help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wells, A. U.
Right arrow Articles by Hansell, D. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wells, A. U.
Right arrow Articles by Hansell, D. M.
American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 962-969, (2003)
© 2003 American Thoracic Society

Original Article

Idiopathic Pulmonary Fibrosis

A Composite Physiologic Index Derived from Disease Extent Observed by Computed Tomography

Athol U. Wells, Sujal R. Desai, Michael B. Rubens, Nicole S. L. Goh, Derek Cramer, Andrew G. Nicholson, Thomas V. Colby, Roland M. du Bois and David M. Hansell

Department of Radiology and Department of Physiology Royal Brompton Hospital, Interstitial Lung Disease Unit; Department of Radiology, King's College Hospital, London, United Kingdom; and Department of Pathology, Mayo Clinic, Scottsdale, Arizona

Correspondence and requests for reprints should be addressed to Dr. Athol U. Wells, Interstitial Lung Disease Unit, Emmanuel Kaye Building, Manresa Road, Chelsea, London SW6 LR6, UK. E-mail: a.wells{at}rbh.nthames.nhs.uk

In idiopathic pulmonary fibrosis, the quantitation of disease severity using pulmonary function tests is often confounded by emphysema. We have identified the composite physiologic index (CPI) most closely reflecting the morphologic extent of pulmonary fibrosis. Consecutive patients with a clinical/computed tomography (CT) diagnosis of idiopathic pulmonary fibrosis (n = 212) were divided into group I (n = 106) and group II (n = 106). The CPI was derived in group I (by fitting pulmonary function tests against disease extent on CT) and was tested in Group II. The formula for the CPI was as follows: extent of disease on CT = 91.0 - (0.65 x percent predicted diffusing capacity for carbon monoxide [DLCO]) - (0.53 x percent predicted FVC) + (0.34 x percent predicted FEV1). In group II, the CPI correlated more strongly with disease extent on CT (r2 = 0.51) than the individual pulmonary function test (DLCO the highest value, r2 = 0.38). A subanalysis demonstrated that the better fit of the CPI was ascribable to a correction of the confounding effects of emphysema. Mortality was predicted more accurately by the CPI than by a pulmonary function test in all clinical subgroups, including a separate cohort of 36 patients with histologically proven usual interstitial pneumonia (CPI, p < 0.0005; FVC, p = 0.002; PO2, p = 0.002). In conclusion, a new CPI, derived against CT and validated using split sample testing, is a more accurate prognostic determinant in usual interstitial pneumonia than an individual pulmonary function test.

Key Words: pulmonary function tests • composite physiologic index • idiopathic pulmonary fibrosis • prognosis




This article has been cited by other articles:


Home page
 Am. J. Respir. Crit. Care Med.Home page
K. M. Antoniou, D. M. Hansell, M. B. Rubens, K. Marten, S. R. Desai, N. M. Siafakas, A. G. Nicholson, R. M. du Bois, and A. U. Wells
Idiopathic Pulmonary Fibrosis: Outcome in Relation to Smoking Status
Am. J. Respir. Crit. Care Med., January 15, 2008; 177(2): 190 - 194.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. E. King Jr., J. Behr, K. K. Brown, R. M. du Bois, L. Lancaster, J. A. de Andrade, G. Stahler, I. Leconte, S. Roux, and G. Raghu
BUILD-1: A Randomized Placebo-controlled Trial of Bosentan in Idiopathic Pulmonary Fibrosis
Am. J. Respir. Crit. Care Med., January 1, 2008; 177(1): 75 - 81.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
B. W. Kinder, K. K. Brown, M. I. Schwarz, J. H. Ix, A. Kervitsky, and T. E. King Jr
Baseline BAL Neutrophilia Predicts Early Mortality in Idiopathic Pulmonary Fibrosis
Chest, January 1, 2008; 133(1): 226 - 232.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. Alakhras, P. A. Decker, H. F. Nadrous, M. Collazo-Clavell, and J. H. Ryu
Body Mass Index and Mortality in Patients With Idiopathic Pulmonary Fibrosis
Chest, May 1, 2007; 131(5): 1448 - 1453.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
C. Mueller-Mang, C. Grosse, K. Schmid, L. Stiebellehner, and A. A. Bankier
What Every Radiologist Should Know about Idiopathic Interstitial Pneumonias
RadioGraphics, May 1, 2007; 27(3): 595 - 615.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. D. Nathan, O. A. Shlobin, S. Ahmad, S. Urbanek, and S. D. Barnett
Pulmonary Hypertension and Pulmonary Function Testing in Idiopathic Pulmonary Fibrosis
Chest, March 1, 2007; 131(3): 657 - 663.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
K. Hamada, S. Nagai, S. Tanaka, T. Handa, M. Shigematsu, T. Nagao, M. Mishima, M. Kitaichi, and T. Izumi
Significance of Pulmonary Arterial Pressure and Diffusion Capacity of the Lung as Prognosticator in Patients With Idiopathic Pulmonary Fibrosis
Chest, March 1, 2007; 131(3): 650 - 656.
[Abstract] [Full Text] [PDF]

