. In patients with moderate/severe emphysema, only a 10% decline in FEV1 predicted mortality (HR 3.7, p=0.046).In IPF, a 5 point increase in CPI over 12 months predicts mortality similarly to relative declines of 10% in FVC or 15% in DL,CO. For CPFE patients, change in FEV1 was the best predictor of mortality. ER -