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Chen YW, Lai CH, Liao YW, Liu MC, Wu YC, Hsu CY, Yu YH, Fu PK. A composite score based on cardiovascular parameters can predict the mortality risk of patients with newly diagnosed interstitial lung disease: A prospective observational study. J Cardiol 2024; 84:287-293. [PMID: 38582493 DOI: 10.1016/j.jjcc.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND It is crucial to identify factors that can predict the risk of mortality in patients newly diagnosed with interstitial lung disease (ILD). This study sought to develop and assess a composite scoring system for mortality prediction among ILD patients based on cardiovascular parameters, which were previously reported as predictors of survival. METHODS We prospectively enrolled patients with newly diagnosed ILD and monitored their survival status for 24 months. Surviving and deceased patients were compared regarding their baseline characteristics including clinical, pulmonary, and cardiovascular parameters. A system of composite scores was established based on significant cardiovascular parameters and the Gender-Age-Physiology (GAP) score. Receiver operating characteristic curves were generated to identify their optimal cut-off values. Univariate as well as multiple multivariate regression models were built to investigate the mortality prediction of different individual and combined parameters. RESULTS Ninety-six patients newly diagnosed with ILD underwent cardiovascular evaluation. In univariate analysis, three cardiovascular parameters were identified as significant predictors of mortality risk in ILD patients, either individually or as a combination of composite scores: tricuspid regurgitation velocity > 3.1 m/s; N-terminal pro-B-type natriuretic peptide level > 300 pg/ml and computed tomography pulmonary artery/ascending aorta diameter ratio > 0.9. In multivariate analysis, a composite score of those parameters [hazard ratio (HR) = 2.37 (confidence interval [CI]:1.06-5.33); p = 0.037; Score 1] and GAP score [HR = 1.62 (CI: 1.11-2.36); p = 0.012] were the most significant predictors for mortality among ILD patients. Combination of Score 1 and GAP score (Score 2) can increase the accuracy of survival predictions (area under the curve 0.83; p < 0.001). CONCLUSIONS A composite score based on cardiovascular parameters and the GAP score can be used to predict the risk of mortality of patients with ILD. Such a score achieved better diagnostic accuracy than the GAP score alone. Nevertheless, further larger-scale randomized controlled trials are required for evaluation of the newly proposed score and confirmation of our results.
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Affiliation(s)
- Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Wan Liao
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Cheng Liu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Wu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsuan Yu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Kuei Fu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Clinical Research, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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Bala M, Rajpoot A, Punera DC, Rathore SS. Hormonal harmony disrupted: hypothyroidism and diabetes mellitus in interstitial lung disease. An observational study. Monaldi Arch Chest Dis 2024. [PMID: 39058019 DOI: 10.4081/monaldi.2024.2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/24/2024] [Indexed: 07/28/2024] Open
Abstract
Interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases that affect the lungs and airways. ILD encompasses approximately 200 different conditions with known and unknown causes. Various comorbidities, such as cardiovascular, psychological, obstructive sleep apnea, and gastrointestinal disorders, are often associated with them. However, little is known about the relationship and prevalence of hypothyroidism and diabetes mellitus (DM) in ILD and COPD. Therefore, understanding these connections is crucial for proper treatment. This cross-sectional, prospective observational study was conducted at a tertiary care hospital in North India. After obtaining informed consent, we consecutively enrolled 100 patients with ILD and 100 patients with COPD who reported to the Respiratory Medicine Outpatient Department. We collected demographic, clinical, and medical data from the patients and conducted appropriate statistical analysis to determine the prevalence of hypothyroidism and DM in patients with ILD. ILD patients exhibit a significantly higher prevalence of hypothyroidism (24% versus 4%) and DM (24% versus 4%) compared to those with COPD (p<0.05). Additionally, the study showed that ILD patients also had a significantly higher prevalence of self-reported gastroesophageal reflux disease (30%), had a higher body mass index, and consulted a pulmonologist earlier than COPD patients after the onset of symptoms (p<0.05). Therefore, it is important to screen for hypothyroidism and DM in ILD patients due to their high prevalence and potential impact on disease progression and management. Additionally, evidence suggests a bidirectional relationship between these conditions, making it essential to screen patients with hypothyroidism and DM for ILD if there is any suspicion. These screening measures could contribute to the early detection and management of these comorbidities, thereby improving the overall outcome for ILD patients.
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Affiliation(s)
- Manju Bala
- Department of Respiratory Medicine, Soban Singh Jeena Government Institute of Medical Science and Research, Almora, Uttarakhand.
| | - Akhlesh Rajpoot
- Department of Respiratory Medicine, Soban Singh Jeena Government Institute of Medical Science and Research, Almora, Uttarakhand.
| | - Dinesh Chandra Punera
- Department of Respiratory Medicine, Soban Singh Jeena Government Institute of Medical Science and Research, Almora, Uttarakhand.
| | - Suyash Singh Rathore
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand.
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Lipinski M, Luks V, Rosenberg H. Just the facts: approach to the patient with Interstitial Lung Disease (ILD) in the emergency department. CAN J EMERG MED 2024; 26:452-454. [PMID: 38720142 DOI: 10.1007/s43678-024-00695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/28/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Matthew Lipinski
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Vanessa Luks
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- OHRI, Ottawa, ON, Canada
- Division of Respirology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Hans Rosenberg
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Althobiani MA, Russell AM, Jacob J, Ranjan Y, Folarin AA, Hurst JR, Porter JC. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne) 2024; 11:1296890. [PMID: 38698783 PMCID: PMC11063378 DOI: 10.3389/fmed.2024.1296890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Interstitial lung diseases (ILDs) refer to a heterogeneous and complex group of conditions characterized by inflammation, fibrosis, or both, in the interstitium of the lungs. This results in impaired gas exchange, leading to a worsening of respiratory symptoms and a decline in lung function. While the etiology of some ILDs is unclear, most cases can be traced back to factors such as genetic predispositions, environmental exposures (including allergens, toxins, and air pollution), underlying autoimmune diseases, or the use of certain medications. There has been an increase in research and evidence aimed at identifying etiology, understanding epidemiology, improving clinical diagnosis, and developing both pharmacological and non-pharmacological treatments. This review provides a comprehensive overview of the current state of knowledge in the field of interstitial lung diseases.
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Affiliation(s)
- Malik A. Althobiani
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anne-Marie Russell
- School of Health and Care Professions, University of Exeter, Exeter, United Kingdom
- School of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Jacob
- UCL Respiratory, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London Respiratory, University College London, London, United Kingdom
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A. Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
| | - Joanna C. Porter
- UCL Respiratory, University College London, London, United Kingdom
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Jung HI, Nam DR, You SH, Jung JW, Gu KM, Jung SY. Nationwide Study of the Epidemiology, Diagnosis, and Treatment of Hypersensitivity Pneumonitis in Korea. J Korean Med Sci 2024; 39:e96. [PMID: 38501183 PMCID: PMC10948259 DOI: 10.3346/jkms.2024.39.e96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/05/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a condition with an uncertain global incidence, and information on its diagnosis and management is limited. This study aimed to address these knowledge gaps. METHODS This study utilized customized claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea from January 2010, to December 2021. Patients with HP were identified based on the diagnosis code (International Classification of Diseases, 10th Revision, J67) between 2011 and 2020. Incident HP cases were defined as new HP claims, excluding those with claims in the previous year. The study examined various factors such as age, sex, comorbidities, diagnostic methods, and treatment patterns. Additionally, multivariate logistic regression analysis was performed to identify risk factors associated with treatment initiation. RESULTS A total of 8,678 HP incident cases were confirmed, with age- and sex-adjusted annual incidence rates ranging from 1.14/100,000 in 2020 to 2.16/100,000 in 2012. The mean age of patients with incident HP was 52 years, with a higher incidence observed among males. Additionally, the most common comorbidity was asthma. Bronchoscopy was performed on 16.9% of patients, and 25.4% of patients did not receive treatment within 1 year of diagnosis. Among those who received treatment, prednisone was the most used systemic steroid, and azathioprine was the most commonly used second-line immunosuppressant. Factors associated with treatment initiation included the female sex, having asthma or gastroesophageal reflux disease (GERD), and undergoing bronchoscopy. CONCLUSION This study provides valuable insights into the incidence, diagnosis, and treatment patterns of HP in South Korea using nationwide medical claims data.
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Affiliation(s)
- Hae In Jung
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dal Ri Nam
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Chung-Ang University, Seoul, Korea
| | - Seung-Hun You
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Chung-Ang University, Seoul, Korea
| | - Jae-Woo Jung
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kang-Mo Gu
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Chung-Ang University, Seoul, Korea.
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Fintelmann FJ, Graur A, Oueidat K, Simon J, Barnes JMH, McDermott S, Genshaft SJ, Healey TT, Suh RD, Maxwell AWP, Abtin F. Ablation of Stage I-II Non-Small Cell Lung Cancer in Patients With Interstitial Lung Disease: A Multicenter Retrospective Study. AJR Am J Roentgenol 2024; 222:e2330300. [PMID: 37966037 DOI: 10.2214/ajr.23.30300] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND. Treatment options for patients with interstitial lung disease (ILD) who develop stage I-II non-small cell lung cancer (NSCLC) are severely limited, given that surgical resection, radiation, and systemic therapy are associated with significant morbidity and mortality. OBJECTIVE. The aim of this study was to evaluate the safety and efficacy of percutaneous ablation of stage I-II NSCLC in patients with ILD. METHODS. This retrospective study included patients with ILD and stage I-II NSCLC treated with percutaneous ablation in three health systems between October 2004 and February 2023. At each site, a single thoracic radiologist, blinded to clinical outcomes, reviewed preprocedural chest CT examinations for the presence and type of ILD according to 2018 criteria proposed by the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society. The primary outcome was 90-day major (grade ≥ 3) adverse events, based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Secondary outcomes were hospital length of stay (HLOS), local tumor control, and overall survival (OS). RESULTS. The study included 33 patients (19 men, 14 women; median age, 78 years; 16 patients with Eastern Cooperative Oncology Group performance status ≤ 1) with ILD who underwent 42 percutaneous ablation sessions (21 cryoablations, 11 radiofrequency ablations, 10 microwave ablations) of 43 NSCLC tumors ((median tumor size, 1.6 cm; IQR, 1.4-2.5 cm; range, 0.7-5.4 cm; 37 stage I, six stage II). The extent of lung fibrosis was 20% or less in 24 patients; 17 patients had imaging findings of definite or probable usual interstitial pneumonia. The 90-day major adverse event rate was 14% (6/42), including one CTCAE grade 4 event. No acute ILD exacerbation or death occurred within 90 days after ablation. The median HLOS was 1 day (IQR, 0-2 days). Median imaging follow-up for local tumor control was 17 months (IQR, 11-32 months). Median imaging or clinical follow-up for OS was 16 months (IQR, 6-26 months). Local tumor control and OS were 78% and 77%, respectively, at 1 year and 73% and 46% at 2 years. CONCLUSION. Percutaneous ablation appears to be a safe and effective treatment option for stage I-II NSCLC in the setting of ILD after multidisciplinary selection. CLINICAL IMPACT. Patients with ILD and stage I-II NSCLC should be considered for percutaneous ablation given that they are frequently ineligible for surgical resection, radiation, and systemic therapy.
