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Iversen IB, Vestergaard JM, Ohlander J, Peters S, Bendstrup E, Bonde JPE, Schlünssen V, Bønløkke JH, Rasmussen F, Stokholm ZA, Andersen MB, Kromhout H, Kolstad HA. The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population. Scand J Work Environ Health 2024:4153. [PMID: 38577971 DOI: 10.5271/sjweh.4153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population. METHODS We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders. RESULTS The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population. CONCLUSIONS This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.
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Affiliation(s)
- Inge Brosbøl Iversen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Elkjær AL, Næser EU, Aaen KT, Hovgaard HL, Juhl-Olsen P, Bendstrup E, Søndergaard K. Validity and reliability of measurement of peripheral oxygen saturation during the 6-Minute Walk Test in patients with systemic sclerosis. Rheumatol Int 2024; 44:611-620. [PMID: 38340159 PMCID: PMC10914912 DOI: 10.1007/s00296-024-05532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/30/2023] [Indexed: 02/12/2024]
Abstract
Peripheral oxygen saturation (SpO2) using the fingers may have important limitations due to Raynaud's phenomenon and sclerodactyly in patients with systemic sclerosis (SSc). Sensors located at more central body positions may be more accurate as these as less prone to Raynaud attacks. To determine the validity and reliability of the SpO2 measured at the finger, forehead, and earlobe during the 6-Minute Walk Test (6MWT). Eighty two patients with SSc had an arterial line placed while performing the 6MWT. Peripheral oxygen saturation was simultaneously measured by finger, forehead, and earlobe sensors and compared to the arterial oxygen saturation (SaO2) measured before and after the 6MWT. 40 patients repeated the 6MWT one week later to determine re-test reliability. We used Bland-Altman plots to display the agreement between SpO2 and SaO2. The intraclass correlation coefficient for repeated measurement of minimum SpO2 was calculated. The mean difference between SpO2 and SaO2 after the 6MWT was - 3% (SD: ± 5), 0% (SD: ± 2), and 1% (SD: ± 2) for the finger, forehead, and earlobe, respectively. The minimum SpO2 measured at the finger demonstrated the poorest re-test reliability: The ICC (95% CI) showed good agreement using the ear and forehead probe (ICCear = 0.89 [95% CI 0.80; 0.94]; ICCforehead = 0.77 [95% CI 0.60; 0.87]), while a modest reliability was found using the finger probe (ICCfinger = 0.65 95% CI [0.43; 0.80]). SpO2 should be measured using either the earlobe or forehead during the 6MWT in patients with SSc. Clinical Trials.Gov (NCT04650659).
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Affiliation(s)
- Amanda Lynggaard Elkjær
- The Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 59, 8200, Aarhus N, Denmark
| | - Esben Uggerby Næser
- The Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 59, 8200, Aarhus N, Denmark.
- The Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 91, 8200, Aarhus N, Denmark.
| | - Katja Thorup Aaen
- The Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 59, 8200, Aarhus N, Denmark
| | - Henrik Lynge Hovgaard
- The Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Juhl-Olsen
- The Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- The Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 91, 8200, Aarhus N, Denmark
| | - Elisabeth Bendstrup
- The Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 91, 8200, Aarhus N, Denmark
- The Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Klaus Søndergaard
- The Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 59, 8200, Aarhus N, Denmark
- The Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 91, 8200, Aarhus N, Denmark
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Østergård NM, Møller J, Kronborg-White S, Prior TS, Kølner-Augustson L, Iversen IB, Kolstad H, Bendstrup E. A new definition and treatment options of allergic alveolitis. Ugeskr Laeger 2024; 186:V11230705. [PMID: 38606704 DOI: 10.61409/v11230705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In this review, we discuss a new definition and treatment options of allergic alveolitis (AA). AA is an immune-mediated interstitial lung disease triggered by inhaled antigens, it is defined as non-fibrotic (inflammatory) and/or fibrotic, and diagnosis relies on a multidisciplinary approach using clinical, radiological and sometimes histological assessments. Treatment involves early antigen elimination and may include corticosteroids or other immunosuppressants. Prognosis varies from reversible inflammation to irreversible fibrosis. Early detection is crucial for better outcomes.
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Affiliation(s)
| | - Janne Møller
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
| | - Sissel Kronborg-White
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
| | - Thomas Skovhus Prior
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
| | | | | | - Henrik Kolstad
- Arbejdsmedicin, Aarhus Universitetshospital
- Klinisk Institut, Aarhus Universitet
| | - Elisabeth Bendstrup
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
- Klinisk Institut, Aarhus Universitet
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4
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Lynn E, Forde SH, Franciosi AN, Bendstrup E, Veltkamp M, Wind AE, Van Moorsel CHM, Lund TK, Durheim MT, Peeters EFHI, Keane MP, McCarthy C. Updated Prevalence of Lymphangioleiomyomatosis in Europe. Am J Respir Crit Care Med 2024; 209:456-459. [PMID: 38060201 DOI: 10.1164/rccm.202310-1736le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Evelyn Lynn
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sarah H Forde
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcel Veltkamp
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Division of Heart and Lungs and
| | - Anne E Wind
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Coline H M Van Moorsel
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Thomas Kromann Lund
- Section for Lung Transplantation, Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michael Thomas Durheim
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; and
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Evelien F H I Peeters
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Kirkeby MH, Bendstrup E, Rose HK. Case report: If it is not asthma-think of lymphangioleiomyomatosis in younger female patients. Front Med (Lausanne) 2024; 11:1328471. [PMID: 38410750 PMCID: PMC10895031 DOI: 10.3389/fmed.2024.1328471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare lung disease predominantly affecting women, and it is characterized by the proliferation of smooth muscle cells and cystic lung destruction. LAM diagnosis is challenging due to varied clinical presentations and resemblance to common conditions such as asthma. We present two female cases where LAM was initially misdiagnosed. Case 1 describes a woman treated for asthma-chronic obstruction pulmonary disease overlap syndrome, while also undergoing treatment with vascular endothelial growth factor (VEGF) inhibitor pazopanib for a retroperitoneal leiomyoma, the latter responding well to treatment. Due to progressive dyspnea, pazopanib-induced pneumonitis was suspected. High-resolution computed tomography (HRCT) showed changes compatible with LAM. A revision of biopsies showed that the leiomyoma was in fact a lymphangioleiomyoma, and VEGF-D was increased. Both supported the LAM diagnosis. Treatment with mTORC1 inhibitor sirolimus was initiated. Case 2 describes a woman, who in resemblance with the woman from case 2 was also suspected of asthma and did not respond clinically to treatment. After several years, HRCT was performed and suspicion of LAM was raised. Transbronchial biopsy and later, an increased VEGF-D supported the LAM diagnosis. As in case 1, treatment with sirolimus was initiated. These cases underscore the importance of reevaluating diagnoses when treatments fail to yield expected results. Improved awareness and early detection of LAM can enhance patient outcomes and life quality. Early LAM diagnosis is vital as mTORC1 inhibitors such as sirolimus can prevent further decline in lung function. Notably, the response of case 2 to pazopanib treatment supports suggestions of its potential as a second-line therapy for perivascular epithelioid cell tumors (PEComas), including LAM.
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Affiliation(s)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hanne Krogh Rose
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Rastoder E, Kamstrup P, Hedsund C, Jordan A, Sivapalan P, Rømer V, Falkvist F, Hamidi S, Bendstrup E, Sperling S, Dons M, Biering-Sørensen T, Falster C, Laursen CB, Carlsen J, Jensen JUS. Thrombelastography and Conventional Coagulation Markers in Chronic Obstructive Pulmonary Disease: A Prospective Paired-Measurements Study Comparing Exacerbation and Stable Phases. Int J Mol Sci 2024; 25:2051. [PMID: 38396728 PMCID: PMC10889576 DOI: 10.3390/ijms25042051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up.
