{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:45:57Z","timestamp":1791297957489,"version":"4.1.0"},"reference-count":38,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T00:00:00Z","timestamp":1415664000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Emphysema and fibrosis, typically the idiopathic pulmonary fibrosis (IPF) form of usual interstitial pneumonia (UIP), can co-exist as combined pulmonary fibrosis emphysema (CPFE). It is unknown whether there is a pathobiologic basis for CPFE beyond the coexistence of fibrosis and emphysema. The aim of this study was to ascertain radiologic differences in severity of fibrosis and emphysema in smokers with IPF versus other forms of UIP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Computed tomography thorax images were prospectively rescored in retrospectively identified smokers (minimum 5-pack-year history) with radiologic UIP (any etiology). Radiologic severity (emphysema\/fibrosis\/reticulation) was scored in consensus by two radiologists, blinded to clinical details, across 5 lung regional levels, and then correlated with clinical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      For the whole cohort (IPF,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 102; non-IPF UIP [mainly rheumatoid arthritis\/asbestosis\/scleroderma],\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 30), IPF and non-IPF UIP smokers were similar regarding pack-year, age, gender, and lung function (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .1). IPF smokers had greater whole lung fibrosis and reticulation scores (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .04 in all cases). CPFE was present in\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 61 (IPF,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 49; non-IPF UIP,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 12). Compared with smokers with non-IPF CPFE, smokers with IPF and emphysema (IPFE) were similar regarding confounders (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .1). There were significantly greater regional reticulation severity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .009), cumulative emphysema severity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04), and cumulative reticulation severity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) scores in IPFE versus non-IPF CPFE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>When controlled for confounders, smokers with IPFE have worse radiologic CPFE than other smokers with non-IPF UIP and emphysema, suggesting an interactive synergy among IPF, emphysema, and smoking, with more extensive emphysema due to either inherent susceptibility and\/or traction effects. IPFE should be considered separately from other CPFE in future work. It is currently unknown whether CPFE is a distinct pathobiologic entity; therefore, we identified subjects with radiologic UIP (any etiology) who had been similarly exposed to smoke, and asked whether there are differences in the extent\/severity of radiologic fibrosis and\/or emphysema in those with IPF versus individuals with non-IPF UIP. Although relevant confounders were similar, IPF smokers had greater whole lung fibrosis and reticulation scores than smokers with secondary forms of UIP, and in the CPFE subgroup, smokers with IPF\/emphysema had worse radiologic CPFE findings than smokers with non-IPF UIP\/emphysema. It is shown for the first time that relevant confounding variables do not explain the observed excess radiologic severity of emphysema and fibrosis in smokers with IPF compared with smokers with non-IPF UIP, lending support to the hypothesis that there is a pathobiologic mechanism or synergy involved in IPF with emphysema that is distinct from the mere co-existence of UIP and emphysematous processes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.03389","type":"journal-article","created":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T23:58:57Z","timestamp":1415750337000},"page":"259-268","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["Idiopathic Pulmonary Fibrosis With Emphysema: Evidence of Synergy Among Emphysema and Idiopathic Pulmonary Fibrosis in Smokers"],"prefix":"10.1177","volume":"60","author":[{"given":"Patrick D","family":"Mitchell","sequence":"first","affiliation":[{"name":"St Vincent's University Hospital, Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeeban P","family":"Das","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Murphy","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Keane","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"},{"name":"University College Dublin, Dublin, Republic of Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seamas C","family":"Donnelly","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"},{"name":"University College Dublin, Dublin, Republic of Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D","family":"Dodd","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus W","family":"Butler","sequence":"additional","affiliation":[{"name":"St Vincent's University Hospital, Dublin"},{"name":"University College Dublin, Dublin, Republic of Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,11,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.65.1.29"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.4.941"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.2.143"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0538"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00021005"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-010-9251-6"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1159\/000050526"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00114010"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.181.1.1810163"},{"key":"e_1_3_2_11_2","first-page":"461439","article-title":"Smoking and pulmonary fibrosis: novel insights","author":"Samara KD","year":"2011","unstructured":"Samara KD, , Margaritopoulos G, , Wells AU, , Siafakas NM, , Antoniou KM. 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