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Affiliation(s)
- Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Karim Oueidat
- Department of Diagnostic Imaging, Lifespan Health System, Providence, RI
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI
| | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Jeanna M Harvey Barnes
- Department of Diagnostic Imaging, Lifespan Health System, Providence, RI
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI
| | - Shaunagh McDermott
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Scott J Genshaft
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Terrance T Healey
- Department of Diagnostic Imaging, Lifespan Health System, Providence, RI
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI
| | - Robert D Suh
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Aaron W P Maxwell
- Department of Diagnostic Imaging, Lifespan Health System, Providence, RI
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI
| | - Fereidoun Abtin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
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Khor YH, Cottin V, Holland AE, Inoue Y, McDonald VM, Oldham J, Renzoni EA, Russell AM, Strek ME, Ryerson CJ. Treatable traits: a comprehensive precision medicine approach in interstitial lung disease. Eur Respir J 2023; 62:2300404. [PMID: 37263752 PMCID: PMC10626565 DOI: 10.1183/13993003.00404-2023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Interstitial lung disease (ILD) is a diverse group of inflammatory and fibrotic lung conditions causing significant morbidity and mortality. A multitude of factors beyond the lungs influence symptoms, health-related quality of life, disease progression and survival in patients with ILD. Despite an increasing emphasis on multidisciplinary management in ILD, the absence of a framework for assessment and delivery of comprehensive patient care poses challenges in clinical practice. The treatable traits approach is a precision medicine care model that operates on the premise of individualised multidimensional assessment for distinct traits that can be targeted by specific interventions. The potential utility of this approach has been described in airway diseases, but has not been adequately considered in ILD. Given the similar disease heterogeneity and complexity between ILD and airway diseases, we explore the concept and potential application of the treatable traits approach in ILD. A framework of aetiological, pulmonary, extrapulmonary and behavioural and lifestyle treatable traits relevant to clinical care and outcomes for patients with ILD is proposed. We further describe key research directions to evaluate the application of the treatable traits approach towards advancing patient care and health outcomes in ILD.
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Vincent Cottin
- National Coordinating Reference Centre for Rare Pulmonary Diseases, OrphaLung, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, Lyon, France
- UMR 754, Claude Bernard University Lyon 1, INRAE, Lyon, France
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, New Lambton Heights, Australia
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Justin Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Anne Marie Russell
- Exeter Respiratory Innovation Centre, University of Exeter, Exeter, UK
- Royal Devon University Hospitals, NHS Foundation Trust, Devon, UK
- Faculty of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Mary E Strek
- Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Symvoulakis E, Vasarmidi E, Linardakis M, Tsiavos A, Mantadaki A, Pitsidianakis G, Karelis A, Petraki C, Nioti K, Mastronikolis S, Tzanakis N, Eraclion Crete AK. Assessing feasibility of targeted primary care referrals for patients with clinical suspicion of interstitial lung disease using lung ultrasound: a prospective case finding study. The potential benefits of LUS utilization. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023022. [PMID: 37382071 PMCID: PMC10494744 DOI: 10.36141/svdld.v40i2.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND In Primary Health Care (PHC) many interstitial lung disease (ILD) cases may remain at diagnostic delay, due to their challenging presentation and the limited experience of general practitioners (GPs) in recognizing their early symptoms. OBJECTIVE We have designed a feasibility study to investigate early ILD case-finding competency between PHC and tertiary care. METHODS A cross-sectional prospective case-finding study was launched at two private health care centers of Heraklion, Crete, Greece, during nine months (2021-2022). After clinical assessment by GP, PHC attenders, who agreed to participate in the study, were referred to the Respiratory Medicine Department, University Hospital of Heraklion, Crete, underwent Lung Ultrasound (LUS) and those with an overall suspicion for ILDs underwent high resolution computed tomography (HRCT) scan. Descriptive statistics and chi-square tests were used. Multiple Poisson regression analysis was performed to explain positive LUS and HRCT decision with selected variables. RESULTS One hundred and nine patients out of 183 were finally included (54.1% females; mean age 61, SD: 8.3 years). Thirty-five (32.1%) were current smokers. Overall, two out of ten cases were assessed to need HRCT due to a moderate or high suspicion (19.3%; 95%CI 12.7, 27.4). However, in those who had dyspnea in relation to counterparts, a significantly higher percentage of patients with LUS findings (57.9% vs. 34.0%, p=0.013) was found, as in those who had crackles (100.0% vs. 44.2%, p= 0.005). Detected possible ILD provisional labelling cases were 6, and most importantly, 5 of those cases were considered highly suspicious for further evaluation based on LUS findings. CONCLUSIONS This is a feasibility study exploring potentials by combining data of medical history, basic auscultation skills, as crackles detection, and inexpensive and radiation-free imaging technique, such as LUS. Cases of ILD labeling may be hidden within PHC, sometimes, much before any clinical manifestation.
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Affiliation(s)
- Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Greece .
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, School of Medicine, University of Crete, Greece.
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Greece .
| | | | - Aikaterini Mantadaki
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Greece .
| | | | - Andreas Karelis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Greece .
| | - Chrysi Petraki
- Private Primary Care Facilities, Heraklion, Crete, Greece.
| | - Kadiani Nioti
- Private Primary Care Facilities, Heraklion, Crete, Greece.
| | | | - Nikolaos Tzanakis
- Department of Respiratory Medicine, School of Medicine, University of Crete, Greece.
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Vagts C, Sweis JJG, Sweis NWG, Ascoli C, Rottoli P, Martone FM, Wells AU, Judson MA, Sweiss NJ, Lower EE, Baughman RP. Initial behaviors and attitudes towards the COVID-19 vaccine in sarcoidosis patients: results of a self-reporting questionnaire. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023012. [PMID: 37382069 PMCID: PMC10494750 DOI: 10.36141/svdld.v40i2.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with self-declared sarcoidosis are at increased risk of COVID-19 related morbidity and mortality for which vaccination can be lifesaving. Despite this, vaccine hesitancy remains a large barrier to global acceptance of vaccination against COVID-19. We aimed to identify individuals with sarcoidosis who had and had not been vaccinated against COVID-19 vaccine to 1) establish a safety profile of COVID-19 vaccination in those with sarcoidosis and 2) to elucidate factors that contribute to COVID-19 vaccine hesitancy. METHODS A questionnaire inquiring about COVID-19 vaccination status, vaccination side effects, and willingness for future vaccination was distributed from December 2020 to May 2021 to individuals with sarcoidosis living in the US and European countries. Details regarding sarcoidosis manifestations and treatment were solicited. Vaccine attitudes were classified as pro or anti-COVID-19 vaccination for subgroup analysis. RESULTS At the time of questionnaire administration, 42% of respondents had already received a COVID-19 vaccination, most of whom either denied side effects or reported a local reaction only. Those off sarcoidosis therapy were more likely to report systemic side effects. Among subjects who had not yet received a COVID-19 vaccine, 27% of individuals reported they would not receive one once available. Reasons against vaccination were overwhelmingly related to the lack of confidence in vaccine safety and/or efficacy and less related to concerns associated with convenience or complacency. Black individuals, women, and younger adults were more likely to decline vaccination. CONCLUSIONS Among individuals with sarcoidosis, COVID-19 vaccination is well-accepted and well-tolerated. Subjects on sarcoidosis therapy reported significantly less vaccination side effects, and thus the correlation between side effects, vaccine type, and vaccine efficacy requires further investigation. Strategies to improve vaccination should focus on improving knowledge and education regarding vaccine safety and efficacy, as well as targeting sources of misinformation, particularly in young, black, and female subpopulations.
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Affiliation(s)
- Christen Vagts
- Division of Pulmonary Critical Care Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago IL, USA.
| | | | | | - Christian Ascoli
- Division of Pulmonary Critical Care Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago IL, USA.
| | - Paola Rottoli
- Specialization School of Respiratory Diseases, Department of Medical, Surgical and Neurological Sciences, Siena University, Italy.
| | | | - Athol U Wells
- Royal Brompton and Harefield National Health Service Foundation Trust, Interstitial Lung Disease Unit, London, UK.
| | - Marc A Judson
- Department of Medicine, Albany Medical College, Albany NY, USA.
| | - Nadera J Sweiss
- Division of Rheumatology and Medical Director of the Arthritis Clinic and Bernie Mac Sarcoidosis Translational Advanced Research (STAR) Center.
| | - Elyse E Lower
- University of Cincinnati Medical Center, Department of Medicine, Cincinnati, OH, USA.
| | - Robert P Baughman
- University of Cincinnati Medical Center, Department of Medicine, Cincinnati, OH, USA.
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10
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Gilbert C, Bennett KM, Brown C, Bush A. Experiences of UK-based adult transition services for interstitial lung disease in childhood: "There's a lot less cushioning". Pediatr Pulmonol 2023. [PMID: 37083202 DOI: 10.1002/ppul.26423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/08/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
Interstitial lung disease in childhood (chILD) is rare and no longer purely a childhood issue as many survive into adulthood, and so have to transition from pediatric to adult healthcare services. Transition is a significant life event that has the potential to impact on physical and mental health outcomes. The European Respiratory Society (ERS) statement on chILD transition highlighted the lack of standardised transition services for chILD transition resulting in a haphazard process. This qualitative study explores how young people and parents in the United Kingdom experienced transition from paediatric to adult healthcare services for chILD. Participants (n = 7) were recruited from chILD patient organisations and online communities. We focused on the experience of transition exploring if there were any information packs or support provided for the transition. Such support may be generic, such as "Ready Steady Go" which provides a systematic approach to transition and disease-specific literature. These latter have not been developed for ILD. Data were analysed by constructivist grounded theory. We present a lived experience of transition with themes of lack of transition preparation and planning, challenges of adapting to adult services, and a changing healthcare scene. Due to the complexity of chILD, parents discussed their need to remain, in part, as an advocate for the young person. Respondents provided recommendations for how transition could be improved along with tips for young people who are new to the transition process, which include educating oneself about the condition, learning medical terminology, and reaching out for support.