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Affiliation(s)
- Ema Rastoder
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Caroline Hedsund
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Alexander Jordan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Valdemar Rømer
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Frederikke Falkvist
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Sadaf Hamidi
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
| | - Maria Dons
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Casper Falster
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Jørn Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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Hvelplund CY, Refsgaard B, Bendstrup E. Perceptions on Use of Opioids in Palliative Care of Dyspnoea in Patients with Fibrotic interstitial lung disease and Chronic Obstructive Pulmonary Disease: A Qualitative Study. Am J Hosp Palliat Care 2024:10499091241227556. [PMID: 38326740 DOI: 10.1177/10499091241227556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Many patients with chronic obstructive pulmonary disease and fibrotic interstitial lung disease suffer from severe dyspnea and reduced quality of life, despite receiving optimal disease-modifying treatment for their illness. Studies have suggested that these patients may benefit from treatment with low-dose opioids. However, many patients decline opioid treatment. This has led to patients not receiving proper palliative treatment of their lung disease. AIM To identify potential barriers that prevent patients from receiving adequate palliative care with opioids and enable doctors to address patients' concerns. DESIGN A qualitative study based on semi-structured interviews. Interviews were transcribed and thematic analysis was done using NVivo. SETTING/PARTICIPANTS Patients were recruited when scheduled for out-patient follow-up at Center for Rare Lung Diseases or at the COPD clinic, Aarhus University Hospital. Eligible patients were 18 years of age, did not currently receive opioids or had ever received opioids for dyspnea. RESULTS A total of 28 patients participated. One patient was excluded before final analysis of 27 patients. Four themes were identified: Fear of side-effects, Need for more information, Stigma of opioids association with severe illness and dying, and No discernible barriers. Furthermore, three sub-themes to Fear of side-effects were identified: Fear of addiction, concern for sedative effect, and fear for loss of mobility due to inability to drive a car. The most expressed concern was Fear of side-effects, especially addiction. CONCLUSIONS Pre-conceived notions about opioids prevent some patients with chronic obstructive lung disease or interstitial lung disease from receiving palliative care for breathlessness.
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Affiliation(s)
- Camilla Yde Hvelplund
- Department of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Birgit Refsgaard
- COPD Clinic, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Østergård NM, Huremovic J, Davidsen JR, Andersen MB, Shaker SB, Harders SMW, Lund TK, Prior TS, Bendstrup E. Identifikation og håndtering af interstitielle lungeabnormaliteter. Ugeskr Laeger 2024; 186:V06230395. [PMID: 38235774 DOI: 10.61409/v06230395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Interstitial lung abnormalities (ILA) are incidentally observed specific CT findings in patients without clinical suspicion of interstitial lung disease (ILD). ILA with basal and peripheral predominance and features suggestive of fibrosis in more than 5% of any part of the lung should be referred for pulmonologist review. The strategy for monitoring as described in this review is based on clinical and radiological risk factors. ILA are associated with risk of progression to ILD and increased mortality. Early identification and assessment of risk factors for progression are essential to improve outcome.
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Affiliation(s)
| | | | | | | | - Saher Burhan Shaker
- Lungemedicinsk Sektion, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | | | - Thomas Kromann Lund
- Afsnit for Lungetransplantation, Københavns Universitetshospital - Rigshospitalet
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Kristensen K, Møller J, Terkelsen AJ, Harbo T, Gormsen LC, Hansen IT, Bendstrup E. A rare case of sarcoid myelitis complicating Löfgren's syndrome. Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023052. [PMID: 38126509 DOI: 10.36141/svdld.v40i4.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/14/2023] [Indexed: 12/23/2023]
Abstract
Neurosarcoidosis is a rare and serious condition. Rapid diagnosis and treatment are crucial to prevent morbidity and mortality. When neurological symptoms are not present at the time of diagnosis, CNS involvement can be undetected. We present a case of neurosarcoidosis complicating Löfgren's syndrome and discus the challenges in diagnostics and treatment, that can be encountered.
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Affiliation(s)
- Katrine Kristensen
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital.
| | - Janne Møller
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University.
| | - Astrid Juhl Terkelsen
- Department of Neurology, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University, Danish Pain Research Centre, Aarhus University.
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University.
| | | | | | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University.
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Luppi F, Manfredi A, Faverio P, Andersen MB, Bono F, Pagni F, Salvarani C, Bendstrup E, Sebastiani M. The usual Interstitial pneumonia pattern in autoimmune rheumatic diseases. BMC Pulm Med 2023; 23:501. [PMID: 38082233 PMCID: PMC10714466 DOI: 10.1186/s12890-023-02783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Usual Interstitial Pneumonia (UIP) is characterized by progression of lung parenchyma that may be observed in various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis and connective tissue diseases. From a diagnostic point of view, a UIP pattern related to ARDs may display imaging and pathological features able to distinguish it from that related to IPF, such as the "straight-edge" sign at HRCT and lymphoplasmacytic infiltrates at histologic specimens. Multidisciplinary approach (MDD), involving at least pulmonologist, rheumatologist and radiologist, is fundamental in the differential diagnosis process, but MDD is also required in the evaluation of severity, progression and response to treatment, that is based on the combination of changes in symptoms, pulmonary function trends, and, in selected patients, serial CT evaluation. Differently from IPF, in patients with ARDs both functional evaluation and patient-reported outcomes may be affected by systemic involvement and comorbidities, including musculoskeletal manifestations of disease. Finally, in regards to pharmacological treatment, immunosuppressants have been considered the cornerstone of therapy, despite the lack of solid evidence in most cases; recently, antifibrotic drugs were also proposed for the treatment of progressive fibrosing ILDs other than IPF. In ARD-ILD, the therapeutic choice should balance the need for the control of systemic and lung involvements with the risk of adverse events from multi-morbidities and -therapies. Purpose of this review is to summarize the definition, the radiological and morphological features of the UIP pattern in ARDs, together with risk factors, diagnostic criteria, prognostic evaluation, monitoring and management approaches of the UIP-ARDs.
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Affiliation(s)
- Fabrizio Luppi
- Respiratory Disease, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Paola Faverio
- Respiratory Disease, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michael Brun Andersen
- Copenhagen University Hospital Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Francesca Bono
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Pagni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Elisabeth Bendstrup
- Center for Rare Lung Disease, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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Maher TM, Stowasser S, Voss F, Bendstrup E, Kreuter M, Martinez FJ, Sime PJ, Stock C. Decline in forced vital capacity as a surrogate for mortality in patients with pulmonary fibrosis. Respirology 2023; 28:1147-1153. [PMID: 37646126 DOI: 10.1111/resp.14579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Surrogate endpoints enable determination of meaningful treatment effects more efficiently than applying the endpoint of ultimate interest. We used data from trials of nintedanib in subjects with pulmonary fibrosis to assess decline in forced vital capacity (FVC) as a surrogate for mortality. METHODS Data from the nintedanib and placebo groups of trials in subjects with idiopathic pulmonary fibrosis, other forms of progressive pulmonary fibrosis, and pulmonary fibrosis due to systemic sclerosis (NCT00514683, NCT01335464, NCT01335477, NCT01979952, NCT02999178, NCT02597933) were pooled. Using joint models for longitudinal and time-to-event data, we assessed the association between decline in FVC % predicted and time to death over 52 weeks. The rate of change in FVC % predicted and the current value of FVC % predicted were modelled longitudinally and estimates applied as predictors in time-to-event models. RESULTS Among 2583 subjects with pulmonary fibrosis, both a greater rate of decline in FVC % predicted and a lower current value of FVC % predicted were associated with an increased risk of death over 52 weeks (HR 1.79 [95% CI: 1.57, 2.03] and HR 1.24 [1.17, 1.32] per 5-percentage point decrease, respectively). Associations between the rate of change in FVC % predicted and the risk of death were consistent between patients with IPF and other ILDs. CONCLUSION Data from clinical trials in subjects with pulmonary fibrosis of diverse aetiology demonstrate a strong association between decline in FVC % predicted and mortality over 52 weeks, supporting FVC decline as a surrogate for mortality in these patients.
