Do you prescribe antifibrotics to patients with combined pulmonary fibrosis and emphysema (CPFE)?

The definition of CPFE is not very well standardized. CPFE commonly presents with upper lung-predominant emphysema and basilar/peripheral-predominant fibrosis. Pulmonary fibrosis in CPFE could be due to IPF or other ILDs. I prescribe antifibrotics for patients with CPFE-IPF and CPFE-other ILDs with progressive pulmonary fibrosis (based on the INBUILD trial). Previous clinical trials with IPF excluded patients with an FEV1/FVC ratio of <0.7, but there were still many patients with emphysema since patients with CPFE commonly have an FEV1/FVC ratio that is normal (due to the combination of restrictive and obstructive impairment). In a posthoc analysis of the INPULSIS trials, ~40% of IPF patients had concurrent emphysema. In this study, the tre...