Clinical significance of assessing unventilated volume and ventilation heterogeneity in patients with combined pulmonary fibrosis and emphysema

Aim. To quantify the parameters of unventilated lung volume and pulmonary ventilation heterogeneity and study their clinical significance in patients with a combination of idiopathic pulmonary fibrosis and pulmonary emphysema (CPFE).

Materials and methods. The case histories of 56 patients with CPFE and 48 patients with idiopathic pulmonary fibrosis (IPF) were analyzed. The study of respiratory function included the measurement of static lung volumes and capacities, speed indicators and diffusion capacity of the lungs. The unventilated volume (ΔTLC) and the fraction of non-ventilated space (PCF) were also analyzed.

Results. The respiratory mechanics parameters in the group of patients with CPFE were significantly higher compared to patients with IPF. The ratio of forced expiration volume in the first second (FEV1) to vital capacity (VC), (median – 0.76) and FEV1 to forced VC (FVC), (median – 0.78) parameters were lower, but in most cases (89.3%) remained normal. The values of ΔTLC and PCF were significantly higher in the group of patients with CPFE (p < 0.001), while statistically significant relationships were found between these parameters and the parameters characterizing bronchial patency (FEV1/VC (p = 0.001), FEV1/FVC (p = 0.003)). With an increase in ΔTLC of more than 500 ml, pulmonary hypertension was significantly more common (OR – 3.102, p = 0.045), and an increase in PCF of more than 15% was statistically more often detected before the onset of death (OR – 7.800, p < 0.001).

Conclusion. Our data indicate the importance of assessing ΔTLC and PCF in the complex diagnostics of the external respiratory system in the CPFE. Their relationships with other indices of airway patency, as well as the incidence of pulmonary hypertension and fatal outcomes, may be an important link in determining the volume of therapy prescribed to these patients.

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