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Affiliation(s)
- Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Imperial College London, London, UK
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Florian Voss
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Patricia J Sime
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christian Stock
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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12
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Farver-Vestergaard I, Mousing CA, Løkke A, Bock K, Christensen TD, Bendixen M, Bendstrup E, Jørgensen LHK, King KL. Endobronchial valve treatment in chronic obstructive pulmonary disease: A qualitative study of patients' expectations. SAGE Open Med 2023; 11:20503121231205709. [PMID: 37846369 PMCID: PMC10576923 DOI: 10.1177/20503121231205709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
Objectives Endobronchial valve (EBV) treatment is a treatment option for selected patients with severe chronic obstructive pulmonary disease (COPD) to reduce dyspnea and improve quality of life. However, the procedure is associated with risk of complications, and not all patients achieve the expected outcomes. The present study explores patients' expectations while waiting for EBV treatment. Methods Fifteen patients accepted for EBV treatment at Aarhus University Hospital in Denmark from October 2020 to June 2021 participated in a 30-min, semi-structured interview about (1) the experience of living with COPD and (2) expectations regarding EBV. Results Four themes were identified: a life of reduced quality; hopes and expectations; information about EBV; and perception of risks. Most patients described their lives as not worth living, and they hoped that EBV would give them their physical and social lives back, while also being aware that EBV would probably not work miracles. Patients' information seeking was influenced by their hopes and expectations to the treatment. They filtered out negative information, focusing on the hope for a positive outcome. This made them willing to run the risk of complications. Conclusion Living a life of considerably reduced quality, patients might have an increased focus on potential positive effects of EBV treatment while filtering out information about potential side effects. This might bias their decision-making process.
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Affiliation(s)
- Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Askov Mousing
- VIA Research Centre for Health and Welfare Technology, Centre for Research in Health and Nursing, Viborg, Denmark
- Faculty of Health Sciences, VIA University College Nursing, Randers, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kathrine Bock
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Karoline Litrup King
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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13
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Sperling S, Leth S, Fløe A, Hyldgaard C, Gissel T, Topcu A, Kristensen L, Sønderskov Dahl L, Martin Schmid J, Jensen-Fangel S, Bendstrup E. Twelve-month follow-up after hospitalization for SARS-COV-2: Physiology improves, symptoms remain. Infect Dis Now 2023; 53:104686. [PMID: 36842501 PMCID: PMC9957660 DOI: 10.1016/j.idnow.2023.104686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Persistent symptoms on short-term follow-up after infection with COVID-19 are common, but long-term consequences have been insufficiently studied. The aim of this study was to characterize pulmonary function and ongoing symptoms 12 months after hospitalization with COVID-19. METHODS This prospective multicenter study included 222 patients hospitalized with PCR-confirmed COVID-19 in the Central Denmark Region. Disease severity was stratified using WHO Clinical Progression Scale. Clinical characteristics, pulmonary function test (PFT), 6-minute walk test (6MWT), and patient-reported outcome measures were collected at follow-up 3 and 12 months after discharge. Outcome measures from follow-up 3 months after discharge have previously been published. RESULTS A total of 179 (81%) patients completed the 12-month follow-up. Median age was 60 years (IQR 51, 69) and 58% were male patients. At 12-month follow-up 49.7% had a normal diffusion capacity for carbon monoxide (DLCO), while 39.4% had DLCO < 80%. The 6MWT distance increased significantly (29 m 95% CI 19, 40; p < 0.01). An mMRC score of 0 was reported by 51% and an mMRC ≥ 2 by 20%. The frequency and severity of fatigue, depression, and anxiety did not improve over time. CONCLUSIONS The study found that impaired DLCO percentage is common 12 months after hospitalization with SARS-CoV-2 and reduction in DLCO percentage is associated to dyspnea.
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Affiliation(s)
- Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Steffen Leth
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Internal Medicine, Gødstrup Hospital, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | | | - Tina Gissel
- Department of Internal Medicine, Viborg Regional Hospital, Denmark
| | - Ayfer Topcu
- Department of Internal Medicine, Regional Hospital Horsens, Denmark
| | | | | | - Johannes Martin Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Søren Jensen-Fangel
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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14
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Kamstrup P, Sivapalan P, Rønn C, Rastoder E, Modin D, Kristensen AK, Bendstrup E, Sørensen R, Biering-Sørensen T, Ulrik CS, Vestbo J, Jensen JU. Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study. Respir Res 2023; 24:172. [PMID: 37370121 DOI: 10.1186/s12931-023-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment,, and (iii) distribution of D-dimer in patients with moderate to severe COPD. METHODS Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital - Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. RESULTS In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1-4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8-3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp - -0.4pp) in the fully adjusted regression. CONCLUSIONS In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Christian Rønn
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Ema Rastoder
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Anna Kjaer Kristensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Elisabeth Bendstrup
- Department Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, 8000, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8200, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, 2100, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, 2650, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark.
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15
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Hummersgaard Hansen A, Wallem Breisnes H, Skovhus Prior T, Hilberg O, Guldager Kring Rasmussen D, Genovese F, Vestergaard Lukassen M, Svensson B, Løcke Langholm L, Manon-Jensen T, Asser Karsdal M, Julie Leeming D, Bendstrup E, Marie Bülow Sand J. A serologically assessed neo-epitope biomarker of cellular fibronectin degradation is related to pulmonary fibrosis. Clin Biochem 2023; 118:110599. [PMID: 37343745 DOI: 10.1016/j.clinbiochem.2023.110599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is characterized by excessive extracellular matrix (ECM) remodeling, herein ECM degradation. Fibronectin (FN) is an important component of the ECM that is produced by multiple cell types, including fibroblasts. Extra domain B (EDB) is specific for a cellular FN isoform which is found in the ECM. We sought to develop a non-invasive test to investigate whether matrix metalloproteinase 8 (MMP-8) degradation of EDB in cellular FN results in a specific protein fragment that can be assessed serologically and if levels relate to pulmonary fibrosis. METHOD Cellular FN was cleaved in vitro by MMP-8 and a protein fragment was identified by mass spectrometry. A monoclonal antibody (mAb) was generated, targeting a neo-epitope originating from EDB in cellular FN. Utilizing this mAb, a neo-epitope specific enzyme-linked immunosorbent assay (FN-EDB) was developed and technically validated. Serum FN-EDB was assessed in an IPF cohort (n=98), registered at clinicaltrials.gov (NCT02818712), and in healthy controls (n=35). RESULTS The FN-EDB assay had high specificity for the MMP-8 degraded neo-epitope and was technically robust. FN-EDB serum levels were not influenced by age, sex, ethnicity, or BMI. Moreover, FN-EDB serum levels were significantly higher in IPF patients (median 31.38 [IQR 25.79-46.84] ng/mL) as compared to healthy controls (median 28.05 [IQR 21.58-33.88] ng/mL, p=0.023). CONCLUSION We developed the neo-epitope specific FN-EDB assay, a competitive ELISA, as a tool for serological assessment of MMP-8 mediated degradation of EDB in cellular FN. This study indicates that degradation of EDB in cellular FN is elevated in IPF and warrants further investigation.
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Affiliation(s)
- Annika Hummersgaard Hansen
- Hepatic and Pulmonary Research, Nordic Bioscience, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Helene Wallem Breisnes
- Hepatic and Pulmonary Research, Nordic Bioscience, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus Denmark
| | - Ole Hilberg
- Medical Department Vejle Hospital, Southern Danish University Hospital, Vejle, Denmark
| | | | | | | | - Birte Svensson
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark
| | | | | | | | | | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus Denmark
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16
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Vaarst JK, Sperling S, Dahl VN, Fløe A, Laursen CB, Gissel TN, Gjoerup PH, Bendstrup E. Lung abscess: Clinical characteristics of 222 Danish patients diagnosed from 2016 to 2021. Respir Med 2023:107305. [PMID: 37302422 DOI: 10.1016/j.rmed.2023.107305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Lung abscess (LA) is a serious respiratory infection often followed by several weeks of antibiotic treatment. This study described the clinical presentation of LA, treatment duration and mortality in a contemporary Danish population. METHODS In a retrospective multicenter cohort study at four Danish hospitals, patients diagnosed with LA were identified using the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) between 2016 and 2021. A predefined data collection tool was used to extract data on demographics, symptoms, clinical findings and treatment. RESULTS Of 302 patients, 222 with LA were included after review of patient records (76%). Mean age was 65 years (54-74), 62.9% was male and 74.9% were ever-smokers. Chronic obstructive pulmonary disease (COPD) (35.1%), use of sedatives (29.3%) and alcohol abuse (21.8%) were common risk factors. Dental status was reported in 51.4%, whereof 41.6% had poor dental status. Patients presented with cough (78.8%), malaise (61.3%) and fever (56.8%) Patients were hospitalized for a median of 14 days (interquartile ranges, IQR 7-21) and median duration of antibiotic treatment was 38 days (IQR 30-51). All-cause mortality after 1, 3 and 12 months was 2.7%, 7.7% and 15.8%, respectively. CONCLUSION Risk factors for LA include COPD and use of sedatives, alcohol abuse, and poor dental status. Despite long-term antibiotic treatment, long-term mortality is markedly high.
