{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:58:07Z","timestamp":1783702687627,"version":"3.55.0"},"reference-count":64,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: Emphysema is frequently observed in patients with fibrosing interstitial lung diseases (f-ILDs), leading to the clinical entity known as combined pulmonary fibrosis and emphysema (CPFE). This study aimed to evaluate the utility of airwave oscillometry (AOS) in detecting small-airway dysfunction (SAD) in patients with CPFE. Due to the coexistence of both restrictive and obstructive airway disease, spirometry is comparatively less sensitive in detecting airflow limitations in this population. Methods: A cohort of 52 patients with CPFE was recruited from Monaldi Hospital, Naples, between January and September 2023. Pulmonary function tests\u2014including spirometry, body plethysmography, and single-breath diffusing capacity for carbon monoxide (DLCO)\u2014were performed at baseline and following bronchodilator administration. Patients with normal FEV1\/FVC ratios underwent airwave oscillometry (AOS) to assess respiratory system resistance (Rrs) and reactance (Xrs), with SAD defined as an R5\u2013R19 value greater than 0.07 kPa\u00b7s\u00b7L\u22121. Results: AOS-defined SAD was present in 40.4% (21\/52) of the cohort. The R5\u2013R19 value in the SAD group was 0.13 \u00b1 0.05 kPa\u00b7s\u00b7L\u22121, which can be compared to 0.04 \u00b1 0.02 kPa\u00b7s\u00b7L\u22121 in patients without SAD. Patients with SAD were more likely to be undergoing maintenance bronchodilator therapy (16\/21; 76.2%) than those without SAD (8\/31; 25.8%) (p = 0.015). Fourteen CPFE patients met the criteria for bronchial responsiveness. CPFE patients who responded to bronchodilators had lower R5-R19 values than non-responders (0.04 \u00b1 0.02 vs. 0.09 \u00b1 0.06 kPa\u00b7s\u00b7L\u22121; p = 0.04). Discussion: Although AOS parameters did not significantly change following bronchodilator administration, this study underscores the value of AOS in detecting peripheral airway dysfunction, which may be under-recognized by conventional spirometry. Conclusions: AOS shows promise as a diagnostic adjunct for identifying SAD in CPFE patients and may complement standard pulmonary function testing in clinical practice. Further multicenter studies with larger cohorts are warranted to validate these findings and investigate the longitudinal impact of SAD on disease progression and treatment outcomes in CPFE.<\/jats:p>","DOI":"10.3390\/diagnostics16081159","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T14:24:58Z","timestamp":1776176698000},"page":"1159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Role of Airwave Oscillometry in Patients with Combined Fibrosis\u2013Emphysema Syndrome (CPFE) with Preserved FEV1\/FVC Ratio"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2902-3558","authenticated-orcid":false,"given":"Raffaella","family":"Pagliaro","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-7315","authenticated-orcid":false,"given":"Filippo","family":"Scial\u00f2","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Medical Biotechnologies, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"},{"name":"CEINGE-Biotecnologie Avanzate Franco Salvatore, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2932-3164","authenticated-orcid":false,"given":"Domenica Francesca","family":"Mariniello","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"D\u2019Agnano","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ilaria","family":"Palma","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3667-9902","authenticated-orcid":false,"given":"Susan F.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-7851","authenticated-orcid":false,"given":"Josuel","family":"Ora","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Saverio","family":"Cerqua","sequence":"additional","affiliation":[{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0929-4394","authenticated-orcid":false,"given":"Giulia Maria","family":"Stella","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy"},{"name":"Respiratory Diseases Unit, Cardiothoracic and Vascular Department, IRCCS San Matteo Polyclinic Hospital, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4692-5901","authenticated-orcid":false,"given":"Andrea","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Perrotta","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018L. Vanvitelli\u2019, 80131 Naples, Italy"},{"name":"U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1164\/rccm.202206-1041ST","article-title":"Syndrome of Combined Pulmonary Fibrosis and Emphysema An Official ATS\/ERS\/JRS\/ALAT Research Statement","volume":"206","author":"Cottin","year":"2022","journal-title":"Am. J. Respir. Crit. 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