Clinical Therapeutic Effect Of Inhaled ICS/LABA Study On Combined Pulmonary Fibrosis And Emphysema Syndrome

Objective:The purpose of this study is to further investigate the effects of Inhaled corticosteroids combined with long-acting β2-agonists in the treatment of combined pulmonary fibrosis and emphysema syndrome(CPFE),and to compare the efficacy of different CPFE phenotypes(smoking related CPFE,connective tissue disease related CPFE)and imaging characteristics.Methods:172 patients diagnosed with CPFE in Affiliated Hospital of Qingdao University from January 1,2015 to June 30,2020 were randomly divided into the experimental group and the control group,69 CPFE patients in the experimental group received ICS/LABA treatment,and 103 CPFE patients in the control group did not receive ICS/LABA treatment.Outpatient follow-up every 3 months,regular medication for 6 months,By the end of treatment the two groups of patients with lung function includes the first second forced expiratory volume percentage of expected value(FEV1 %)percent of expected value,forced vital capacity(FVC%)percent of expected value,carbon monoxide diffusion capacity(DLCO%),high resolution computed tomography(HRCT)and half quantitative analysis of the value and comparing echocardiographic pulmonary artery pressure.Statistical analysis SPSS 26.0software was used for statistical analysis,shapiro-Wilk(SW)method was used for normality test for quantitative data,median(upper quartile,lower quartile)was used for non-normal quantitative data,Wilcoxon rank sum test was used for comparison between each group at 6months and baseline.Kruskal-wallis H test was used for comparison of non-normal quantitative data between two groups and multiple groups,and the test level α=0.05 was defined.Result:Compared with baseline level,FEV1%,FVC % and DLCO % levels were increased by 5.13%,5.6% and 7.43%,respectively,and HRCT score and pulmonary artery pressure were decreased in the experimental group after 6 months of ICS/LABA regular intervention.The HRCT score,FEV1%,FVC% and DLCO% and the difference of pulmonary artery pressure before and after treatment between the experimental group and the control group were statistically significant(Z=-11.10--9.80,P<0.05).The subgroup of CPFE patients was analyzed,in the experimental group,smoking related CPFE patients had significantly improved lung function FVC %,FEV1 % and DLCO% compared with CTD related CPFE patients,but the improvement of HRCT score and pulmonary artery pressure was only statistically significant in smoking related CPFE patients(P<0.05).There was no significant difference in HRCT score and pulmonary artery pressure in CTD related CPFE group(P > 0.05).In the control group,as is CPFE population without ICS/LABA treatment,the pulmonary function FVC%,FEV1% and DLCO%of patients with smoking-related CPFE showed a decreasing trend,HRCT score and pulmonary artery pressure showed an increasing trend,and the differences were statistically significant(P<0.05).There were no significant changes in FVC%,FEV1% and DLCO% of lung function,HRCT score and pulmonary artery pressure in CTD related CPFE group(P >0.05).There were statistically significant differences in HRCT scores,FEV1 %,FVC %,DLCO%and pulmonary artery pressure before and after treatment between the experimental group and the control group(Z=-8.20--7.03,P<0.05).The HRCT score,FEV1%,FVC%,DLCO% and the difference of pulmonary artery pressure before and after treatment in the experimental group and the CPFE subgroup in the control group were statistically significant(Z=-7.43--6.56,P<0.05).There was no significant difference in FEV1%,FVC%,DLCO%,HRCT score and pulmonary artery pressure level between patients with central lobular type,total lobular type and paraseptal type before and after treatment(P > 0.05).DLCO % after treatment was significantly lower than before treatment(P < 0.05);HRCT score and pulmonary artery pressure were significantly higher than before treatment(P < 0.05).The FEV1 % and DLCO % before treatment were significantly lower than after treatment in patients with double lower lung grid shadow.HRCT score and pulmonary artery pressure before treatment were slightly higher than after treatment with statistical significance(P<0.05).Conclusions:ICS/LABA improved lung function(FEV1 %,FVC %and DLCO %)and HRCT in CPFE patients.In subgroup analysis,ICS/LABA improved lung function,HRCT score,and pulmonary artery pressure in patients with smoking related CPFE compared with those with connective tissue disease related CPFE.In the control group,smoking related CPFE without ICS/LABA intervention tended to worsen lung function,HRCT score,and pulmonary artery pressure compared to CPFE patients with connective tissue disease.Analysis of the imaging characteristics of the experimental group showed that in the experimental group,the lung function of the double upper lung mixed emphysema was decreased after treatment,and the HRCT score and pulmonary artery pressure were increased,with a poor overall prognosis.In the lesions dominated by double lower lung grid shadow,the lung function was significantly improved after treatment with HRCT score and pulmonary artery pressure,with a good overall prognosis.