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Affiliation(s)
| | - Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Christian Borbjerg Laursen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN) Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Region of Southern Denmark, Denmark
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Kronborg-White S, Bendstrup E, Madsen LB, Rasmussen F, Poletti V. Association between Parenchymal B-Cell Follicles and CT-Proven Enlarged Mediastinal Lymph Nodes in Patients with Pulmonary Fibrosis. Respiration 2023; 102:515-522. [PMID: 37290416 DOI: 10.1159/000530474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Mediastinal lymph node enlargement (MLNE) is a finding described in a subset of patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs) and is associated with accelerated disease progression and increased mortality. The cause of MLNE is still not known. Our hypothesis is that there is an association between MLNE and B-cell follicles in lung tissue, another aspect detectable in the lung tissue of patients with IPF and other ILDs. OBJECTIVES The aim of this study was to assess if there is an association between MLNE and B-cell follicles in lung tissue in patients with IPF and other ILDs. METHOD Patients having transbronchial cryobiopsies performed as part of an investigation for ILD were included in this prospective observational study. MLNE (smallest diameter ≥10 mm) were assessed in station 7, 4R, and 4L on high-resolution computed tomography scans. B-cell follicles were assessed on haematoxylin-eosin-stained specimens. Lung function, 6-minute walk test, acute exacerbation, and mortality were registered after 2 years. In addition, we investigated if the finding of B-cell follicles was consistent in patients who underwent both surgical lung biopsies (SLBs) and cryobiopsies. RESULTS In total, 93 patients were included for analysis (46% diagnosed with IPF, 54% diagnosed with other ILDs). MLNE was found in 26 (60%) of the IPF patients and in 23 (46%) of the non-IPF patients (p = 0.164). Diffusing capacity for carbon monoxide was significantly lower (p = 0.03) in patients with MLNE compared to patients without MLNE. B-cell follicles were found in 11 (26%) of the IPF patients and in 22 (44%) of the non-IPF patients (p = 0.064). Germinal centres were not seen in any of the patients. There was no association between MLNE and B-cell follicles (p = 0.057). No significant difference in change of pulmonary function test was seen at 2-year follow-up when comparing the patients with and without MLNE or B-cell follicles. In 13 patients, both SLBs and cryobiopsies were performed. The presence of B-cell follicles was not consistent when comparing the two different methods. CONCLUSION MLNE is evident in a substantial part of patients with ILD and is associated with lower DLCO at inclusion. We could not demonstrate an association between histological B-cell follicles in biopsies and MLNE. A possible explanation for this is that the cryobiopsies might not have captured the changes we sought.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
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18
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Jönsson ÅLM, Hilberg O, Simonsen U, Christensen JH, Bendstrup E. New insights in the genetic variant spectrum of SLC34A2 in pulmonary alveolar microlithiasis; a systematic review. Orphanet J Rare Dis 2023; 18:130. [PMID: 37259144 DOI: 10.1186/s13023-023-02712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive lung disease caused by variants in the SLC34A2 gene encoding the sodium-dependent phosphate transport protein 2B, NaPi-2b. PAM is characterized by deposition of calcium phosphate crystals in the alveoli. Onset and clinical course vary considerably; some patients remain asymptomatic while others develop severe respiratory failure with a significant symptom burden and compromised survival. It is likely that PAM is under-reported due to lack of recognition, misdiagnosis, and mild clinical presentation. Most patients are genetically uncharacterized as the diagnostic confirmation of PAM has traditionally not included a genetic analysis. Genetic testing may in the future be the preferred tool for diagnostics instead of invasive methods. This systematic review aims to provide an overview of the growing knowledge of PAM genetics. Rare variants in SLC34A2 are found in almost all genetically tested patients. So far, 34 allelic variants have been identified in at least 68 patients. A majority of these are present in the homozygous state; however, a few are found in the compound heterozygous form. Most of the allelic variants involve only a single nucleotide. Half of the variants are either nonsense or frameshifts, resulting in premature termination of the protein or decay of the mRNA. There is currently no cure for PAM, and the only effective treatment is lung transplantation. Management is mainly symptomatic, but an improved understanding of the underlying pathophysiology will hopefully result in development of targeted treatment options. More standardized data on PAM patients, including a genetic diagnosis covering larger international populations, would support the design and implementation of clinical studies to the benefit of patients. Further genetic characterization and understanding of how the molecular changes influence disease phenotype will hopefully allow earlier diagnosis and treatment of the disease in the future.
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Affiliation(s)
- Åsa Lina M Jönsson
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark.
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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19
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Peljto AL, Blumhagen RZ, Walts AD, Cardwell J, Powers J, Corte TJ, Dickinson JL, Glaspole I, Moodley YP, Vasakova MK, Bendstrup E, Davidsen JR, Borie R, Crestani B, Dieude P, Bonella F, Costabel U, Gudmundsson G, Donnelly SC, Egan J, Henry MT, Keane MP, Kennedy MP, McCarthy C, McElroy AN, Olaniyi JA, O’Reilly KMA, Richeldi L, Leone PM, Poletti V, Puppo F, Tomassetti S, Luzzi V, Kokturk N, Mogulkoc N, Fiddler CA, Hirani N, Jenkins RG, Maher TM, Molyneaux PL, Parfrey H, Braybrooke R, Blackwell TS, Jackson PD, Nathan SD, Porteous MK, Brown KK, Christie JD, Collard HR, Eickelberg O, Foster EE, Gibson KF, Glassberg M, Kass DJ, Kropski JA, Lederer D, Linderholm AL, Loyd J, Mathai SK, Montesi SB, Noth I, Oldham JM, Palmisciano AJ, Reichner CA, Rojas M, Roman J, Schluger N, Shea BS, Swigris JJ, Wolters PJ, Zhang Y, Prele CMA, Enghelmayer JI, Otaola M, Ryerson CJ, Salinas M, Sterclova M, Gebremariam TH, Myllärniemi M, Carbone RG, Furusawa H, Hirose M, Inoue Y, Miyazaki Y, Ohta K, Ohta S, Okamoto T, Kim DS, Pardo A, Selman M, Aranda AU, Park MS, Park JS, Song JW, Molina-Molina M, Planas-Cerezales L, Westergren-Thorsson G, Smith AV, Manichaikul AW, Kim JS, Rich SS, Oelsner EC, Barr RG, Rotter JI, Dupuis J, O’Connor G, Vasan RS, Cho MH, Silverman EK, Schwarz MI, Steele MP, Lee JS, Yang IV, Fingerlin TE, Schwartz DA. Idiopathic Pulmonary Fibrosis Is Associated with Common Genetic Variants and Limited Rare Variants. Am J Respir Crit Care Med 2023; 207:1194-1202. [PMID: 36602845 PMCID: PMC10161752 DOI: 10.1164/rccm.202207-1331oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) is a rare, irreversible, and progressive disease of the lungs. Common genetic variants, in addition to nongenetic factors, have been consistently associated with IPF. Rare variants identified by candidate gene, family-based, and exome studies have also been reported to associate with IPF. However, the extent to which rare variants, genome-wide, may contribute to the risk of IPF remains unknown. Objectives: We used whole-genome sequencing to investigate the role of rare variants, genome-wide, on IPF risk. Methods: As part of the Trans-Omics for Precision Medicine Program, we sequenced 2,180 cases of IPF. Association testing focused on the aggregated effect of rare variants (minor allele frequency ⩽0.01) within genes or regions. We also identified individual rare variants that are influential within genes and estimated the heritability of IPF on the basis of rare and common variants. Measurements and Main Results: Rare variants in both TERT and RTEL1 were significantly associated with IPF. A single rare variant in each of the TERT and RTEL1 genes was found to consistently influence the aggregated test statistics. There was no significant evidence of association with other previously reported rare variants. The SNP heritability of IPF was estimated to be 32% (SE = 3%). Conclusions: Rare variants within the TERT and RTEL1 genes and well-established common variants have the largest contribution to IPF risk overall. Efforts in risk profiling or the development of therapies for IPF that focus on TERT, RTEL1, common variants, and environmental risk factors are likely to have the largest impact on this complex disease.