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Affiliation(s)
- Carlee Gilbert
- School of Psychology, Institute for Population Health, University of Liverpool, Liverpool, UK
| | - Kate M Bennett
- School of Psychology, Institute for Population Health, University of Liverpool, Liverpool, UK
| | - Christopher Brown
- School of Psychology, Institute for Population Health, University of Liverpool, Liverpool, UK
| | - Andrew Bush
- Faculty of Medicine, Imperial College, National Heart and Lung Institute, Royal Brompton Harefield NHS Foundation Trust, London, UK
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11
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Recognising the importance of chronic lung disease: a consensus statement from the Global Alliance for Chronic Diseases (Lung Diseases group). Respir Res 2023; 24:15. [PMID: 36639661 PMCID: PMC9838069 DOI: 10.1186/s12931-022-02297-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic respiratory diseases are disorders of the airways and other structures of the lung, and include chronic obstructive pulmonary disease (COPD), lung cancer, asthma, bronchiectasis, interstitial lung diseases, occupational lung diseases and pulmonary hypertension. Through this article we take a broad view of chronic lung disease while highlighting (1) the complex interactions of lung diseases with environmental factors (e.g. climate change, smoking and vaping) and multimorbidity and (2) proposed areas to strengthen for better global patient outcomes. CONCLUSION We suggest new directions for the research agenda in high-priority populations and those experiencing health disparities. We call for lung disease to be made a research priority with greater funding allocation globally.
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12
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Phua G, Tan GP, Phua HP, Lim WY, Neo HY, Chai GT. Health-related quality of life in a multiracial Asian interstitial lung disease cohort. J Thorac Dis 2022; 14:4713-4724. [PMID: 36647495 PMCID: PMC9840018 DOI: 10.21037/jtd-22-906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
Background Understanding health-related quality of life (HRQL) in patients with interstitial lung disease (ILD) provides insight into disease burden and treatment effects on patients' well-being. We examined HRQL in a multiracial Asian ILD cohort using the King's brief ILD (K-BILD) and EuroQol 5-dimension-3-level (EQ5D-3L) questionnaires and their associations with several clinical variables. Methods This was a single-centre cross-sectional study of ILD patients in a university-affiliated tertiary public hospital in Singapore. All patients completed two self-administered HRQL questionnaires upon study entry, and their clinical information was retrieved from electronic medical records. Results Ninety-nine patients (56% male, 75% Chinese) were included. The median (interquartile range) age was 63 (54-72) years. The most common ILD diagnosis was connective tissue disease-related ILD (n=51, 52%), followed by idiopathic pulmonary fibrosis (n=27, 27%). The mean (standard deviation) scores for the EQ5D-3L utility value, EQ5D Visual Analogue Scale (VAS) and K-BILD total were 0.806 (0.284), 75.1 (12.8) and 63.9 (14.3), respectively. A moderate correlation was found between the EQ5D-3L and K-BILD total and domain scores. The HRQL scores also correlate moderately with the modified Medical Research Council dyspnoea scale (mMRC) scores. There was a weak-to-moderate correlation between HRQL and forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO) and Charlson comorbidity index. Multiple linear regression showed a significant association of K-BILD total [beta coefficient 0.244, 95% confidence interval (CI): 0.075-0.414; P=0.005], K-BILD 'breathlessness and activities' (beta coefficient 0.448, 95% CI: 0.192-0.703; P=0.001), and the 'psychological' domain (beta coefficient 0.256, 95% CI: 0.024-0.488; P=0.031) with DLCO %pred after adjustment for age, sex, BMI, race, smoking history, comorbidities, FVC %pred and ILD diagnosis. Non-Chinese race was a predictor of better K-BILD 'psychological' domain (beta coefficient 8.680, 95% CI: 0.656-16.704; P=0.034) after adjustment. Conclusions HRQL is significantly impaired in ILD patients, and low DLCO is a strong predictor of this impairment.
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Affiliation(s)
- Grace Phua
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore
| | - Geak Poh Tan
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hwee Pin Phua
- Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei-Yen Lim
- Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - Han-Yee Neo
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore;,Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gin Tsen Chai
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore;,Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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13
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[Research Progress on the Pathogenesis of Lung Cancer Associated with
Idiopathic Pulmonary Fibrosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:811-818. [PMID: 36419395 PMCID: PMC9720683 DOI: 10.3779/j.issn.1009-3419.2022.101.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease (ILD) of unknown causes, which is characterized by pulmonary fibrosis. The median survival period after diagnosis is about 2-4 years. In recent years, the incidence rate of lung cancer associated with IPF (IPF-LC) is increasing, and the prognosis is worse than that of IPF alone. Pulmonary fibrosis may be closely associated with the occurrence and development of lung cancer. Although the pathogenesis of IPF-LC is still unclear, the current research shows that there are similarities between the pathogenesis of these two diseases at molecular and cellular levels. At present, the research on the cellular and molecular mechanism of lung cancer related to pulmonary fibrosis has become the focus of researchers' attention. This article reviews the related literature, focusing on the latest status of the cellular and molecular mechanisms and treatment of IPF-LC, hoping to help clinicians understand IPF-LC.
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14
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Guan S, Tustison N, Qing K, Shim YM, Mugler J, Altes T, Albon D, Froh D, Mehrad B, Patrie J, Ropp A, Miller B, Nehrbas J, Mata J. 3D Single-Breath Chemical Shift Imaging Hyperpolarized Xe-129 MRI of Healthy, CF, IPF, and COPD Subjects. Tomography 2022; 8:2574-2587. [PMID: 36287814 PMCID: PMC9607398 DOI: 10.3390/tomography8050215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
3D Single-breath Chemical Shift Imaging (3D-SBCSI) is a hybrid MR-spectroscopic imaging modality that uses hyperpolarized xenon-129 gas (Xe-129) to differentiate lung diseases by probing functional characteristics. This study tests the efficacy of 3D-SBCSI in differentiating physiology among pulmonary diseases. A total of 45 subjects-16 healthy, 11 idiopathic pulmonary fibrosis (IPF), 13 cystic fibrosis (CF), and 5 chronic obstructive pulmonary disease (COPD)-were given 1/3 forced vital capacity (FVC) of hyperpolarized Xe-129, inhaled for a ~7 s MRI acquisition. Proton, Xe-129 ventilation, and 3D-SBCSI images were acquired with separate breath-holds using a radiofrequency chest coil tuned to Xe-129. The Xe-129 spectrum was analyzed in each lung voxel for ratios of spectroscopic peaks, chemical shifts, and T2* relaxation. CF and COPD subjects had significantly more ventilation defects than IPF and healthy subjects, which correlated with FEV1 predicted (R = -0.74). FEV1 predicted correlated well with RBC/Gas ratio (R = 0.67). COPD and IPF had significantly higher Tissue/RBC ratios than other subjects, longer RBC T2* relaxation times, and greater RBC chemical shifts. CF subjects had more ventilation defects than healthy subjects, elevated Tissue/RBC ratio, shorter Tissue T2* relaxation, and greater RBC chemical shift. 3D-SBCSI may be helpful in the detection and characterization of pulmonary disease, following treatment efficacy, and predicting disease outcomes.
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Affiliation(s)
- Steven Guan
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Nick Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope, Duarte, CA 91010, USA
| | - Yun Michael Shim
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - John Mugler
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Talissa Altes
- Department of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Dana Albon
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Deborah Froh
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Borna Mehrad
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - James Patrie
- Department of Public Health, University of Virginia, Charlottesville, VA 22903, USA
| | - Alan Ropp
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Braden Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Jill Nehrbas
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Jaime Mata
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
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15
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Parikh R, Konstantinidis I, O'Sullivan DM, Farber HW. Pulmonary hypertension in patients with interstitial lung disease: a tool for early detection. Pulm Circ 2022; 12:e12141. [PMID: 36225536 PMCID: PMC9531548 DOI: 10.1002/pul2.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) complicates the treatment of interstitial lung disease (ILD) patients resulting in poor functional status and worse outcomes. Early recognition of PH in ILD is important for initiating therapy and considering lung transplantation. However, no standard exists regarding which patients to screen for PH-ILD or the optimal method to do so. The aim of this study was to create a risk assessment tool that could reliably predict PH in ILD patients. We developed a PH-ILD Detection tool that incorporated history, exam, 6-min walk distance, diffusion capacity for carbon monoxide, chest imaging, and cardiac biomarkers to create an eight-component score. This tool was analyzed retrospectively in 154 ILD patients where each patient was given a score ranging from 0 to 12. The sensitivity (SN) and specificity (SP) of the PH-ILD Detection tool and an area-under-the-curve (AUC) were calculated. In this cohort, 74 patients (48.1%) had PH-ILD. A score of ≥6 on the PH-ILD Detection tool was associated with a diagnosis of PH-ILD (SN: 86.5%; SP: 86.3%; area-under-the-curve: 0.920, p < 0.001). The PH-ILD Detection tool provides high SN and SP for detecting PH in ILD patients. With confirmation in larger cohorts, this tool could improve the diagnosis of PH in ILD and may suggest further testing with right heart catheterization and earlier intervention with inhaled treprostinil and/or lung transplant evaluation.
