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Min B, Grant-Orser A, Johannson KA. Peripheral blood monocyte count and outcomes in patients with interstitial lung disease: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:230072. [PMID: 37673424 PMCID: PMC10481330 DOI: 10.1183/16000617.0072-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/13/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Peripheral blood monocyte counts have been associated with poor outcomes in interstitial lung disease (ILD). However, studies are limited by variable biomarker thresholds, analytic approaches and heterogenous populations. This systematic review and meta-analysis characterised the relationship between monocytes and clinical outcomes in ILD. METHODS Electronic database searches were performed. Two reviewers screened abstracts and extracted data. Pooled estimates (hazard ratios (HRs)) of monocyte count thresholds were calculated for their association with mortality using ≥0.6×109 and >0.9×109 cells·L-1 for unadjusted models and ≥0.95×109 cells·L-1 for adjusted models, using random effects, with heterogeneity and bias assessed. Disease progression associated with monocytes >0.9×109cells·L-1 was also calculated. RESULTS Of 3279 abstracts, 13 were included in the systematic review and eight in the meta-analysis. The pooled unadjusted HR for mortality for monocyte counts ≥0.6×109 cells·L-1 was 1.71 (95% CI 1.34-2.19, p<0.001, I2=0%) and for monocyte counts >0.90×109 cells·L-1 it was 2.44 (95% CI 1.53-3.87, p=0.0002, I2=52%). The pooled adjusted HR for mortality for monocyte counts ≥0.95×109 cells·L-1 was 1.93 (95% CI 1.24-3.01, p=0.0038 I2=69%). The pooled HR for disease progression associated with increased monocyte counts was 1.83 (95% CI 1.40-2.39, p<0.0001, I2=28%). CONCLUSIONS Peripheral blood monocyte counts were associated with an increased risk of mortality and disease progression in patients with ILD.
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Affiliation(s)
- Bohyung Min
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
| | - Amanda Grant-Orser
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
| | - Kerri A Johannson
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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Mendoza N, Casas-Recasens S, Olvera N, Hernandez-Gonzalez F, Cruz T, Albacar N, Alsina-Restoy X, Frino-Garcia A, López-Saiz G, Robres L, Rojas M, Agustí A, Sellarés J, Faner R. Blood Immunophenotypes of Idiopathic Pulmonary Fibrosis: Relationship with Disease Severity and Progression. Int J Mol Sci 2023; 24:13832. [PMID: 37762135 PMCID: PMC10531459 DOI: 10.3390/ijms241813832] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
(1) The role of the immune response in the pathogenesis of idiopathic pulmonary fibrosis (IPF) remains controversial. We hypothesized that peripheral blood immune phenotypes will be different in IPF patients and may relate to the disease severity and progression. (2) Whole blood flow cytometry staining was performed at diagnosis in 32 IPF patients, and in 32 age- and smoking-matched healthy controls. Thirty-one IPF patients were followed up for one year and categorized as stable or progressors based on lung function, deterioration and/or death. At 18-60 months, immunophenotypes were characterized again. (3) The main results showed that: (1) compared to matched controls, at diagnosis, patients with IPF showed more neutrophils, CD8+HLA-DR+ and CD8+CD28- T cells, and fewer B lymphocytes and naïve T cells; (2) in IPF, circulating neutrophils, eosinophils and naïve T cells were associated with lung function abnormalities; (3) patients whose disease progressed during the 12 months of follow-up showed evidence of cytotoxic dysregulation, with increased CD8+CD28- T cells, decreased naïve T cells and an inverted CD4/CD8 ratio at baseline; and (4) blood cell alterations were stable over time in survivors. (4) IPF is associated with abnormalities in circulating immune cells, particularly in the cytotoxic cell domain. Patients with progressive IPF, despite antifibrotic therapy, present an over-activated and exhausted immunophenotype at diagnosis, which is maintained over time.