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Affiliation(s)
- Anna L. Peljto
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Z. Blumhagen
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- National Jewish Health, Denver, Colorado
| | | | - Jonathan Cardwell
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Julia Powers
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Tamera J. Corte
- Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Joanne L. Dickinson
- Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ian Glaspole
- Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Sydney, Australia
| | - Yuben P. Moodley
- Department of Respiratory Medicine, University of Western Australia, Perth, Australia
| | | | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper R. Davidsen
- South Danish Center for Interstitial Lung Diseases, Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | | | - Bruno Crestani
- Service de Pneumologie A and
- Université Paris Cité, INSERM, Physiopathologie et Épidémiologie des Maladies Respiratoires, Paris, France
| | | | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Jim Egan
- National Lung Transplantation Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael T. Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Michael P. Keane
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
| | - Marcus P. Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Cormac McCarthy
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
| | | | | | | | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo M. Leone
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, G. B. Morgagni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences, DIMES University of Bologna, Bologna, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Valentina Luzzi
- Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | | | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | | | | | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Helen Parfrey
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Rebecca Braybrooke
- Division of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Peter D. Jackson
- Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | - Mary K. Porteous
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jason D. Christie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold R. Collard
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Oliver Eickelberg
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elena E. Foster
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, California
| | - Kevin F. Gibson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Arizona, Phoenix, Arizona
| | - Daniel J. Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - David Lederer
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Angela L. Linderholm
- Department of Internal Medicine, University of California, Davis, Davis, California
| | - Jim Loyd
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Amy J. Palmisciano
- Division of Pulmonary, Critical Care and Sleep Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cristina A. Reichner
- Division of Pulmonary, Critical Care and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Mauricio Rojas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus, Ohio
| | - Jesse Roman
- Division of Pulmonary, Allergy, and Critical Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neil Schluger
- Columbia University Medical Center, New York, New York
| | - Barry S. Shea
- Division of Pulmonary, Critical Care and Sleep Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Paul J. Wolters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cecilia M. A. Prele
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
| | - Juan I. Enghelmayer
- Brown University, Providence, Rhode Island
- Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria Otaola
- Instituto de Rehabilitación Psicofísica de Buenos Aires, Buenos Aires, Argentina
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Martina Sterclova
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marjukka Myllärniemi
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Hirose
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Shin Ohta
- Department of Medicine, Showa University, Tokyo, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dong Soon Kim
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Annie Pardo
- Faculty of Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alvaro U. Aranda
- Cardiopulmonary Research Center, Alliance Pulmonary Group, Guaynabo, Puerto Rico
| | - Moo Suk Park
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Sun Park
- Seoul National University Bundang Hospital, Seoul National University, Seongnam, Republic of Korea
| | - Jin Woo Song
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | | | - Lurdes Planas-Cerezales
- Interstitial Lung Disease Multidisciplinary Unit, University Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | | | - Albert V. Smith
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | - Stephen S. Rich
- Center for Public Health Genomics, and
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Elizabeth C. Oelsner
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - R. Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Josee Dupuis
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - George O’Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Ramachandran S. Vasan
- Boston University and National Heart, Lung, and Blood Institute Framingham Heart Study, Boston, Massachusetts; and
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marvin I. Schwarz
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Mark P. Steele
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Joyce S. Lee
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Ivana V. Yang
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - David A. Schwartz
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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20
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Saunders C, Sperling S, Bendstrup E. Concerns regarding a suggested long COVID paradigm – Authors' reply. The Lancet Respiratory Medicine 2023; 11:e36-e37. [PMID: 36997265 DOI: 10.1016/s2213-2600(23)00087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Chloe Saunders
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Søren Sperling
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Elisabeth Bendstrup
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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21
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Hyldgaard C, Bendstrup E, Kreuter M. Reply: A response to the study by Hyldgaard et al. Respirology 2023; 28:414. [PMID: 36599419 DOI: 10.1111/resp.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
See related Letter
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Affiliation(s)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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22
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Kreuter M, Bendstrup E, Jouneau S, Maher TM, Inoue Y, Miede C, Lievens D, Crestani B. Weight loss and outcomes in subjects with progressive pulmonary fibrosis: data from the INBUILD trial. Respir Res 2023; 24:71. [PMID: 36894966 PMCID: PMC9999543 DOI: 10.1186/s12931-023-02371-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Lower body mass index (BMI) and weight loss have been associated with worse outcomes in some studies in patients with pulmonary fibrosis. We analyzed outcomes in subgroups by BMI at baseline and associations between weight change and outcomes in subjects with progressive pulmonary fibrosis (PPF) in the INBUILD trial. METHODS Subjects with PPF other than idiopathic pulmonary fibrosis were randomized to receive nintedanib or placebo. In subgroups by BMI at baseline (< 25, ≥ 25 to < 30, ≥ 30 kg/m2), we analyzed the rate of decline in FVC (mL/year) over 52 weeks and time-to-event endpoints indicating disease progression over the whole trial. We used a joint modelling approach to assess associations between change in weight and the time-to-event endpoints. RESULTS Among 662 subjects, 28.4%, 36.6% and 35.0% had BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively. The rate of decline in FVC over 52 weeks was numerically greater in subjects with baseline BMI < 25 than ≥ 25 to < 30 or ≥ 30 kg/m2 (nintedanib: - 123.4, - 83.3, - 46.9 mL/year, respectively; placebo: - 229.5; - 176.9; - 171.2 mL/year, respectively). No heterogeneity was detected in the effect of nintedanib on reducing the rate of FVC decline among these subgroups (interaction p = 0.83). In the placebo group, in subjects with baseline BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively, 24.5%, 21.4% and 14.0% of subjects had an acute exacerbation or died, and 60.2%, 54.5% and 50.4% of subjects had ILD progression (absolute decline in FVC % predicted ≥ 10%) or died over the whole trial. The proportions of subjects with these events were similar or lower in subjects who received nintedanib versus placebo across the subgroups. Based on a joint modelling approach, over the whole trial, a 4 kg weight decrease corresponded to a 1.38-fold (95% CI 1.13, 1.68) increase in the risk of acute exacerbation or death. No association was detected between weight loss and the risk of ILD progression or the risk of ILD progression or death. CONCLUSIONS In patients with PPF, lower BMI at baseline and weight loss may be associated with worse outcomes and measures to prevent weight loss may be required. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02999178 .