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Affiliation(s)
- Raj Parikh
- Division of Pulmonary, Critical Care, and SleepHartford HospitalHartfordConnecticutUSA
| | | | - David M. O'Sullivan
- Department of Research AdministrationHartford HealthCareHartfordConnecticutUSA
| | - Harrison W. Farber
- Division of Pulmonary, Sleep and Critical Care MedicineTufts Medical CenterBostonMassachusettsUSA
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16
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Kewalramani N, Machahua C, Poletti V, Cadranel J, Wells AU, Funke-Chambour M. Lung cancer in patients with fibrosing interstitial lung diseases – An overview of current knowledge and challenges. ERJ Open Res 2022; 8:00115-2022. [PMID: 35747227 PMCID: PMC9209850 DOI: 10.1183/23120541.00115-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Patients with progressive fibrosing interstitial lung diseases (fILD) have increased morbidity and mortality. Lung fibrosis can be associated with lung cancer. The pathogenesis of both diseases shows similarities, although not all mechanisms are understood. The combination of the diseases is challenging, due to the amplified risk of mortality, and also because lung cancer treatment carries additional risks in patients with underlying lung fibrosis. Acute exacerbations in fILD patients are linked to increased mortality, and the risk of acute exacerbations is increased after lung cancer treatment with surgery, chemotherapy or radiotherapy. Careful selection of treatment modalities is crucial to improve survival while maintaining acceptable quality of life in patients with combined lung cancer and fILD. This overview of epidemiology, pathogenesis, treatment and a possible role for antifibrotic drugs in patients with lung cancer and fILD is the summary of a session presented during the virtual European Respiratory Society Congress in 2021. The review summarises current knowledge and identifies areas of uncertainty. Most current data relate to patients with combined idiopathic pulmonary fibrosis and lung cancer. There is a pressing need for additional prospective studies, required for the formulation of a consensus statement or guideline on the optimal care of patients with lung cancer and fILD. Lung fibrosis can be associated with lung cancer. More and better-designed studies are needed to determine the true incidence/prevalence of lung cancer in fILD. Optimal treatment strategies urgently need to be defined and evaluated.https://bit.ly/37CzTMu
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17
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Sedentary Time and Cognitive Impairment in Patients Using Long-Term Oxygen Therapy: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031726. [PMID: 35162749 PMCID: PMC8835276 DOI: 10.3390/ijerph19031726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/17/2022]
Abstract
Physical inactivity is a predictor of death in patients with chronic respiratory disease. Cognitive impairment is common among patients with chronic respiratory disease. However, the association between sedentary time and cognitive impairment in patients with chronic respiratory disease using long-term oxygen therapy is unclear. This study aimed to determine the relationship between sedentary time and cognitive impairment in patients on long-term oxygen therapy. This cross-sectional study included 96 patients with chronic respiratory disease on long-term oxygen therapy (mean age 77.3 years; female, 22%). The primary outcomes measured were sedentary time (Japanese version of the International Physical Activity Questionnaire Short Form), cognitive function (Montreal Cognitive Assessment), and dyspnea (modified Medical Research Council scale). The factors associated with sedentary time were confirmed by multiple regression analysis. The median sedentary time was 600.0 min. The median Montreal Cognitive Assessment score was 24.0 points, and 67 (70%) patients had mild cognitive impairment. In multiple regression analysis, sedentary time was associated with dyspnea (β = 0.397, p < 0.001) and cognitive function (β = −0.239, p = 0.020). This study indicates that sedentary time in patients on long-term oxygen therapy was associated with dyspnea and cognitive impairment.
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18
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Impact of Concomitant Medication Burden on Tolerability of Disease-targeted Therapy and Survival in Interstitial Lung Disease. Ann Am Thorac Soc 2022; 19:962-970. [DOI: 10.1513/annalsats.202108-980oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review. Int J Mol Sci 2021; 22:ijms222212244. [PMID: 34830123 PMCID: PMC8622767 DOI: 10.3390/ijms222212244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
New drugs, including immune checkpoint inhibitors and targeted therapy, have changed the prognosis in a subset of patients with advanced lung cancer, and are now actively investigated in a number of trials with neoadjuvant and adjuvant regimens. However, no phase III randomized studies were published yet. The current narrative review proves that targeted therapies are safe in neoadjuvant approach. Unsurprisingly, administration of therapy is related to an acceptable toxicity profile. Severe adverse events’ rate that rarely compromises outcomes of patients with advanced lung cancer is not that commonly accepted in early lung cancer as it may lead to missing the chance of curative surgery. Among those complications, the most important factors that may limit the use of targeted therapies are severe respiratory adverse events precluding the resection occurring after treatment with some anaplastic lymphoma kinase and rarely after epidermal growth factor receptor tyrosine kinase inhibitors. At this point, in the presented literature assessing the feasibility of neoadjuvant therapies with anaplastic lymphoma kinase and epidermal growth factor receptor tyrosine kinase inhibitors, we did not find any unexpected intraoperative events that would be of special interest to a thoracic surgeon. Moreover, the postoperative course was associated with typical rate of complications.
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20
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von der Beck D, Grimminger F, Seeger W, Günther A, Löh B. Interstitial Lung Disease: Seasonality of Hospitalizations and In-Hospital Mortality 2005-2015. Respiration 2021; 101:253-261. [PMID: 34628406 DOI: 10.1159/000519214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The overall incidence of interstitial lung disease and disease-associated mortality have been found on the rise. Hospitalizations for interstitial lung disease are typically caused by airway infection or the acute exacerbation of the underlying disease. Seasonal variance in ambient air pollution has recently been linked to exacerbation and mortality. We sought to examine the seasonal pattern of hospitalizations in Germany, use of mechanical ventilation, and in-hospital mortality on a year-by-year basis to identify their overall trend and to characterize seasonal patterns. METHODS The national in-patient database of the federal statistical office of Germany was searched for cases of interstitial lung disease. RESULTS A total of 130,366 hospitalizations for ILD occurred from 2005 to 2015. Time series data were examined for seasonality using X-11 statistics. The incidence of hospitalizations, mechanical ventilation, and in-hospital mortality show clear seasonal peaks in the cold season. The observed seasonality cannot be attributed to the variance of selected comorbidities. Also, there is a significant overall upward trend regarding hospitalization counts, especially in the use of non-invasive ventilation. CONCLUSION Time series analysis of in-hospital data shows an ILD-related rise of hospitalizations, in-hospital mortality, and non-invasive ventilation. This emphasizes a growing importance of interstitial lung diseases for health-care systems. Strong seasonality is seen in these variables. Data therefore support previous studies of ILD exacerbation. More research on infectious causes and environmental factors is warranted.
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Affiliation(s)
- Daniel von der Beck
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany,
| | - Friedrich Grimminger
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.,Department of Pulmonology, Hochtaunus Clinic, Bad Homburg, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Andreas Günther
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.,Agaplesion Lung Clinic Waldhof Elgershausen, Greifensstein, Germany
| | - Benjamin Löh
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.,Department of Pulmonology, Hochtaunus Clinic, Bad Homburg, Germany
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21
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Maqhuzu PN, Kreuter M, Bahmer T, Kahn N, Claussen M, Holle R, Schwarzkopf L. Cost drivers in the pharmacological treatment of interstitial lung disease. Respir Res 2021; 22:218. [PMID: 34344376 PMCID: PMC8335870 DOI: 10.1186/s12931-021-01807-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Treatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. To highlight economic burden of drug treatment in different ILD-subtypes we assessed cost trends and therewith-associated drivers. METHODS Using data from the German, observational HILDA study we estimated adjusted mean medication costs over 36-month intervals using one- and two-part Generalized Estimating Equation (GEE) regression models with a gamma distribution and log link. Next, we determined factors associated with costs. RESULTS In Idiopathic pulmonary fibrosis (IPF) mean per capita medication costs increased from €1442 before to €11,000€ at the end of study. In non-IPF subtypes, the increase took place at much lower level. Mean per capita ILD-specific medication costs at the end of the study ranged between €487 (other ILD) and €9142 (IPF). At baseline, higher FVC %predicted values were associated with lower medication costs in IPF (-9%) and sarcoidosis (-1%). During follow up higher comorbidity burden escalated costs in progressive fibrosing ILD (PF-ILD) (+52%), sarcoidosis (+60%) and other ILDs (+24%). The effect of disease duration was not uniform, with cost savings in PF-ILD (-8%) and sarcoidosis (-6%), but increased spending in IPF (+11%). CONCLUSION Pharmacological management of ILD, in particular of IPF imposes a substantial economic burden on the healthcare system. Strategies to reduce comorbidity burden and early treatment may reduce the impact of ILDs on the healthcare system.
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Affiliation(s)
- Phillen Nozibuyiso Maqhuzu
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
- University Hospital Schleswig-Holstein Campus Kiel, Internal Medicine I, Member of the German Center for Lung Research (DZL), Arnold-Heller-Str. 3 /Haus 41a, 24105, Kiel, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Marchioninistr. 15, 81377, Munich, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institut Fuer Therapieforschung (IFT), Leopoldstr. 175, 80804, Munich, Germany
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22
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Molgat-Seon Y, Guler SA, Peters CM, Vasilescu DM, Puyat JH, Coxson HO, Ryerson CJ, Guenette JA. Pectoralis muscle area and its association with indices of disease severity in interstitial lung disease. Respir Med 2021; 186:106539. [PMID: 34271524 DOI: 10.1016/j.rmed.2021.106539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023]
Abstract
RATIONALE The pathophysiology of interstitial lung disease (ILD) impacts body composition, whereby ILD severity is linked to lower lean mass. OBJECTIVES To determine i) if pectoralis muscle area (PMA) is a surrogate for whole-body lean mass in ILD, ii) whether PMA is associated with ILD severity, and iii) if the longitudinal change in PMA is associated with pulmonary function and mortality in ILD. METHODS Patients with ILD (n = 164) were analyzed retrospectively. PMA was quantified from a chest computed tomography scan. Peripheral oxygen saturation (SpO2), 6-min walk distance (6MWD), and pulmonary function were obtained as part of routine clinical care. Dyspnea and quality of life were assessed using the UCSD Shortness of Breath Questionnaire and European Quality of Life 5 Dimensions questionnaire, respectively. RESULTS PMA was associated with whole-body lean mass (p < 0.001). After adjusting for age, sex, height, body mass, and prednisone status, PMA was associated with %-predicted forced vital capacity (FVC), %-predicted diffusion capacity (DLCO), resting and exertional SpO2, and dyspnea (all p < 0.05), but not forced expiratory volume in 1 s (FEV1), FEV1/FVC, 6MWD, or quality of life (all p > 0.05). The annual negative PMA slope was associated with annual negative slopes in FVC, FEV1, and DLCO (all p < 0.05), but not FEV1/FVC (p = 0.46). Annual slope in PMA was associated with all-cause mortality (hazard ratio = -0.80, 95% CI:0.889-0.959; p < 0.001). CONCLUSION In patients with ILD, PMA is a suitable surrogate for whole-body lean mass. A lower PMA is associated with indices of ILD severity, which supports the notion that ILD progression may involve sarcopenia.
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Affiliation(s)
- Yannick Molgat-Seon
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Sabina A Guler
- Department of Pulmonary Medicine, University Hospital and University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Carli M Peters
- School of Kinesiology, Faculty of Education, The University of British Columbia, 6081 University Boulevard, Vancouver, British Columbia, V6T 1Z1, Canada
| | - Dragoş M Vasilescu
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Joseph H Puyat
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; School of Kinesiology, Faculty of Education, The University of British Columbia, 6081 University Boulevard, Vancouver, British Columbia, V6T 1Z1, Canada; Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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Luppi F, Kalluri M, Faverio P, Kreuter M, Ferrara G. Idiopathic pulmonary fibrosis beyond the lung: understanding disease mechanisms to improve diagnosis and management. Respir Res 2021; 22:109. [PMID: 33865386 PMCID: PMC8052779 DOI: 10.1186/s12931-021-01711-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disorder with an estimated median survival time of 3–5 years after diagnosis. This condition occurs primarily in elderly subjects, and epidemiological studies suggest that the main risk factors, ageing and exposure to cigarette smoke, are associated with both pulmonary and extrapulmonary comorbidities (defined as the occurrence of two or more disorders in a single individual). Ageing and senescence, through interactions with environmental factors, may contribute to the pathogenesis of IPF by various mechanisms, causing lung epithelium damage and increasing the resistance of myofibroblasts to apoptosis, eventually resulting in extracellular matrix accumulation and pulmonary fibrosis. As a paradigm, syndromes featuring short telomeres represent archetypal premature ageing syndromes and are often associated with pulmonary fibrosis. The pathophysiological features induced by ageing and senescence in patients with IPF may translate to pulmonary and extrapulmonary features, including emphysema, pulmonary hypertension, lung cancer, coronary artery disease, gastro-oesophageal reflux, diabetes mellitus and many other chronic diseases, which may lead to substantial negative consequences in terms of various outcome parameters in IPF. Therefore, the careful diagnosis and treatment of comorbidities may represent an outstanding chance to improve quality of life and survival, and it is necessary to contemplate all possible management options for IPF, including early identification and treatment of comorbidities.