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Affiliation(s)
- Nuria Mendoza
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Biomedicine Department, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Sandra Casas-Recasens
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
| | - Núria Olvera
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Barcelona Supercomputing Center (BSC), 08034 Barcelona, Spain
| | - Fernanda Hernandez-Gonzalez
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Biomedicine Department, Universitat de Barcelona, 08036 Barcelona, Spain
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Tamara Cruz
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
| | - Núria Albacar
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Xavier Alsina-Restoy
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Alejandro Frino-Garcia
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Gemma López-Saiz
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Lucas Robres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
| | - Mauricio Rojas
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Alvar Agustí
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Biomedicine Department, Universitat de Barcelona, 08036 Barcelona, Spain
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Jacobo Sellarés
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Respiratory Institute, Clinic Barcelona, 08036 Barcelona, Spain; (X.A.-R.); (A.F.-G.); (G.L.-S.)
| | - Rosa Faner
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (N.M.); (S.C.-R.); (N.O.); (F.H.-G.); (T.C.); (N.A.); (A.A.); (J.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain;
- Biomedicine Department, Universitat de Barcelona, 08036 Barcelona, Spain
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Shchepikhin EI, Shmelev EI, Ergeshov AE, Zaytseva AS, Shergina EA, Adamovskaya E. Possibilities of non-invasive diagnosis of fibrotic phenotype of interstitial lung diseases. TERAPEVT ARKH 2023; 95:230-235. [PMID: 37167144 DOI: 10.26442/00403660.2023.03.202073] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Progressive pulmonary fibrosis is a major problem in respiratory medicine. Currently, there are no reliable biomarkers for early diagnosis of progressive pulmonary fibrosis, which leads to delayed diagnosis. AIM To determine the role of serum biomarkers CA-19-9 and CA-125 and the possibilities of capillaroscopy of the nail fold in the diagnosis of progressive pulmonary fibrosis. MATERIALS AND METHODS The study included 43 patients with interstitial changes in the lungs. Based on the presence/absence of signs of progression over the previous 12 months, patients were divided into 2 groups. All patients underwent forced spirometry, body plethysmography, diffusion test, CT, lung ultrasound, capillaroscopy of the nail fold, study of serum concentrations of CA-19-9 and CA-125. RESULTS In the group of patients with a progressive fibrotic phenotype of Interstitial lung diseases, a greater severity of capillaroscopic changes and a higher level of CA-19-9 were revealed. Correlation of these parameters with changes according to CT scan data (Warrick test) and lung ultrasound was shown. CONCLUSION The data obtained demonstrate the possibilities of non-invasive diagnosis of progressive fibrosing interstitial lung diseases and require further research and prospective follow-up to assess the diagnostic and prognostic role of the studied biomarkers, as well as to determine their place in clinical practice.
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Mikolasch TA, George PM, Sahota J, Nancarrow T, Barratt SL, Woodhead FA, Kouranos V, Cope VS, Creamer AW, Fidan S, Ganeshan B, Hoy L, Mackintosh JA, Shortman R, Duckworth A, Fallon J, Garthwaite H, Heightman M, Adamali HI, Lines S, Win T, Wollerton R, Renzoni EA, Steward M, Wells AU, Gibbons M, Groves AM, Gooptu B, Scotton CJ, Porter JC. Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis. EClinicalMedicine 2023; 55:101758. [PMID: 36483266 PMCID: PMC9722446 DOI: 10.1016/j.eclinm.2022.101758] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease trajectory. The aim of this study was to assess the potential of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in IPF. Methods We adopted a two-stage discovery (n = 71) and validation (n = 134) design using patients from the UCL partners (UCLp) cohort. We then combined discovery and validation cohorts and included an additional 794 people with IPF, using real-life data from 5 other UK centers, to give a combined cohort of 999 patients. Data were collected from patients presenting over a 13-year period (2006-2019) with mean follow up of 3.7 years (censoring: 2018-2020). Findings In the discovery analysis, we showed that high values of NLR (>/ = 2.9 vs < 2.9) were associated with increased risk of mortality in IPF (HR 2.04, 95% CI 1.09-3.81, n = 71, p = 0.025). This was confirmed in the validation (HR 1.91, 95% CI 1.15-3.18, n = 134, p = 0.0114) and combined cohorts (HR 1.65, n = 999, 95% CI 1.39-1.95; p < 0·0001). NLR correlated with GAP stage and GAP index (p < 0.0001). Stratifying patients by NLR category (low/high) showed significant differences in survival for GAP stage 2 (p < 0.0001), however not for GAP stage 1 or 3. In a multivariate analysis, a high NLR was an independent predictor of mortality/progression after adjustment for individual GAP components and steroid/anti-fibrotic use (p < 0·03). Furthermore, incorporation of baseline NLR in a modified GAP-stage/index, GAP-index/stage-plus, refined prognostic ability as measured by concordance (C)-index. Interpretation We have identified NLR as a widely available test that significantly correlates with lung function, can predict outcomes in IPF and refines cohort staging with GAP. NLR may allow timely prioritisation of at-risk patients, even in the absence of lung function. Funding Breathing Matters, GSK, CF Trust, BLF-Asthma, MRC, NIHR Alpha-1 Foundation.