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, and German Center for Lung Research, Heidelberg, Germany. .,Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Stéphane Jouneau
- Department of Respiratory Medicine, Competences Centre for Rare Pulmonary Diseases, CHU Rennes, University of Rennes, Rennes, France
| | - Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | | | - Dirk Lievens
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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23
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Kronborg-White S, Bendstrup E, Gori L, Luzzi V, Madsen LB, Poletti V, Rasmussen TR, Trigiani M, Vezzosi S, Tomassetti S. A pilot study on the use of the super dimension navigation system for optimal cryobiopsy location in interstitial lung disease diagnostics. Pulmonology 2023; 29:119-123. [PMID: 34526242 DOI: 10.1016/j.pulmoe.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transbronchial cryobiopsies has become increasingly important in the diagnostic workup for interstitial lung diseases. The rate of complications and mortality are low compared to surgical lung biopsies, but the diagnostic yield is not as high. The reason for the lower diagnostic yield could in some cases be explained by biopsies taken too centrally or in less affected areas. In this pilot study we examined the feasibility of using the electromagnetic navigation system, superDimension (SD), when performing cryobiopsies to increase the diagnostic yield. METHODS Electromagnetic navigation bronchoscopy and cryobiopsies were performed using SD. An electromagnetic board placed on the back of the patient and a position sensor at the tip of the navigational probe created a real-time 3D reconstruction of previously acquired computer tomography images. The procedure was performed with the patients in general anesthesia using a rigid bronchoscope when performed in Florence and with a flexible bronchoscope through an orotracheal tube when performed in Aarhus. RESULTS In total, 18 patients were included. Five patients were excluded, partly due to technical difficulties. Disposable 1.7 mm cryoprobes were used in Aarhus, and reusable 1.9 mm probes in Florence. Pneumothorax was detected in three (23%), mild hemorrhage was seen in one (8%) and moderate hemorrhage in six (46%). The biopsies contributed to the diagnosis in 11 of the patients (85%). CONCLUSION Using superDimension electromagnetic navigation system when performing cryobiopsies is feasible. A larger prospective trial is necessary to homogenize the technique between centres and to evaluate diagnostic advantage and complications.
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Affiliation(s)
- S Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark.
| | - E Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - L Gori
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - V Luzzi
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - L B Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - V Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | - T R Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - M Trigiani
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - S Vezzosi
- Department of Quality, control and Technology, Careggi University Hospital, Florence, Italy
| | - S Tomassetti
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
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24
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Saunders C, Sperling S, Bendstrup E. A new paradigm is needed to explain long COVID. Lancet Respir Med 2023; 11:e12-e13. [PMID: 36620963 DOI: 10.1016/s2213-2600(22)00501-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Chloe Saunders
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Søren Sperling
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Elisabeth Bendstrup
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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25
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Ørum MB, Rönsholt FF, Jeppesen M, Bendstrup E, Katzenstein TL, Ott P, Perch M, Pressler T, Qvist T, Jensen-Fangel S. Outcome of elexacaftor/tezacaftor/ivacaftor therapy in patients with cystic fibrosis and solid organ transplantation. Pediatr Pulmonol 2023; 58:602-605. [PMID: 36314653 DOI: 10.1002/ppul.26217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/16/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
We report a case series of four patients with cystic fibrosis (CF) and previous solid organ transplantation (SOT) receiving elexacaftor/tezacaftor/ivacaftor therapy for 6 months or more. Data was collected retrospectively. The treatment was well tolerated and all patients reported subjective improvements.
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Affiliation(s)
- Matilde B Ørum
- Department of Infectious Diseases, Cystic Fibrosis Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - Frederikke F Rönsholt
- Department of Cardiology, Section for Lung Transplantation, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark.,Department of Infectious Diseases, Cystic Fibrosis Clinic, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark
| | - Majbritt Jeppesen
- Department of Infectious Diseases, Cystic Fibrosis Clinic, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Respiratory Diseases and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Cystic Fibrosis Clinic, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark
| | - Peter Ott
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark.,Department Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tacjana Pressler
- Department of Infectious Diseases, Cystic Fibrosis Clinic, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark
| | - Tavs Qvist
- Department of Infectious Diseases, Cystic Fibrosis Clinic, University Hospital Rigshospitalet Copenhagen, Kobenhavn, Denmark
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Cystic Fibrosis Clinic, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Papiris SA, Campo I, Mariani F, Kallieri M, Kolilekas L, Papaioannou AI, Gonca Chousein E, Cetinkaya E, Bonella F, Borie R, Kokosi M, Pickworth T, Molina-Molina M, Gasa M, Radzikowska E, Fijolek J, Jouneau S, Gomez E, McCarthy C, Bendstrup E, Piotrowski WJ, Pabary R, Hadchouel A, Coolen-Allou N, Alfaro T, Robalo Cordeiro C, Antonogiannaki EM, Tomos IP, Papakosta D, Kontakiotis T, Panagiotou P, Douros K, Schams A, Lettieri S, Papaevangelou V, Kanaka-Gantenbein C, Karakatsani A, Loukides S, Costabel U, Crestani B, Morgan C, Tazawa R, Bush A, Griese M, Manali ED. COVID-19 in patients with pulmonary alveolar proteinosis: a European multicentre study. ERJ Open Res 2023; 9:00199-2022. [PMID: 36601310 PMCID: PMC9271262 DOI: 10.1183/23120541.00199-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Adult PAP patients experience similar #COVID19 rates to the general population, and high rates of hospitalisation and deaths, underscoring their vulnerability and the need for measures to prevent infection. The impact of iGM-CSF must be considered. https://bit.ly/3M0wKnZ.
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Affiliation(s)
- Spyros A. Papiris
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilaria Campo
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Mariani
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Kallieri
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andriana I. Papaioannou
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efsun Gonca Chousein
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Erdogan Cetinkaya
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Dept, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany; European Reference Network (ERN)-LUNG, ILD Core Net
| | - Raphael Borie
- Université de Paris, INSERM UMR 1152, APHP, Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Centre de référence des maladies pulmonaires rares, Paris, France
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Interstitial Lung Disease Unit, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | | | - Maria Molina-Molina
- ILD Multidisciplinary Unit, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Mercè Gasa
- ILD Multidisciplinary Unit, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Elżbieta Radzikowska
- 3rd Dept of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Justyna Fijolek
- 3rd Dept of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Stéphane Jouneau
- IRSET UMR 1085, Université de Rennes Service de Pneumologie, CHU de Rennes, Rennes, France
| | | | - Cormac McCarthy
- University College Dublin School of Medicine Education and Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Elisabeth Bendstrup
- Center for Rare Lung diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Wojciech J. Piotrowski
- Dept of Pneumonology, 2nd Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | - Rishi Pabary
- Paediatrics and Paediatric Respirology, Imperial College and Imperial Centre for Paediatrics and Child Health, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Alice Hadchouel
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant and INSERM U1151, Institut Necker Enfants Malades, Université de Paris, Faculté de Médecine, Paris, France
| | | | - Tiago Alfaro
- Dept of Pulmonology, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Carlos Robalo Cordeiro
- Dept of Pulmonology, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Elvira-Markela Antonogiannaki
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P. Tomos
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Papakosta
- Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Exochi, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Exochi, Thessaloniki, Greece
| | - Panagiota Panagiotou
- First Dept of Paediatrics, Agia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Third Dept of Pediatrics “Attikon” University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andrea Schams
- Dept of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Sara Lettieri
- Laboratorio di Biochimica e Genetica, UOC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vassiliki Papaevangelou
- Third Dept of Pediatrics “Attikon” University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Dept of Paediatrics, Agia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stelios Loukides
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Dept, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany; European Reference Network (ERN)-LUNG, ILD Core Net
| | - Bruno Crestani
- Université de Paris, INSERM UMR 1152, APHP, Hôpital Bichat, Service de Pneumologie A, FHU APOLLO, Centre de référence des maladies pulmonaires rares, Paris, France
| | - Cliff Morgan
- Interstitial Lung Disease Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Interstitial Lung Disease Unit, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Ryushi Tazawa
- Health Administration Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, Imperial College and Imperial Centre for Paediatrics and Child Health, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Matthias Griese
- Dept of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Effrosyni D. Manali
- General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece,Effrosyni Manali ()
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Karampitsakos T, Spagnolo P, Mogulkoc N, Wuyts WA, Tomassetti S, Bendstrup E, Molina-Molina M, Manali ED, Unat ÖS, Bonella F, Kahn N, Kolilekas L, Rosi E, Gori L, Ravaglia C, Poletti V, Daniil Z, Prior TS, Papanikolaou IC, Aso S, Tryfon S, Papakosta D, Tzilas V, Balestro E, Papiris S, Antoniou K, Bouros D, Wells A, Kreuter M, Tzouvelekis A. Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe. Respirology 2023; 28:56-65. [PMID: 36117239 DOI: 10.1111/resp.14363] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE There remains a paucity of large databases for patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. We aimed to create a European registry. METHODS This was a multicentre, retrospective study across seven European countries between 1 January 2010 and 18 May 2021. RESULTS We identified 324 patients with lung cancer among 3178 patients with IPF (prevalence = 10.2%). By the end of the 10 year-period following IPF diagnosis, 26.6% of alive patients with IPF had been diagnosed with lung cancer. Patients with IPF and lung cancer experienced increased risk of all-cause mortality than IPF patients without lung cancer (HR: 1.51, [95% CI: 1.22-1.86], p < 0.0001). All-cause mortality was significantly lower for patients with IPF and lung cancer with a monocyte count of either <0.60 or 0.60-<0.95 K/μl than patients with monocyte count ≥0.95 K/μl (HR [<0.60 vs. ≥0.95 K/μl]: 0.35, [95% CI: 0.17-0.72], HR [0.60-<0.95 vs. ≥0.95 K/μl]: 0.42, [95% CI: 0.21-0.82], p = 0.003). Patients with IPF and lung cancer that received antifibrotics presented with decreased all cause-mortality compared to those who did not receive antifibrotics (HR: 0.61, [95% CI: 0.42-0.87], p = 0.006). In the adjusted model, a significantly lower proportion of surgically treated patients with IPF and otherwise technically operable lung cancer experienced all-cause mortality compared to non-surgically treated patients (HR: 0.30 [95% CI: 0.11-0.86], p = 0.02). CONCLUSION Lung cancer exerts a dramatic impact on patients with IPF. A consensus statement for the management of patients with IPF and lung cancer is sorely needed.