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Affiliation(s)
- Fabrizio Luppi
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Monza, Italy
| | - Meena Kalluri
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-134 Clinical Sciences Building, 11304 83 Ave., Edmonton, AB, T6G 2G3, Canada
| | - Paola Faverio
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Monza, Italy
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, University of Heidelberg, German Center for Lung Research, ThoraxklinikHeidelberg, Germany
| | - Giovanni Ferrara
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB, Canada. .,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-134 Clinical Sciences Building, 11304 83 Ave., Edmonton, AB, T6G 2G3, Canada.
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Khor YH, Ryerson CJ, Landry SA, Howard ME, Churchward TJ, Edwards BA, Hamilton GS, Joosten SA. Interstitial lung disease and obstructive sleep apnea. Sleep Med Rev 2021; 58:101442. [PMID: 33561604 DOI: 10.1016/j.smrv.2021.101442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common comorbidities in patients with interstitial lung disease (ILD). Growing evidence highlights the significance of sleep disturbance on health outcomes in this population. The relationships between ILD and OSA are complex and possibly bidirectional, with multiple mechanisms postulated for the pathogenic and physiologic links. This review synthesizes current evidence and hypotheses regarding different aspects of the relationships between ILD and OSA, emphasizing the interactions between epidemiology, pathogenesis, and pathophysiology.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Thomas J Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia.
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25
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The prevalence of obstructive sleep apnea in interstitial lung disease: a systematic review and meta-analysis. Sleep Breath 2021; 25:1219-1228. [PMID: 33403599 DOI: 10.1007/s11325-020-02282-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the overall prevalence of obstructive sleep apnea (OSA) in interstitial lung disease (ILD). METHODS We performed a systematic search of the academic literature while adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines on four scientific databases including EMBASE, CENTRAL, Scopus, and MEDLINE. We performed a meta-analysis to evaluate the prevalence and severity of OSA. Severity was defined by apnea-hypopnea index (AHI) as mild (AHI ≥ 5 to < 15/h), moderate (AHI ≥ 15 to < 30/h), and severe (AHI ≥ 30/h). RESULTS From 1397 studies, we found 10 eligible studies with 569 patients with ILD (mean age: 65.3 ± 6.0 years). Among these patients, 332 (61%) suffered from OSA with 32% categorized as mild, 17% moderate, and 9% severe. CONCLUSION: This systematic review and meta-analysis provides preliminary evidence regarding the high prevalence of OSA in ILD.
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26
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Maqhuzu PN, Szentes BL, Kreuter M, Bahmer T, Kahn N, Claussen M, Holle R, Schwarzkopf L. Determinants of health-related quality of life decline in interstitial lung disease. Health Qual Life Outcomes 2020; 18:334. [PMID: 33032602 PMCID: PMC7542726 DOI: 10.1186/s12955-020-01570-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period.
Methods We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration. Results Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: − 0.02, p = 0.007), VAS (ß-coefficient: − 0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß-coefficient: − 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in ‘breathlessness and activities’ (ß-coefficient: − 0.04, p = 0.003) and ‘chest symptoms’ (ß-coefficient: − 0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß-coefficient: 0.06, p < 0.007). Conclusion Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.
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Affiliation(s)
- Phillen Nozibuyiso Maqhuzu
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
| | - Boglarka L Szentes
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany.,University Hospital Schleswig-Holstein Campus Kiel, Internal Medicine I, German Center for Lung Research (DZL), Arnold-Heller-Str. 3 /Haus 41a, 24105, Kiel, Germany
| | - Nicolas Kahn
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Marchioninistr. 15, 81377, Munich, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.,Institut Fuer Therapieforschung (IFT), Leopoldstr. 175, 80804, Munich, Germany
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Obstructive sleep apnea in patients with interstitial lung disease: Prevalence and predictive factors. PLoS One 2020. [PMID: 33017401 DOI: 10.1371/journal.pone.0239963.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Interstitial lung diseases (ILDs) are chronic, progressive, parenchymal lung diseases with high morbidity and mortality. In recent studies, the prevalence of obstructive sleep apnea (OSA) in patients with ILD has been reported to be high. However, the prevalence and predictive factors of OSA in Korean ILD patients are not well defined. Therefore, the aim of this study was to evaluate the prevalence and predictive factors of OSA in Korean patients with ILD. Clinical data from 86 patients with ILD enrolled from December 2017 to April 2019 at Haeundae-Paik Hospital, Busan, South Korea, were retrospectively analyzed. OSA was monitored with a level 4 portable device and defined as an apnea-hypopnea index of more than 5 per hour of sleep. The median follow-up period was 7 months. The mean age was 69.8 years, and 64% of participants were men. Among the ILDs, idiopathic pulmonary fibrosis (IPF) was the most common (66.3%), followed by connective tissue disease-associated ILD (16.3%) and cryptogenic organizing pneumonia (5.8%). Forty-six ILD patients (53.5%) were diagnosed with OSA, and IPF patients had OSA more frequently (64.9% vs. 31.0%, p = 0.003) than those with other ILDs. Older age (odds ratio [OR], 1.11, 95% CI 1.04-1.19, p = 0.002), higher body weight (OR 1.05, 95% CI 1.01-1.10, p = 0.012), and diabetes mellitus (OR 4.03, 95% CI 1.26-12.91, p = 0.019) were independent risk factors for OSA in the multivariable logistic regression analysis. In the multivariable Cox analysis, an IPF diagnosis was a significant risk factor for one-year mortality (hazard ratio [HR] 7.92, 95% CI: 1.01-61.83, p = 0.048) in ILD patients; however, OSA was not. In conclusion, half of Korean patients with ILD had OSA. Older age, higher body weight, and diabetes mellitus were risk factors for OSA in patients with ILD.
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28
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Evaluation of health-related quality of life and the related factors in a group of Chinese patients with interstitial lung diseases. PLoS One 2020; 15:e0236346. [PMID: 32726327 PMCID: PMC7417083 DOI: 10.1371/journal.pone.0236346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Interstitial lung diseases (ILDs) include a wide variety of chronic
progressive pulmonary diseases characterized by lung inflammation, fibrosis
and hypoxemia and can progress to respiratory failure and even death. ILDs
are associated with varying degrees of quality of life impairments in
affected people. Studies on the quality of life in patients with ILDs are
still limited, and there are few studies with long-term follow-up periods in
these patients. Methods Data from patients who were clinically diagnosed with ILDs in the Respiratory
Department, Beijing Chaoyang Hospital, Capital Medical University from
January 2017 to February 2018 were collected. Clinical status and HRQoL were
assessed at baseline and subsequently at 6- and 12-month intervals with the
LCQ, mMRC, HADS, SF-36, and SGRQ. Multivariate linear regression was used to
evaluate the determinants of the decline in HRQoL. Results A total of 139 patients with idiopathic interstitial pneumonia (IIP) and 30
with connective tissue disease-associated ILD (CTD-ILD) were enrolled, 140
of whom completed the follow-up. The mean age was 63.7 years, and 92
patients were men. At baseline, the decline in HRQoL assessed by the SF-36
and SGRQ was significantly associated with the mMRC, LCQ and HADS depression
score. In the follow-up, changes in FVC%, DLco%, mMRC and LCQ were
significantly associated with changes in HRQoL. Conclusions HRQoL in both IIP and CTD-ILD patients deteriorates to varying degrees, and
the trend suggests that poor HRQoL in these patients is associated with many
determinants, primarily dyspnea, cough and depression. Improving HRQoL is
the main aim when treating patients living with ILDs.
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Syed H, Ascoli C, Linssen CFM, Vagts C, Iden T, Syed A, Kron J, Polly K, Perkins D, Finn PW, Novak R, Drent M, Baughman R, Sweiss NJ. Infection prevention in sarcoidosis: proposal for vaccination and prophylactic therapy. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:87-98. [PMID: 33093774 PMCID: PMC7569559 DOI: 10.36141/svdld.v37i2.9599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Sarcoidosis is a systemic inflammatory disease characterized by granuloma formation in affected organs and caused by dysregulated immune response to an unknown antigen. Sarcoidosis patients receiving immunosuppressive medications are at increased risk of infection. Lymphopenia is also commonly seen among patient with sarcoidosis. In this review, risk of infections, including opportunistic infections, will be outlined. Recommendations for vaccinations and prophylactic therapy based on literature review will also be summarized. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 87-98).