Home page
 Ann Rheum DisHome page
M H Buch, C P Denton, D E Furst, L Guillevin, L J Rubin, A U Wells, M Matucci-Cerinic, G Riemekasten, P Emery, H Chadha-Boreham, et al.
Submaximal exercise testing in the assessment of interstitial lung disease secondary to systemic sclerosis: reproducibility and correlations of the 6-min walk test
Ann Rheum Dis, February 1, 2007; 66(2): 169 - 173.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
S. J. Copley, Y. C. G. Lee, D. M. Hansell, P. Sivakumaran, M. B. Rubens, A. J. Newman Taylor, R. M. Rudd, A. W. Musk, and A. U. Wells
Asbestos-induced and Smoking-related Disease: Apportioning Pulmonary Function Deficit by Using Thin-Section CT
Radiology, December 1, 2006; 242(1): 258 - 266.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
J. Gauldie, M. Kolb, K. Ask, G. Martin, P. Bonniaud, and D. Warburton
Smad3 Signaling Involved in Pulmonary Fibrosis and Emphysema
Proceedings of the ATS, November 1, 2006; 3(8): 696 - 702.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
Y. S. Wasfi, C. S. Rose, J. R. Murphy, L. J. Silveira, J. C. Grutters, Y. Inoue, M. A. Judson, and L. A. Maier
A New Tool To Assess Sarcoidosis Severity
Chest, May 1, 2006; 129(5): 1234 - 1245.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
F. J. Martinez
Idiopathic Interstitial Pneumonias: Usual Interstitial Pneumonia versus Nonspecific Interstitial Pneumonia.
Proceedings of the ATS, January 1, 2006; 3(1): 81 - 95.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. S. Kim, H. R. Collard, and T. E. King Jr.
Classification and natural history of the idiopathic interstitial pneumonias.
Proceedings of the ATS, January 1, 2006; 3(4): 285 - 292.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
F. J. Martinez and K. Flaherty
Pulmonary function testing in idiopathic interstitial pneumonias.
Proceedings of the ATS, January 1, 2006; 3(4): 315 - 321.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, F. Burgos, R. Casaburi, A. Coates, C. P. M. van der Grinten, P. Gustafsson, J. Hankinson, et al.
Interpretative strategies for lung function tests
Eur. Respir. J., November 1, 2005; 26(5): 948 - 968.
[Full Text] [PDF]

Home page
 ChestHome page
S. D. Nathan
Therapeutic Intervention: Assessing the Role of the International Consensus Guidelines
Chest, November 1, 2005; 128(5_suppl_1): 533S - 539S.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. E. King Jr.
Clinical Advances in the Diagnosis and Therapy of the Interstitial Lung Diseases
Am. J. Respir. Crit. Care Med., August 1, 2005; 172(3): 268 - 279.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. Eaton, P. Young, D. Milne, and A. U. Wells
Six-Minute Walk, Maximal Exercise Tests: Reproducibility in Fibrotic Interstitial Pneumonia
Am. J. Respir. Crit. Care Med., May 15, 2005; 171(10): 1150 - 1157.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Y. Jegal, D. S. Kim, T. S. Shim, C.-M. Lim, S. Do Lee, Y. Koh, W. S. Kim, W. D. Kim, J. S. Lee, W. D. Travis, et al.
Physiology Is a Stronger Predictor of Survival than Pathology in Fibrotic Interstitial Pneumonia
Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 639 - 644.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. D. Nathan
Lung Transplantation: Disease-Specific Considerations for Referral
Chest, March 1, 2005; 127(3): 1006 - 1016.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. J. Swigris, W. G. Kuschner, J. L. Kelsey, and M. K. Gould
Idiopathic Pulmonary Fibrosis: Challenges and Opportunities for the Clinician and Investigator
Chest, January 1, 2005; 127(1): 275 - 283.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
N. Khalil and R. O'Connor
Idiopathic pulmonary fibrosis: current understanding of the pathogenesis and the status of treatment
Can. Med. Assoc. J., July 20, 2004; 171(2): 153 - 160.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Tuberculosis, Lung Infections, Interstitial Lung Disease, Social Issues and Journalology in AJRCCM 2003
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 288 - 300.
[Full Text] [PDF]

Home page
 Am. J. Respir. Cell Mol. Bio.Home page
N. Kaminski, J. A. Belperio, P. B. Bitterman, L. Chen, S. W. Chensue, A. M.K. Choi, S. Dacic, J. H. Dauber, R. M. du Bois, J. J. Enghild, et al.
Idiopathic Pulmonary Fibrosis
Am. J. Respir. Cell Mol. Biol., September 1, 2003; 29(3): S1 - 105.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. I. Latsi, R. M. du Bois, A. G. Nicholson, T. V. Colby, D. Bisirtzoglou, A. Nikolakopoulou, S. Veeraraghavan, D. M. Hansell, and A. U. Wells
Fibrotic Idiopathic Interstitial Pneumonia: The Prognostic Value of Longitudinal Functional Trends
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 531 - 537.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Kumar, P. Goldstraw, K. Yamada, A. G. Nicholson, A. U. Wells, D. M. Hansell, R. M. duBois, and G. Ladas
Pulmonary fibrosis and lung cancer: Risk and benefit analysis of pulmonary resection
J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1321 - 1327.
[Abstract] [Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2003 American Thoracic Society