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Affiliation(s)
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Wim A Wuyts
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Molina-Molina
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ömer Selim Unat
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumonology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Lykourgos Kolilekas
- 7th Department of Respiratory Medicine, Hospital for Thoracic Diseases, 'SOTIRIA', Athens, Greece
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Claudia Ravaglia
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Samantha Aso
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Stavros Tryfon
- Pulmonary Clinic, NHS General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Despoina Papakosta
- Pulmonary Department, 'G Papanikolaou' General Hospital, Thessaloniki, Greece.,Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Vasillios Tzilas
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Antoniou
- Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athol Wells
- Interstitial Lung Disease Unit, Ιmperial College London, Royal Brompton and Harefield, London, UK
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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28
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Johansen MB, Bendstrup E, Davidsen JR, Shaker SB, Martin HM. The diagnostic trajectories of Danish patients with autoimmune rheumatologic disease associated interstitial lung disease: an interview-based study. Eur Clin Respir J 2023; 10:2178601. [PMID: 36891195 PMCID: PMC9987749 DOI: 10.1080/20018525.2023.2178601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background Autoimmune rheumatologic disease associated interstitial lung diseases (ARD-ILD) are rare conditions and the association between ARDs and respiratory symptoms often goes unrecognised by ARD patients and general practitioners (GPs). The diagnostic trajectory from the first respiratory symptoms to an ARD-ILD diagnosis is often delayed and may increase the burden of symptoms and allow further disease progression.The aim of this study was to 1) characterise the diagnostic trajectories of ARD-ILD patients and to 2) identify barriers for obtaining a timely ILD diagnosis based on the experiences and perceptions of both patients and healthcare professionals. Method Semi-structured qualitative interviews were conducted with Danish ARD-ILD patients, rheumatologists, pulmonologists and ILD nurses. Results Sixteen patients, six rheumatologists, three ILD nurses and three pulmonologists participated. Five characteristics of diagnostic trajectories were identified in the patient interviews: 1) early referral to lung specialists; 2) early delay; 3) delay or shortcut depending on specific circumstances; 4) parallel diagnostic trajectories connected late in the process; 5) early identification of lung involvement without proper interpretation. With the exception of early referral to lung specialists, all of the diagnostic trajectory characteristics identified led to delayed diagnosis. Delayed diagnostic trajectories resulted in patients experiencing increased uncertainty. Inconsistent disease terminology, insufficient knowledge and lack of awareness of ARD-ILD among central healthcare professionals and delayed referral to ILD specialists were main contributors to the diagnostic delay identified by the informants. Conclusion Five characteristics of the diagnostic trajectories were identified, four of which led to diagnostic delay of ARD-ILD. Improved diagnostic trajectories can shorten the diagnostic trajectory and increase early access to appropriate specialist medical care. Improved awareness and expertise in ARD-ILD across different medical specialties, especially among GPs, may contribute to more efficient and timely diagnostic trajectories and improved patient experiences.
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Affiliation(s)
- M B Johansen
- VIVE Health, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - E Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J R Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S B Shaker
- Department of Respiratory Medicine, Herlev-Gentofte Hospital, Gentofte, Denmark
| | - H M Martin
- VIVE Health, The Danish Center for Social Science Research, Copenhagen, Denmark.,SDCC Trial Unit, Steno Diabetes Center Copenhagen, Herlev, Denmark
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29
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Knarborg M, Hyldgaard C, Bendstrup E, Davidsen JR, Løkke A, Shaker SB, Hilberg O. Comorbidity and mortality in systemic sclerosis and matched controls: Impact of interstitial lung disease. A population based cohort study based on health registry data. Chron Respir Dis 2023; 20:14799731231195041. [PMID: 37596992 PMCID: PMC10440053 DOI: 10.1177/14799731231195041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/20/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVE This population-based, matched cohort study evaluates the impact of comorbidities on mortality among systemic sclerosis (SSc) patients with and without interstitial lung disease (ILD). METHOD Patients with a first-time SSc diagnosis between 2002 and 2015 were identified in the Danish National Patient Registry, separated into two cohorts - with ILD (SSc-ILD) and without ILD (non-ILD SSc), and matched 1:4 with controls from the general population on age, sex, residency and marital status. Comorbidity and mortality data were obtained from national registries. The Deyo-Charlson comorbidity score (DCcs) was used for assessment of the burden of comorbidities. RESULTS 1732 patients with SSc and 6919 controls were included; 258 (14.9%) patients had SSc-ILD. The hazard ratio (HR) for death was 2.8 (95% CI 2.4-3.3) in SSc, and especially increased in SSc-ILD (HR 4.2 (95% CI 3.2-5.4)), males (HR 3.1 95% CI 2.4-4.1) and younger adults (aged 18-40 (HR 6.9, 95% CI 3.4-14.2) and 41-50 (HR 7.7, 95% CI 3.8-15.6)). In non-ILD SSc, mortality increased with increasing DCcs. Cancer was the most frequent cause of death in SSc (24.9% of deaths) and in controls (33.5%), in SSc followed by musculoskeletal and connective tissue diseases (22.7%); the cause of only 0.8% of deaths among controls. CONCLUSION The high prevalence of comorbidities in SSc had extensive impact on mortality. Mortality was increased in males, in young adults and in SSc-ILD, underlining the excess mortality associated with ILD. These findings emphasise the importance of timely diagnosis and optimal management of organ involvement and comorbidities in SSc.
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Affiliation(s)
- Malene Knarborg
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Hyldgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper Rømhild Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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30
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Rønn C, Sivapalan P, Eklöf J, Kamstrup P, Biering-Sørensen T, Bonnesen B, Harboe ZB, Browatzki A, Kjærgaard JL, Meyer CN, Jensen TT, Johansson SL, Bendstrup E, Ulrik CS, Stæhr Jensen JU. Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients. Clin Microbiol Infect 2022; 29:523-529. [PMID: 36503112 DOI: 10.1016/j.cmi.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES International guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. METHODS A retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. RESULTS In total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2-1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0-1.2); moderate dose: HR, 1.2 (CI, 1.1-1.3), and high dose: HR, 1.5 (CI, 1.4-1.6); "no use" was the reference. Sensitivity analyses confirmed these findings. CONCLUSIONS In the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.
