Patientenfragebogen zur Erfassung der Ursachen interstitieller und seltener Lungenerkrankungen – klinische Sektion der DGP

Hintergrund Interstitielle Lungenerkrankungen (ILD) umfassen verschiedenste heterogene, zumeist chronische Erkrankungen des Interstitiums und/oder der Alveolen mit bekannten und unbekannten Ursachen. Die Diagnostik der ILD ist sehr komplex und sollte interdisziplinär erfolgen. Eine der wesentlichen Basisuntersuchungen ist eine umfangreiche Anamnese. Hierzu kam im deutschsprachigen Raum bisher der Frankfurter Bogen von 1985 zur Anwendung, der mittlerweile jedoch sprachlich und inhaltlich einer Überarbeitung bedurfte.

Methode Unter Schirmherrschaft der klinischen Sektion der DGP erfolgte die Erstellung eines neuen Patientenfragebogens zur Diagnostik interstitieller und seltener Lungenerkrankungen. Der Fragebogen entstand unter Mitarbeit von Pneumologen mit ILD-Expertise, Arbeitsmedizinern und Psychologen sowie der Unterstützung von Selbsthilfegruppen. Abschließend wurde der Fragebogen mithilfe von Patienten sprachlich optimiert.

Ergebnisse Der neu erstellte Patientenfragebogen zur Diagnostik interstitieller und seltener Lungenerkrankungen umfasst mehrere Bereiche: Initiale und aktuelle Symptome, Fragen zur Vorgeschichte inklusive Medikation, pulmonale und extrapulmonale Vorerkrankungen, mögliche Expositionen im häuslichen, privatem und beruflichem Umfeld sowie Familienanamnese und Reisetätigkeiten.

Schlussfolgerung Der neu erstellte Fragebogen kann in der klinischen Routine die Diagnostik bei Patienten mit Verdacht auf eine interstitielle Lungenerkrankung wesentlich erleichtern.

Airway-centered interstitial fibrosis - an under-recognized subtype of diffuse parenchymal lung diseases

Airway centered interstitial fibrosis (ACIF) has been recently suggesed as a rare histological pattern of interstitial lung disease of variable etiology and outcome. It is characterized by fibrosis of the respiratory bronchioles and the peribronchiolar interstitium. We describe the clinical features of 13 patients (7 female, mean age 55 years) with histologically proven ACIF in 12 cases and long-term follow up. In ten patients, exogenous agents could be detected (mould n=5, wood n=2, leather exposure n=1, occupational exposure n=2). Two patients had rheumatoid arthritis and 1 patient suffered from recurrent aspiration. In three patients no associated exposure could be detected. Eight patients were never-smokers, while five were ex- smokers. At time of diagnosis patients presented with a moderate restrictive ventilation impairment and sever reduction in diffusion capacity (VC 61%, TLC 66%, DLCOc-SB 38% pred.). All patients were started on immunosuppressive therapy with steroids which were combined with azathioprine in seven and with mycophenolate mofetil in one patient. Median time of follow up was 52 months (2-127 months). Patients with ACIF due to exogenous agents or associated with RA were stable with immunosuppressive therapy. One patient with idiopathic ACIF showed a progressive deterioration within 29 months despite immunosuppression and died while on a waiting-list for lung transplantation. In our experience ACIF is a rare finding, which is relatively frequently observed in the context of hypersensitivity pneumonitis, aspiration and rheumatoid arthritis, while idiopathic ACIF was a minority. In the majority of patients, ACIF showed a favorable long-term outcome with immunosuppressive therapy. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 218-229).

Identification of a plasma miRNA biomarker signature for allergic asthma: A translational approach

BACKGROUND

Asthma is a heterogeneous chronic disease with different phenotypes and treatment responses. Thus, there is a high clinical need for molecular disease biomarkers to aid in differentiating these distinct phenotypes. As MicroRNAs (miRNAs), that regulate gene expression at the post-transcriptional level, are altered in experimental and human asthma, circulating miRNAs are attractive candidates for the identification of novel biomarkers. This study aimed to identify plasmatic miRNA-based biomarkers of asthma, through a translational approach.

METHODS

We prescreened miRNAs in plasma samples from two different murine models of experimental asthma (ovalbumin and house dust mite); miRNAs deregulated in both models were further tested in a human training cohort of 20 asthma patients and 9 healthy controls. Candidate miRNAs were then validated in a second, independent group of 26 asthma patients and 12 healthy controls.

RESULTS

Ten miRNA ratios consisting of 13 miRNAs were differentially regulated in both murine models. Measuring these miRNAs in the training cohort identified a biomarker signature consisting of five miRNA ratios (7 miRNAs). This signature showed a good sensitivity and specificity in the test cohort with an area under the receiver operating characteristic curve (AUC) of 0.92. Correlation of miRNA ratios with clinical characteristics further revealed associations with FVC % predicted, and oral corticosteroid or antileukotriene use.

CONCLUSION

Distinct plasma miRNAs are differentially regulated both in murine and in human allergic asthma and were associated with clinical characteristics of patients. Thus, we suggest that miRNA levels in plasma might have future potential to subphenotype patients with asthma.

[Expert Knowledge and Supporting Advice for the Clinical Use of Nintedanib in Patients with Idiopathic Pulmonary Fibrosis]

In October 2016, a group of German IPF experts were invited by Boehringer Ingelheim to meet in Frankfurt with the aim, (a) to discuss relevant aspects of the management and treatment of idiopathic pulmonary fibrosis (IPF) using nintedanib; and, (b) to provide supportive advice for daily clinical practice with nintedanib. The resulting information compiled in this document is confined to practical issues regarding the use of nintedanib in patients with IPF. Where different therapeutic options were available, the choice of IPF medication was not discussed and the experts alluded to current guidelines for the diagnosis and treatment of IPF.The participants discussed a comprehensive spectrum of clinical questions related to 10 different topics, including patient-related aspects at initiation of IPF therapy, the treatment of anticoagulated IPF patients, and the handling of nintedanib-related adverse events such as gastrointestinal side effects and elevated liver enzymes. In addition, the experts evaluated therapeutic options for IPF patients with continuous disease progression, clinical scenarios that justify discontinuation of nintedanib treatment, and therapeutic options for IPF patients with an acute exacerbation or severe infection. Finally, the participants discussed the handling of nintendanib before/after elective surgical intervention (e. g. lung transplantation) and the current evidence for antifibrotic combination therapy in patients with IPF.For each topic discussed, the resulting information incorporates published evidence from clinical trials. In case of insufficient or lacking evidence, the experts have formulated recommendations based on their personal clinical experience and evaluation.