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Affiliation(s)
- Huzaefah Syed
- Division of Rheumatology, Allergy, and Immunology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Ascoli
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Catharina FM Linssen
- Department of Medical Microbiology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, the Netherlands
| | - Christen Vagts
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas Iden
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamer Syed
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Jordana Kron
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelly Polly
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - David Perkins
- Division of Nephrology, University of Illinois at Chicago, Chicago, IL, USA
| | - Patricia W Finn
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard Novak
- Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| | - Marjolein Drent
- ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
| | - Robert Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Nadera J Sweiss
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
- Division of Rheumatology, University of Illinois at Chicago, Chicago, IL, USA
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Safety and Efficacy of Pirfenidone in Advanced Idiopathic Pulmonary Fibrosis: A Nationwide Post-Marketing Surveillance Study in Korean Patients. Adv Ther 2020; 37:2303-2316. [PMID: 32297284 PMCID: PMC7467484 DOI: 10.1007/s12325-020-01328-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Indexed: 12/12/2022]
Abstract
Aim The efficacy and safety of pirfenidone have been previously demonstrated in patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF). However, the effect of pirfenidone in patients with advanced IPF remains unclear. Here, we investigated the effects of pirfenidone against advanced IPF in a real-world setting. Methods A prospective nationwide post-marketing study was conducted on 258 patients from 10 Korean institutions. Patients with a predicted forced vital capacity (FVC) less than 50% or a diffusing capacity of the lung for carbon monoxide (DLco) less than 35% at baseline were classified as the advanced IPF group. Results Of 219 patients included in the analysis, the majority were male (76.3%); the mean age was 67.3 years, and the advanced group accounted for 17.8% of the patients. The median treatment duration was 298 days. Among the subjects, 86.3% experienced adverse events (AEs), of which a decreased appetite (32.4%) and a photosensitivity reaction (13.7%) were the most frequent. The incidence of AEs was similar between the advanced and non-advanced groups (92.3% vs. 85.0%, respectively; p = 0.229). Although the overall discontinuation rate was higher in the advanced group than in the non-advanced group (74.4% vs. 50.0%, respectively; p = 0.006), the percentages of the patients who discontinued treatment as a result of AEs were similar in both groups (20.5% vs. 23.3%, respectively; p = 0.704). In all patients, the rates of decline in the predicted FVC and DLco over 48 weeks were − 4.3 ± 1.3% and − 4.4 ± 1.7%, respectively. There was no between-group difference in the rate of lung function decline. Conclusions Pirfenidone used for the treatment of patients with IPF in a real-world setting was well tolerated, with an acceptable safety profile and a consistent therapeutic effect, regardless of the disease severity. Trial Registration ClinicalTrials.gov NCT03761082; the trial was retrospectively registered on December 3, 2018. Electronic supplementary material The online version of this article (10.1007/s12325-020-01328-8) contains supplementary material, which is available to authorized users.
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Antin-Ozerkis D, Hinchcliff M. Connective Tissue Disease-Associated Interstitial Lung Disease: Evaluation and Management. Clin Chest Med 2020; 40:617-636. [PMID: 31376896 DOI: 10.1016/j.ccm.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Interstitial lung disease is common among patients with connective tissue disease and is an important contributor to morbidity and mortality. Infection and drug toxicity must always be excluded as the cause of radiographic findings. Immunosuppression remains a mainstay of therapy despite few controlled trials supporting its use. When a decision regarding therapy initiation is made, considerations include an assessment of disease severity as well as a determination of the rate of progression. Because patients may have extrathoracic disease activity, a multidisciplinary approach is crucial and should include supportive and nonpharmacologic management strategies.
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Affiliation(s)
- Danielle Antin-Ozerkis
- Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, PO Box 208057, New Haven, CT 06520-8057, USA.
| | - Monique Hinchcliff
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, PO Box 208031, New Haven, CT 06520-8031, USA
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Wälscher J, Witt S, Schwarzkopf L, Kreuter M. Hospitalisation patterns of patients with interstitial lung disease in the light of comorbidities and medical treatment - a German claims data analysis. Respir Res 2020; 21:73. [PMID: 32216792 PMCID: PMC7098099 DOI: 10.1186/s12931-020-01335-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is a heterogeneous group of mainly chronic lung diseases differing in disease course and prognosis. For most subtypes, evidence on relevance and outcomes of hospitalisations is lacking. METHODS Using German claims data we investigated number of hospitalisations (zero-inflated-negative-binomial models providing rate ratios (RR)) and time to first hospitalisation (Cox proportional-hazard models providing hazard ratios (RR)) for nine ILD-subtypes. Models were stratified by ILD-related and non-ILD-related hospitalisations. We adjusted for age, gender, ILD-subtype, ILD-relevant comorbidities and ILD-medication (immunosuppressive drugs, steroids, anti-fibrotic drugs). RESULTS Among 36,816 ILD-patients (mean age 64.7 years, 56.2% male, mean observation period 9.3 quarters), 71.2% had non-ILD-related and 56.6% ILD-related hospitalisations. We observed more and earlier non-ILD-related hospitalisations in ILD patients other than sarcoidosis. Medical ILD-treatment was associated with increased frequency and in case of late initiation, earlier (non-)ILD-related hospitalisations. Comorbidities were associated with generally increased hospitalisation frequency except for COPD (RR = 0.90) and PH (RR = 0.94) in non-ILD-related and for lung cancer in ILD-related hospitalisations (RR = 0.89). Coronary heart disease was linked with earlier (ILD-related: HR = 1.17, non-ILD-related HR = 1.19), but most other conditions with delayed hospitalisations. CONCLUSION Hospitalisations are frequent across all ILD-subtypes. The hospitalisation risk might be reduced independently of the subtype by improved management of comorbidities and improved pharmacological and non-pharmacological ILD therapy.
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Affiliation(s)
- Julia Wälscher
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research (DZL), Röntgenstr. 1, D-69126, Heidelberg, Germany
| | - Sabine Witt
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research (DZL), Röntgenstr. 1, D-69126, Heidelberg, Germany.
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Lee JH, Park CS, Song JW. Obstructive sleep apnea in patients with interstitial lung disease: Prevalence and predictive factors. PLoS One 2020; 15:e0239963. [PMID: 33017401 PMCID: PMC7535061 DOI: 10.1371/journal.pone.0239963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Interstitial lung diseases (ILDs) are chronic, progressive, parenchymal lung diseases with high morbidity and mortality. In recent studies, the prevalence of obstructive sleep apnea (OSA) in patients with ILD has been reported to be high. However, the prevalence and predictive factors of OSA in Korean ILD patients are not well defined. Therefore, the aim of this study was to evaluate the prevalence and predictive factors of OSA in Korean patients with ILD. Clinical data from 86 patients with ILD enrolled from December 2017 to April 2019 at Haeundae-Paik Hospital, Busan, South Korea, were retrospectively analyzed. OSA was monitored with a level 4 portable device and defined as an apnea-hypopnea index of more than 5 per hour of sleep. The median follow-up period was 7 months. The mean age was 69.8 years, and 64% of participants were men. Among the ILDs, idiopathic pulmonary fibrosis (IPF) was the most common (66.3%), followed by connective tissue disease-associated ILD (16.3%) and cryptogenic organizing pneumonia (5.8%). Forty-six ILD patients (53.5%) were diagnosed with OSA, and IPF patients had OSA more frequently (64.9% vs. 31.0%, p = 0.003) than those with other ILDs. Older age (odds ratio [OR], 1.11, 95% CI 1.04-1.19, p = 0.002), higher body weight (OR 1.05, 95% CI 1.01-1.10, p = 0.012), and diabetes mellitus (OR 4.03, 95% CI 1.26-12.91, p = 0.019) were independent risk factors for OSA in the multivariable logistic regression analysis. In the multivariable Cox analysis, an IPF diagnosis was a significant risk factor for one-year mortality (hazard ratio [HR] 7.92, 95% CI: 1.01-61.83, p = 0.048) in ILD patients; however, OSA was not. In conclusion, half of Korean patients with ILD had OSA. Older age, higher body weight, and diabetes mellitus were risk factors for OSA in patients with ILD.
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Affiliation(s)
- Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chan Sun Park
- Division of Allergy, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Butler SJ, Li LSK, Ellerton L, Gershon AS, Goldstein RS, Brooks D. Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes. ERJ Open Res 2019; 5:00264-2019. [PMID: 31832430 PMCID: PMC6899339 DOI: 10.1183/23120541.00264-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/07/2019] [Indexed: 01/11/2023] Open
Abstract
Background The presence of comorbid conditions could impact performance in pulmonary rehabilitation (PR) programmes. We aimed to compare the comorbidity prevalence among those with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) and evaluate the impact on PR response. Methods We performed a retrospective cohort study, recording comorbidities for all patients with COPD or ILD referred to PR. Participants were classified as responders to PR if they met the minimal important difference for exercise capacity and health-related quality of life (HRQoL). The prevalence of comorbidities and impact on PR outcomes were compared by lung disease and by sex using a univariate analysis and multivariate logistic regression. Results The mean number of comorbidities was similar among those with COPD (3.3±2.1, n=242) and ILD (3.2±1.9, n=66) (p>0.05). Females had a higher number of comorbidities than males in both COPD (p=0.001) and ILD (p=0.017) populations. Circulatory (64%) and endocrine/metabolic (45%) conditions were most common in COPD. In ILD, digestive (55%) and circulatory (53%) comorbidities were most prevalent. In people with ILD, those over 65 years, with musculoskeletal/connective tissue disease or circulatory disease were less likely to obtain meaningful improvements in exercise capacity. There was no impact of comorbidities on exercise capacity in COPD or on HRQoL in ILD. Conclusions The majority of patients with COPD or ILD enrolled in PR programmes have multiple comorbidities that may affect improvements in exercise capacity. PR programmes may be less effective for older adults with ILD and comorbid circulatory or musculoskeletal disease.
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Affiliation(s)
- Stacey J Butler
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Lok Sze Katrina Li
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Lauren Ellerton
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Andrea S Gershon
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roger S Goldstein
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Dept of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.,Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
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Lv H, Liu J, Pan Q, Cai R, Zhang J. Clinical Retrospective Analysis of Interstitial Lung Disease Patients Associated with Pulmonary Hypertension. Med Sci Monit 2019; 25:7763-7769. [PMID: 31618191 PMCID: PMC6816330 DOI: 10.12659/msm.916585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/28/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is a common complication of interstitial lung disease. This study was conducted to retrospectively analyze the incidence of pulmonary hypertension among interstitial lung disease patients and the correlation between systolic pulmonary artery pressure (PASP) and pulmonary functions. We also intended to investigate whether antinuclear antibody (ANA) could be an effective indicator of pulmonary hypertension. MATERIAL AND METHODS There were 182 patients diagnosed with interstitial lung disease through high-resolution computed tomography (HRCT). Pulmonary hypertension was defined as an increase of mean pulmonary arterial pressure (PAPm) ≥25 mmHg (~PASP ≥40 mmHg) at rest. Severe pulmonary hypertension was defined as PAPm ≥35 mmHg. There were 104 cases including in this study. There were 67 cases from the ANA positive (ANA+) group and 37 cases from the ANA negative (ANA-) group. All study patients had pulmonary function tests, which included the measurements of maximal voluntary ventilation (MVV), residual volume (RV), total lung capacity (TLC), forced expiratory volume (FVC), vital capacity (VC), and diffusing capacity of the lungs for carbon monoxide (DLCO). RESULTS The pulmonary hypertension incidence in the study cohort was 25%, and the severe pulmonary hypertension incidence was 6.48%. The incidence of pulmonary hypertension in ANA+ cases was 22.22%. The incidence of pulmonary hypertension in the ANA- cases was 32.14%. The lung function test results showed moderate relationships between DLCO, FVC%, VC%, and PASP; no relationship between MVV, FEV1/FVC%, RV/TLC, and PASP; minimum relationship between FVC%, VC%, and PASP in the ANA+ group; and moderate relationship between FVC%, VC%, and PASP in the ANA- group. CONCLUSIONS Pulmonary hypertension occurred in 25% of the 182 interstitial lung disease patients and was negatively associated with deteriorated lung functions (specifically VC%, FVC%, and DLCO parameters). ANA level was not associated with the prognosis of pulmonary hypertension of patients with interstitial lung disease, and it did not significantly affect the correlation between PASP and pulmonary functions. Thus, ANA level did not seem to be a necessary indicator of pulmonary hypertension, and a more effective treatment method for pulmonary hypertension of patients with interstitial lung disease is urgently needed.