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Affiliation(s)
- Theresia A. Mikolasch
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
| | - Peter M. George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Jagdeep Sahota
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
| | - Thomas Nancarrow
- College of Medicine & Health, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Shaney L. Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Felix A. Woodhead
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | | | - Andrew W. Creamer
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Silan Fidan
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Luke Hoy
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - John A. Mackintosh
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- The Prince Charles Hospital, Queensland, Australia
| | - Robert Shortman
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Anna Duckworth
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Janet Fallon
- Department of Respiratory Medicine, Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK
| | | | | | - Huzaifa I. Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Sarah Lines
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Thida Win
- Lister Hospital, North East Herts Trust, Stevenage UK
| | - Rebecca Wollerton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Elisabetta A. Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Matthew Steward
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Michael Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Bibek Gooptu
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Chris J. Scotton
- College of Medicine & Health, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Joanna C. Porter
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
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Wang Y, Guo Z, Ma R, Wang J, Wu N, Fan Y, Ye Q. Prognostic Predictive Characteristics in Patients With Fibrosing Interstitial Lung Disease: A Retrospective Cohort Study. Front Pharmacol 2022; 13:924754. [PMID: 35847019 PMCID: PMC9283576 DOI: 10.3389/fphar.2022.924754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Limited data are available regarding the entire spectrum of interstitial lung disease with a progressive fibrosing feature. We investigated the prevalence and prognostic predictive characteristics in patients with PF-ILD.Methods: This retrospective cohort study included patients with fibrosing ILD who were investigated between 1 January 2015 and 30 April 2021. We recorded clinical features and outcomes to identify the possible risk factors for fibrosing progression as well as mortality.Results: Of the 579 patients with fibrosing ILD, 227 (39.21%) met the criteria for progression. Clubbing of fingers [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03 to 2.24, p = 0.035] and a high-resolution computed tomography (HRCT)-documented usual interstitial pneumonia (UIP)-like fibrotic pattern (OR 1.95, 95% CI 1.33 to 2.86, p = 0.001) were risk factors for fibrosis progression. The mortality was worse in patients with PF with hypoxemia [hazard ratio (HR) 2.08, 95% CI 1.31 to 3.32, p = 0.002], in those with baseline diffusion capacity of the lung for carbon monoxide (DLCO) % predicted <50% (HR 2.25, 95% CI 1.45 to 3.50, p < 0.001), or in those with UIP-like fibrotic pattern (HR 1.68, 95% CI 1.04 to 2.71, p < 0.001).Conclusion: Clubbing of fingers and an HRCT-documented UIP-like fibrotic pattern were more likely to be associated with progressive fibrosing with varied prevalence based on the specific diagnosis. Among patients with progressive fibrosing, those with hypoxemia, lower baseline DLCO% predicted, or UIP-like fibrotic pattern showed poor mortality.
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Affiliation(s)
- Yuanying Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ziyun Guo
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruimin Ma
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Na Wu
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yali Fan
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiao Ye,
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Moua T, Petnak T, Charokopos A, Baqir M, Ryu JH. Challenges in the Diagnosis and Management of Fibrotic Hypersensitivity Pneumonitis: A Practical Review of Current Approaches. J Clin Med 2022; 11:jcm11061473. [PMID: 35329800 PMCID: PMC8955902 DOI: 10.3390/jcm11061473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023] Open
Abstract
Recent advances in fibrotic hypersensitivity pneumonitis include improved diagnostic guidance, systematic assessments of immunosuppressive therapy, and the recent availability of antifibrotic therapy (nintedanib) for those with progressive disease. A standardized approach to diagnosis may lead to better inclusion criteria for future therapeutic protocols and delineation of disease or treatment response predictors for real-world management. This review will highlight current diagnostic and treatment challenges and remaining knowledge gaps or areas of uncertainty, with a practical overview of supporting evidence and its clinical implications. Exposure history, serologic testing for antigen sensitivity, bronchoalveolar lavage lymphocytosis, histopathology, and radiologic findings will be covered in the diagnosis section, with immunosuppression, antifibrotic therapy, lung transplantation, and disease prognosis in the treatment and management section.
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