Combined Pulmonary Fibrosis and Emphysema, a clinical review

Combined Pulmonary Fibrosis and Emphysema (CPFE) refers to the coexistence of upper lobe predominant emphysema with diffuse pulmonary fibrosis, mainly in the lower lobes. Although initially described in patients with Idiopathic Pulmonary Fibrosis (IPF), since then it has been described in other forms of pulmonary fibrosis, most notably collagen tissue disorder associated interstitial lung diseases. High Resolution Computed Tomography (HRCT) has a pivotal role in diagnosis. Recognizing CPFE is not an academic exercise but has significant clinical implications. Thus, it is important for the treating physician to be familiarized with the radiological characteristics that will establish diagnosis. In this review we will discuss the special physiologic and radiological features of CPFE, the challenges in monitoring the course of the disease, the natural history and also the clinical importance of potential complications.