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Affiliation(s)
- Hongxia Lv
- Department of Respiratory Medicine, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, P.R. China
| | - Junfeng Liu
- Department of Medical Imaging, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, P.R. China
| | - Qianqian Pan
- Department of Respiratory Medicine, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, P.R. China
| | - Renping Cai
- Department of Respiratory Medicine, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, P.R. China
| | - Junying Zhang
- Department of Respiratory Medicine, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, P.R. China
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Machado A, Quadflieg K, Oliveira A, Keytsman C, Marques A, Hansen D, Burtin C. Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review. J Clin Med 2019; 8:E1458. [PMID: 31540240 PMCID: PMC6780679 DOI: 10.3390/jcm8091458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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Affiliation(s)
- Ana Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
| | - Kirsten Quadflieg
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Charly Keytsman
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810 Aveiro, Portugal
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Jessa hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium.
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Lonzetti L, Zanon M, Pacini GS, Altmayer S, Martins de Oliveira D, Rubin AS, Gazzoni FF, Barros MC, Hochhegger B. Magnetic resonance imaging of interstitial lung diseases: A state-of-the-art review. Respir Med 2019; 155:79-85. [PMID: 31323528 DOI: 10.1016/j.rmed.2019.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/31/2019] [Accepted: 07/05/2019] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) has been emerging as an imaging modality to assess interstitial lung diseases (ILD). An optimal chest MRI protocol for ILDs should include non-contrast breath-holding sequences, steady-state free-precession sequences, and contrast-enhanced sequences. One of the main MRI applications in ILDs is the differentiation between areas of active inflammation (i.e. reversible stage) and fibrosis. Alveolitis presents high signal intensity on T2-weighted sequences (WS) and early-enhancement on contrast-enhanced MR sequences, while fibrotic-predominant lesions present low signal and late-enhancement in these sequences, respectively. MRI can be useful in connective tissue diseases, idiopathic pulmonary fibrosis, and sarcoidosis. The aim of this state-of-the-art review was to perform a state-of-the-art review on the use of MRI in ILDs, and propose the optimal MRI protocols for imaging ILDs.
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Affiliation(s)
- Lilian Lonzetti
- Department of Rheumatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, R. Sarmento Leite, 245, 90050-170, Brazil.
| | - Matheus Zanon
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Stephan Altmayer
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil.
| | - Diogo Martins de Oliveira
- School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil.
| | - Adalberto Sperb Rubin
- Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Fernando Ferreira Gazzoni
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Marcelo Cardoso Barros
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil; Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Bruno Hochhegger
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil; Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
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Margaritopoulos GA, Kokosi MA, Wells AU. Diagnosing complications and co-morbidities of fibrotic interstitial lung disease. Expert Rev Respir Med 2019; 13:645-658. [PMID: 31215263 DOI: 10.1080/17476348.2019.1632196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Interstitial lung diseases (ILDs) represent a heterogeneous group of rare disorders that include more than 200 entities, mostly associated with high mortality. In recent years, the progress regarding the understanding of the pathogenesis of these diseases led to the approval of specific treatments. In ILDs, the presence of comorbidities has a significant impact on the quality of life and the survival of patients and, therefore, their diagnosis and treatment has a pivotal role in management and could improve overall outcome. Areas covered: We discuss key diagnostic issues with regard to the most frequent comorbidities in ILDs. Treatment options are also discussed as the decision to investigate more definitively in order to identify specific comorbidities (including lung cancer, pulmonary hypertension, GE reflux, and obstructive sleep apnoea) is critically dependent upon whether comorbidity-specific treatments are likely to be helpful in individual patients, judged on a case by case basis. Expert opinion: The extent to which clinicians proactively pursue the identification of comorbidities depends on realistic treatment goals in individual patients.
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Affiliation(s)
| | - Maria A Kokosi
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
| | - Athol U Wells
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
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Frank AL, Kreuter M, Schwarzkopf L. Economic burden of incident interstitial lung disease (ILD) and the impact of comorbidity on costs of care. Respir Med 2019; 152:25-31. [PMID: 31128606 DOI: 10.1016/j.rmed.2019.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evidence about the economic burden related to interstitial lung diseases (ILDs) and the cost-driving factors is sparse. In the knowledge that distinct comorbidities affect the clinical course of ILDs, our study investigates their impact on costs of care within first year after diagnosis. METHODS Using claims data of individuals diagnosed with Idiopathic Interstitial Pneumonia (IIP) (n = 14 453) or sarcoidosis (n = 9106) between 2010 and 2013, we calculated total and ILD-associated mean annual per capita costs adjusted by age, sex and comorbidity burden via Generalized Linear Gamma models. Then, we assessed the cost impact of chronic obstructive pulmonary disease (COPD), diabetes, coronary artery disease, depression, gastro-esophageal reflux disease, pulmonary hypertension (PH), obstructive sleep apnoea syndrome (OSAS) and lung cancer using the model-based parameter estimates. RESULTS Total mean annual per capita costs were €11 131 in the pooled cohort, €12 111 in IIP and €8793 in sarcoidosis, each with a 1/3 share of ILD-associated cost. Most comorbidities had a significant cost-driving effect, which was most pronounced for lung cancer in total (1.989 pooled, 2.491 sarcoidosis, 1.696 IIP) and for PH in ILD-associated costs (2.606 pooled, 2.347 IIP, 3.648 sarcoidosis). The lung-associated comorbidities COPD, PH, OSAS more strongly affected ILD-associated than total costs. CONCLUSION Comorbidities increase the already substantial costs of care in ILDs. To support patient-centred ILD care, not only highly cost-driving conditions that are inherent with high mortality themselves require systematic management. Moreover, conditions that are more rather restricting the patient's activities of daily living should be addressed - despite a low-cost impact.
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Affiliation(s)
- Anna Lena Frank
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstraße 1, 69126, Heidelberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
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Gutierrez J, Tedaldi EM, Armon C, Patel V, Hart R, Buchacz K. Sleep disturbances in HIV-infected patients associated with depression and high risk of obstructive sleep apnea. SAGE Open Med 2019; 7:2050312119842268. [PMID: 31001423 PMCID: PMC6454647 DOI: 10.1177/2050312119842268] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/05/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate sleep disturbances in a diverse, contemporary HIV-positive patient cohort and to identify demographic, clinical, and immune correlates. METHODS A convenience sample of 176 patients from a racially and ethnically diverse HIV-positive patient cohort in an urban population. This was a cross-sectional, epidemiologic study. We surveyed participants using multiple standardized instruments to assess depression, sleep quality, and risk for sleep apnea. We analyzed demographic, behavioral, and clinical correlates. RESULTS A total of 56% of participants were female, 75% Black and 64% had heterosexual HIV risk. The median age was 49 years. Poor sleep quality (Pittsburgh Sleep Quality Index > 5) was reported by 73% of patients and 52% met insomnia diagnosis criteria. A single question about self-reported sleep problems predicted a Pittsburgh Sleep Quality Index > 5 with a sensitivity and specificity of 82% and 81%, respectively. Female sex was significantly associated with higher risk of poor sleep quality, depression, and insomnia, whereas higher risk of obstructive sleep apnea was significantly associated with older age, male sex, obesity (body mass index ⩾ 30 kg/m2), and metabolic comorbidities. High risk for obstructive sleep apnea, high rate of depression, and poor sleep hygiene represent treatment targets for sleep problems in HIV patients. CONCLUSION Sleep disturbances were common in this patient cohort, although largely undiagnosed and untreated. Sleep problems are linked to worse disease progression and increased cardiovascular mortality. Screening for sleep problems with a single question had high sensitivity and specificity. In those patients with self-reported sleep problems, screening for obstructive sleep apnea, depression, and sleep hygiene habits should be part of routine HIV care.
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Affiliation(s)
- Jeydith Gutierrez
- Department of Internal Medicine,
University of Iowa Hospitals and Clinics and The Roy J. and Lucille A. Carver
College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ellen M Tedaldi
- Section of General Internal Medicine,
Department of Medicine, Lewis Katz School of Medicine, Temple University,
Philadelphia, PA, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, MO,
USA
| | - Vaidahi Patel
- Section of General Internal Medicine,
Department of Medicine, Lewis Katz School of Medicine, Temple University,
Philadelphia, PA, USA
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers
for Disease Control and Prevention, Atlanta, GA, USA
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Chwiesko A, Kowal-Bielecka O, Sierakowski S. Perspectives on the interlinked nature of systemic sclerosis and reflux disease. Expert Rev Gastroenterol Hepatol 2019; 13:213-227. [PMID: 30791766 DOI: 10.1080/17474124.2019.1561274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic sclerosis (SSc) is a multisystem connective tissue disease, characterized by chronic inflammation and vascular changes that result in esophageal smooth muscle atrophy and fibrosis. Subsequent progressive loss of peristalsis in the distal esophagus and loss of lower esophageal sphincter function lead to problems with the protective barrier and exposure of sensitive tissues to the gastroduodenal contents, a disorder called reflux disease. Areas covered: Depending on the range, nature and symptoms of the disease, the term 'reflux disease' may refer to gastroesophageal reflux, laryngopharyngeal reflux, microaspiration into the airways and silent reflux. Despite the links between these visceral complications, this connection remains controversial. This is due to a lack of complete understanding, the asymptomatic nature of the disease and the limited diagnostic accuracy of tests, which can delay diagnosis. Such delays are problematic, given that the early detection of GERD in SSc patients, the timing of assessment, the treatment of the organs involved are critical aspects of patient prognosis and disease outcome. Expert commentary: This review summarizes the most recent knowledge about the pathophysiology, diagnosis and prospective treatment of GERD in SSc patients and highlights how innovative technologies applied through an integrative, interdisciplinary approach may soon lead to effective treatment strategies.
