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Liu Y, Jiang Y, Sun Y. Interstitial lung abnormality in COPD is associated with higher prevalence of antinuclear antibody. Expert Rev Respir Med 2023; 17:735-742. [PMID: 37698170 DOI: 10.1080/17476348.2023.2257135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
OBJECT To investigate whether the prevalence of positive ANA was increased in COPD with interstitial lung abnormality (ILA). METHODS Patients with COPD from 1 September, 2019 to 31 August, 2022 were consecutively enrolled in this cross-sectional study. The characteristics, PFTs, visual assessment of ILA and emphysema on chest CT, and tests for ANA and CRP were recorded for analysis. RESULTS In the study period, 100 patients with COPD were enrolled, with 90 (90.0%) males, aging 69.4 ± 8.3 years. ILA was present in 42% (n = 42) of the patients, with subpleural non-fibrotic ILA being the most common pattern. In patients with ILA, the prevalence of positive ANA was higher (45.2%) as compared to those without ILA (13.3%); between whom the difference in DLCO was also significant. In patients with positive ANA, the scores of ILA were higher, while FEV1, DLCO, DLCO % predicted, FVC, total lung capacity (TLC), and TLC % predicted were significantly lower, as compared to those with negative ANA. CONCLUSION The presence of ILA in patients with COPD was associated with a higher prevalence of positive ANA. Patients with positive ANA tended to have lower FEV1, DLCO and lung volume.
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Affiliation(s)
- Yujia Liu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital; Research Center of Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
- Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Yanwen Jiang
- Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital; Research Center of Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
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Liu Y, Tang J, Sun Y. Impact of Interstitial Lung Abnormalities on Disease Expression and Outcomes in COPD or Emphysema: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:189-206. [PMID: 36890863 PMCID: PMC9987235 DOI: 10.2147/copd.s392349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
Background Both COPD and interstitial lung abnormalities (ILAs) are conditions associated with smoking and age. The impact of coexistent ILAs on the manifestations and outcomes of COPD or emphysema awaits evaluation. Methods We searched PubMed and Embase using Medical Subject Headings terms in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Eleven studies were included in the review. The sample size of the studies ranged from 30 to 9579. ILAs were reported in 6.5% to 25.7% of the patients with COPD/emphysema, higher than that reported in the general populations. COPD/emphysema patients with ILAs were older, mostly male, and had a higher smoking index than those without ILAs. Hospital admission and mortality were increased in COPD patients with ILAs compared to those without ILAs, whereas the frequency of COPD exacerbations was discrepant in 2 of the studies. The FEV1 and FEV1% predicted tended to be higher in the group with ILAs, but not significantly in most of the studies. Conclusion ILAs were more frequent in subjects with COPD/emphysema than in the general population. ILAs may have a negative impact on hospital admission and mortality of COPD/emphysema. The impact of ILAs on lung functions and exacerbations of COPD/emphysema was discrepant in these studies. Further prospective studies are warranted to provide high-quality evidence of the association and interaction between COPD/emphysema and ILAs.
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Affiliation(s)
- Yujia Liu
- Department of Respiratory and Critical Medicine, Peking University Third Hospital, Beijing, People's Republic of China.,Department of Respiratory and Critical Medicine, Peking University International Hospital, Beijing, People's Republic of China
| | - Jingyun Tang
- Blood Research Laboratory, Chengdu Blood Center, Chengdu, Sichuan, People's Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Medicine, Peking University Third Hospital, Beijing, People's Republic of China
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Choi JY, Song JW, Rhee CK. Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease. Tuberc Respir Dis (Seoul) 2022; 85:122-136. [PMID: 35385639 PMCID: PMC8987660 DOI: 10.4046/trd.2021.0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Li E, Knight JM, Wu Y, Luong A, Rodriguez A, Kheradmand F, Corry DB. Airway mycosis in allergic airway disease. Adv Immunol 2019; 142:85-140. [PMID: 31296304 DOI: 10.1016/bs.ai.2019.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The allergic airway diseases, including chronic rhinosinusitis (CRS), asthma, allergic bronchopulmonary mycosis (ABPM) and many others, comprise a heterogeneous collection of inflammatory disorders affecting the upper and lower airways and lung parenchyma that represent the most common chronic diseases of humanity. In addition to their shared tissue tropism, the allergic airway diseases are characterized by a distinct pattern of inflammation involving the accumulation of eosinophils, type 2 macrophages, innate lymphoid cells type 2 (ILC2), IgE-secreting B cells, and T helper type 2 (Th2) cells in airway tissues, and the prominent production of type 2 cytokines including interleukin (IL-) 33, IL-4, IL-5, IL-13, and many others. These factors and related inflammatory molecules induce characteristic remodeling and other changes of the airways that include goblet cell metaplasia, enhanced mucus secretion, smooth muscle hypertrophy, tissue swelling and polyp formation that account for the major clinical manifestations of nasal obstruction, headache, hyposmia, cough, shortness of breath, chest pain, wheezing, and, in the most severe cases of lower airway disease, death due to respiratory failure or disseminated, systemic disease. The syndromic nature of the allergic airway diseases that now include many physiological variants or endotypes suggests that distinct endogenous or environmental factors underlie their expression. However, findings from different perspectives now collectively link these disorders to a single infectious source, the fungi, and a molecular pathogenesis that involves the local production of airway proteinases by these organisms. In this review, we discuss the evidence linking fungi and their proteinases to the surprisingly wide variety of chronic airway and systemic disorders and the immune pathogenesis of these conditions as they relate to environmental fungi. We further discuss the important implications these new findings have for the diagnosis and future therapy of these common conditions.
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Affiliation(s)
- Evan Li
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - J Morgan Knight
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States; Biology of Inflammation Center, Baylor College of Medicine, Houston, TX, United States
| | - Yifan Wu
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Amber Luong
- Department of Otolaryngology, University of Texas Health Science at Houston, Houston, TX, United States
| | - Antony Rodriguez
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States; Biology of Inflammation Center, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, TX, United States
| | - Farrah Kheradmand
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States; Biology of Inflammation Center, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, TX, United States
| | - David B Corry
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States; Biology of Inflammation Center, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, TX, United States.
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