CPFE Index Can't Replace CT for Emphysema: Yet H. Khor, MD, PhD

Emphysema extent of 20% or greater on CT imaging was associated with worse transplant-free survival in patients with combined pulmonary fibrosis and emphysema (CPFE), for both idiopathic pulmonary fibrosis (IPF) and non-IPF interstitial lung disease (ILD).¹

The findings, recently published in CHEST, aimed to address the gap in non-IPF fibrotic ILD representation in CPFE research. Although the CPFE index is a relatively new biomarker, it only showed moderate correlation with CT for extent of emphysema and had weak agreement, likely due to the variability between patients, Yet H. Khor, MD, PhD, lead study author and associate professor at Monash University, said in an interview with The American Journal of Managed Care^®.

“The CPFE index should not be viewed as a replacement of a CT assessment, which is the definitive method for diagnosing the presence of emphysema,” she explained. “But I think having said that, the CPFE index does show good specificity, meaning that it has a potential role as a screening tool or adjunctive role.”

Lower thresholds of emphysema extent were also independently linked to transplant-free survival in non-IPF fibrotic ILD but only showed a trend toward significance in patients with IPF.¹ The CPFE index itself is derived from spirometry measurements, which the study found less informative than CT imaging for diagnosing emphysema. Despite CT scans being widely accessible in most regions, they can still be a scarce resource for patients needing longer-term follow-up or repeat assessments, Khor said.

“In this situation where resources are more restricted or it’s desirable not to perform CT in a large population of patients, then this CPFE index can be used to identify a group of patients that are unlikely to have substantial emphysema that can skip the test or identify the group that is more likely to yield a significant finding of emphysema on the selected cases,” she explained.

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References

1. McCrear S. CPFE: why spirometry alone misses emphysema in fibrotic ILD. AJMC. August 31, 2026. Accessed September 10, 2026. https://www.ajmc.com/view/cpfe-why-spirometry-alone-misses-emphysema-in-fibrotic-ild