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Affiliation(s)
- Adam Chwiesko
- a Department of Gastroenterology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Otylia Kowal-Bielecka
- b Department of Rheumatology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Stanislaw Sierakowski
- b Department of Rheumatology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
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Wen Y, Wang D, Zhou M, Zhou Y, Guo Y, Chen W. Potential Effects of Lung Function Reduction on Health-Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020260. [PMID: 30658477 PMCID: PMC6352019 DOI: 10.3390/ijerph16020260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 01/06/2023]
Abstract
Health-related quality of life (HRQOL) was reported to reflect overall quality of life and individual perceptions related to health. Decreased lung function is associated with reduced ventilation and oxygen intake and reported to affect body functions. However, the effect of lung function reduction on HRQOL is still unclear. A total of 8398 retired workers from Dongfeng-Tongji Cohort Study were included in this cross section study. Lung function was measured using an electronic spirometer. HRQOL was evaluated through a questionnaire designed according to the WHOQOL-BREF. The mean of the HRQOL scores of its four domains (physical health, psychological state, social relationships and environment) is the total HRQOL score. A general linear model was used to analyse the association between lung function and HRQOL. In the continuous analysis by the general linear model, FVC was associated with the total HRQOL, physical health domain and social relationships domain scores. In the categorical analysis, there was a linear trend between FVC and the total HRQOL and physical health scores. We also found a similar relationship between FEV1 and HRQOL scores. Further analysis suggested that elevated lung function could improve the scores of pain and discomfort facet and independence facet of physical health domain. The lung function was significantly positively associated with HRQOL in middle-aged and older Chinese.
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Affiliation(s)
- Yuhan Wen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yun Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yanjun Guo
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Holtze C, Flaherty K, Kreuter M, Luppi F, Moua T, Vancheri C, Scholand MB. Healthcare utilisation and costs in the diagnosis and treatment of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27:27/150/180078. [DOI: 10.1183/16000617.0078-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/23/2018] [Indexed: 01/06/2023] Open
Abstract
There are over 200 interstitial lung diseases (ILDs). In addition to patients with idiopathic pulmonary fibrosis (IPF), a percentage of patients with other ILDs also develop progressive fibrosis of the lung during their disease course. Patients with progressive-fibrosing ILDs may show limited response to immunomodulatory therapy, worsening symptoms and lung function and, ultimately, early mortality. There are few data for ILDs that may present a progressive fibrosing phenotype specifically, but we believe the burden and healthcare costs associated with these conditions may be comparable to those reported in IPF. This review discusses the burden of ILDs that may present a progressive fibrosing phenotype and the factors impacting healthcare utilisation.
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Margaritopoulos GA, Trachalaki A, Wells AU, Vasarmidi E, Bibaki E, Papastratigakis G, Detorakis S, Tzanakis N, Antoniou KM. Pirfenidone improves survival in IPF: results from a real-life study. BMC Pulm Med 2018; 18:177. [PMID: 30470213 PMCID: PMC6251092 DOI: 10.1186/s12890-018-0736-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pirfenidone is an antifibrotic compound approved for the treatment of idiopathic pulmonary fibrosis (IPF). We present our real-world experience in terms of Pirfenidone's effect on mortality and adverse events profile outside the restrictions of a clinical trial. METHODS This is a retrospective observational intention to treat study of 82 consecutive IPF patients (UHH cohort). RESULTS We observed a high 3-years survival rate of 73% without excluding patients who discontinued treatment for different reasons. The survival was compared to the survival of an IPF cohort from a tertiary referral center (RBH cohort). After exclusion of severe cases (DLco< 30%), in unadjusted analysis, the survival in the UHH cohort was better than in the RBH cohort (HR:0.32, 95% CI: 0.19-0.53, p < 0.0001). After adjustment for age, gender and FVC, the survival remained higher in the UHH cohort (HR:0.28, 95% CI: 0.16-0.48, p < 0.0001). We observed a similar safety profile compared to previously published data and a lower rate of drug discontinuation due to photosensitivity reactions. CONCLUSION Pirfenidone provides a survival benefit in a real-life IPF cohort compared to previously used medications. Counselling patients and proactively managing possible adverse effects can reduce the necessity to discontinue pirfenidone.
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Affiliation(s)
- George A Margaritopoulos
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece.,Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athina Trachalaki
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Eirini Vasarmidi
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Eleni Bibaki
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | | | - Stathis Detorakis
- Radiology Department, University Hospital of Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Katerina M Antoniou
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece.
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45
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Diffuse Parenchymal Lung Diseases in the Elderly. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Witusik A, Mokros Ł, Kuna P, Nowakowska-Domagała K, Antczak A, Pietras T. Type A Behavior Pattern, Impulsiveness, Risk Propensity, and Empathy as Predictors of Dyspnea and Number of Infections in Men with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study. Med Sci Monit 2018; 24:3832-3839. [PMID: 29874681 PMCID: PMC6018375 DOI: 10.12659/msm.907742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/15/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stress and psychological factors can induce dyspnea in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess selected elements of the clinical presentation of COPD in the context of the severity of type A pattern of behavior, impulsiveness, and tendency for empathy. MATERIAL AND METHODS This was a cross-sectional study. The study group consisted of 179 men with COPD and the control group consisted of 31 healthy male smokers. In all patients, the number of infectious exacerbations over the past year, the result on the dyspnea scale (MRC), and the FEV1-to- predicted FEV1 ratio was assessed. The A pattern of behavior was measured using the Type A scale. To measure impulsivity, risk propensity, and empathy, the IVE impulsivity questionnaire was used. RESULTS An increase in the number of infectious exacerbations was associated with an increased score on the Type A scale, an increase in risk propensity, and a decrease in impulsivity score. Increased severity of dyspnea was associated with an increase in Type A behavior pattern score and an increase in the risk propensity score. CONCLUSIONS Type A behavior pattern and risk propensity are independent predictors of the number of infections in the last year and of the subjective severity of dyspnea among men with COPD and healthy male smokers.
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Affiliation(s)
- Andrzej Witusik
- Department of Psychology, Institute of Pedagogical Sciences, Faculty of Social Science, Piotrków Trybunalski Branch, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Łódź, Łódź, Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy, Medical University of Łódź, Łódź, Poland
| | | | - Adam Antczak
- Department of General and Oncological Pulmonology, Medical University of Łódź, Łódź, Poland
| | - Tadeusz Pietras
- Department of Clinical Pharmacology, Medical University of Łódź, Łódź, Poland
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Szentes BL, Kreuter M, Bahmer T, Birring SS, Claussen M, Waelscher J, Leidl R, Schwarzkopf L. Quality of life assessment in interstitial lung diseases:a comparison of the disease-specific K-BILD with the generic EQ-5D-5L. Respir Res 2018; 19:101. [PMID: 29801506 PMCID: PMC5970441 DOI: 10.1186/s12931-018-0808-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background Patients with interstitial lung diseases (ILD) have impaired health-related quality of life (HRQL). Little is known about the applicability of the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) and the generic EQ-5D-5L in a German setting. Methods We assessed disease-specific (K-BILD) and generic HRQL (EQ-5D experience based value set (EBVS) and Visual Analog Scale (VAS)) in 229 patients with different ILD subtypes in a longitudinal observational study (HILDA). Additionally, we assessed the correlation of the HRQL measures with lung function and comorbidities. In a linear regression model, we investigated predictors (including age, sex, ILD subtype, FVC percentage of predicted value (FVC%pred), DLCO percentage of predicted value, and comorbidities). Results Among the 229 patients mean age was 63.2 (Standard deviation (SD): 12.9), 67.3% male, 24.0% had idiopathic pulmonary fibrosis, and 22.3% sarcoidosis. Means scores were as follows for EQ-5D EBVS 0.66(SD 0.17), VAS 61.4 (SD 19.1) and K-BILD Total 53.6 (SD 13.8). K-BILD had good construct validity (high correlation with EQ-5D EBVS (0.71)) and good internal consistency (Cronbach’s alpha 0.89). Moreover, all HRQL measures were highly accepted by patients including low missing items and there were no ceiling or floor effects. A higher FVC % pred was associated with higher HRQL in all measures meanwhile comorbidities had a negative influence on HRQL. Conclusions K-BILD and EQ-5D had similar HRQL trends and were associated similarly to the same disease-related factors in Germany. Our data supports the use of K-BILD in clinical practice in Germany, since it captures disease specific effects of ILD. Additionally, the use of the EQ-5D-5L could provide comparison to different disease areas and give an overview about the position of ILD patients in comparison to general population. Electronic supplementary material The online version of this article (10.1186/s12931-018-0808-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Boglárka Lilla Szentes
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases Pneumology and Respiratory Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse, 169126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm, 80 22927, Großhansdorf, Germany
| | - Surinder S Birring
- Centre of Human & Aerospace Physiological Sciences, School of Basic & Medical Biosciences Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.,Department of Respiratory Medicine, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm, 80 22927, Großhansdorf, Germany
| | - Julia Waelscher
- Center for Interstitial and Rare Lung Diseases Pneumology and Respiratory Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse, 169126, Heidelberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Ludwigstr. 28, 80539, Munich, RG, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
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Schwarzkopf L, Witt S, Waelscher J, Polke M, Kreuter M. Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases - a claims data analysis. Respir Res 2018; 19:73. [PMID: 29695236 PMCID: PMC5918773 DOI: 10.1186/s12931-018-0769-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/02/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are associated with a high burden of disease. However, data on the prognostic impact of comorbidities and comorbidity-related pharmaceutical treatments in patients with various ILDs remain sparse. METHODS Using longitudinal claims data from a German Statutory Health Insurance Fund, we assessed comorbidity in ILD subtypes and associated drug treatments. Baseline comorbidity was assessed via the Elixhauser Comorbidity Index that was amended by ILD-relevant conditions. Drug treatment was assessed on the substance level using the ATC-codes of drugs prescribed at the time of ILD diagnosis. Subsequently, the comorbid conditions (main analysis) and pharmaceutical substances (secondary analysis) with a meaningful association to survival were identified for the complete ILD cohort and within the subtype strata. For this, we applied multivariate Cox models using a LASSO selection process and visualized the findings within comorbidomes. RESULTS In the 36,821 patients with ILDs, chronic obstructive pulmonary disease (COPD), arterial hypertension, and ischaemic heart disease (IHD) were the most prevalent comorbidities. The majority of patients with cardiovascular diseases received pharmaceutical treatment, while, in other relevant comorbidities, treatment quotas were low (COPD 46%, gastro-oesophageal reflux disease 65%). Comorbidities had a clinically meaningful detrimental effect on survival that tended to be more pronounced in the case of untreated conditions (e.g. hazard ratios for treated IHD 0.97 vs. 1.33 for untreated IHD). Moreover, comorbidity impact varied substantially between distinct subtypes. CONCLUSIONS Our analyses suggest that comorbid conditions and their treatment profile significantly affect mortality in various ILDs. Therefore, comprehensive comorbidity assessment and management remains important in any ILD.
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Affiliation(s)
- Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Sabine Witt
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Julia Waelscher
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse 1, 69126, Heidelberg, Germany.
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