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Affiliation(s)
- Christian Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark.
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Barbara Bonnesen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Jakob Lyngby Kjærgaard
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Christian Niels Meyer
- Department of Pulmonary Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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31
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Sørensen SR, Bendstrup E, Davidsen JR. [Not Available]. Ugeskr Laeger 2022; 184:V05220307. [PMID: 36426814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Oxygen is a standard treatment for patients with chronic lung diseases and hypoxemia. The two main groups of lung diseases leading to oxygen treatment is chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Several guidelines for home oxygen therapy for patients with ILD is, however, based on older observation and extrapolations from studies on COPD. This review focuses on the different oxygen treatment modalities for patients with ILD focusing on present evidence and upcoming trials that might change the oxygen therapy approach for patients with ILD.
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Affiliation(s)
| | - Elisabeth Bendstrup
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Health, Aarhus Universitet
| | - Jesper Rømhild Davidsen
- Lungemedicinsk Afdeling, Odense Universitetshospital
- Ambulatorium for lungebindevævssygdomme og Sjældne lungesygdomme, Odense Universitetshospital
- Forskningsenhed for Lungemedicin, Klinisk Institut, Syddansk Universitet
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32
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Hyldgaard C, Torrisi S, Kronborg Brix‐White S, Prior TS, Ganter C, Bendstrup E, Kreuter M. Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response. Respirology 2022; 28:373-379. [PMID: 36372786 DOI: 10.1111/resp.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients. METHODS Clinical information and treatment data were obtained retrospectively at two ILD centres. Pulmonary function data were analysed using (1) mixed effects linear regression models with and without clinical covariates and (2) propensity score matching using gender, age, physiology (GAP) stage, smoking and presence of ground glass opacities. RESULTS Sixty-five percent of the 249 patients included received corticosteroids and/or other immunomodulators. Treated patients had lower forced vital capacity (FVC) (72% vs. 83% predicted) and diffusing capacity for carbon monoxide (DLco) (44% vs. 60% predicted). In mixed effects linear regression, the adjusted change in FVC was -0.22%, [-0.34; -0.11], and -0.15% [-0.28;-0.012] for DLco. The difference in pulmonary function decline between treated and untreated patients was insignificant, -0.082% per month, [-0.28; 0.11], p = 0.10 for FVC and -0.14% per month, [-0.36; 0.079], p = 0.15, for DLco. In propensity score matched analysis, the difference in change in FVC was 0.039% per month, p = 0.12, and for DLco, 0.0085% per month, p = 0.7. CONCLUSION The pulmonary function trajectories for treated and untreated patients were parallel, despite treated patients having more severe disease at baseline. The persisting differences between the groups suggest no overall effect, although improvement or stabilization may be seen in some patients. Prospective studies are needed to define subsets of patients with unclassifiable interstitial lung disease and their optimal management.
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Affiliation(s)
- Charlotte Hyldgaard
- Silkeborg Regional Hospital, Diagnostic Center University Research Clinic for Innovative Patient Pathways Silkeborg Denmark
| | - Sebastiano Torrisi
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico‐Vittorio Emanuele University of Catania Catania Italy
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik University of Heidelberg and German Center for Lung Research Heidelberg Germany
| | - Sissel Kronborg Brix‐White
- Center for Rare Lung Diseases, Department of Respiratory Disease and Allergy Aarhus University Hospital Aarhus Denmark
| | - Thomas Skovhus Prior
- Silkeborg Regional Hospital, Diagnostic Center University Research Clinic for Innovative Patient Pathways Silkeborg Denmark
- Center for Rare Lung Diseases, Department of Respiratory Disease and Allergy Aarhus University Hospital Aarhus Denmark
| | - Claudia Ganter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik University of Heidelberg and German Center for Lung Research Heidelberg Germany
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Disease and Allergy Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik University of Heidelberg and German Center for Lung Research Heidelberg Germany
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Hyldgaard C, Shaker SB, Davidsen JR, Ellingsen T, Bendstrup E. [Pulmonary manifestations in rheumatoid arthritis]. Ugeskr Laeger 2022; 184:V04220252. [PMID: 36345900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rheumatoid arthritis (RA) affects more than 30,000 Danes. In this review, we discuss RA in connection with chronic obstructive pulmonary disease (COPD), bronchiectasis and interstitial lung disease (ILD) which are among the most common lung manifestations and are associated with increased mortality. Early suspicion based upon respiratory symptoms should prompt imaging and pulmonary function test. Smoking cessation, vaccination, and rehabilitation are important. COPD and bronchiectasis are treated according to guidelines. Multidisciplinary collaboration in RA-ILD is important and treatment decisions are based on clinical experience and imaging suggesting an inflammatory or fibrotic phenotype.
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Affiliation(s)
| | - Saher Burhan Shaker
- Lungemedicinsk Afdeling, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Jesper Rømhild Davidsen
- PUlmo-REuma Klinik (PURE), Odense Universitetshospital
- Lungemedicinsk Afdeling, Odense Universitetshospital
| | - Torkell Ellingsen
- PUlmo-REuma Klinik (PURE), Odense Universitetshospital
- Reumatologisk Afdeling, Odense Universitetshospital
| | - Elisabeth Bendstrup
- Center for Sjældne Lungesygdomme, Lungemedicinsk Afdeling, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Health, Aarhus Universitet
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Abstract
INTRODUCTION Interstitial lung diseases (ILDs) are a heterogeneous group of inflammatory and/or fibrotic conditions with variable outcome and often a dismal prognosis. Since many ILDs are progressive in nature, monitoring of signs and symptoms of progression is essential to inform treatment decisions and patient counseling. Monitoring of ILDs is a multimodality process and includes all aspects of the disease, e.g. measurement of pulmonary function and exercise capacity, symptom registration and quality of life (QoL), imaging, comorbidities and/or involvement of other organs to assess disease activity, symptom burden, treatment effects, adverse events, the need for supportive and palliative care, and lung transplantation. AREAS COVERED For this narrative review, we searched the PUBMED database to identify articles relevant for monitoring ILDs, including pulmonary function tests, exercise capacity, imaging, telemedicine, symptoms, and QoL. EXPERT OPINION Due to the high heterogeneity of the ILDs and their disease course, an individualized multimodality approach must be applied. Future strategies include use of telemedicine for home monitoring of lung function and symptoms, use of artificial intelligence to support automatized guidance of patients, computerized evaluation of ILD changes on imaging, and new imaging tools with less radiation dosage.
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Affiliation(s)
- Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Sissel Kronborg-White
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Janne Møller
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Skovhus Prior
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Kamstrup P, Sand JMB, Ulrik CS, Janner J, Rønn CP, Rønnow SR, Leeming DJ, Jensen SG, Wilcke T, Mathioudakis AG, Miravitlles M, Lapperre T, Bendstrup E, Frikke-Schmidt R, Murray DD, Itenov T, Bossios A, Nielsen SD, Vestbo J, Biering-Sørensen T, Karsdal M, Jensen JU, Sivapalan P. Biomarkers of Clot Activation and Degradation and Risk of Future Major Cardiovascular Events in Acute Exacerbation of COPD: A Cohort Sub-Study in a Randomized Trial Population. Biomedicines 2022; 10:biomedicines10082011. [PMID: 36009558 PMCID: PMC9405886 DOI: 10.3390/biomedicines10082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022] Open
Abstract
Cardiovascular diseases are common in patients with chronic obstructive pulmonary disease (COPD). Clot formation and resolution secondary to systemic inflammation may be a part of the explanation. The aim was to determine whether biomarkers of clot formation (products of von Willebrand Factor formation and activation) and clot resolution (product of fibrin degeneration) during COPD exacerbation predicted major cardiovascular events (MACE). The cohort was based on clinical data and biobank plasma samples from a trial including patients admitted with an acute exacerbation of COPD (CORTICO-COP). Neo-epitope biomarkers of formation and the activation of von Willebrand factor (VWF-N and V-WFA, respectively) and cross-linked fibrin degradation (X-FIB) were assessed using ELISAs in EDTA plasma at the time of acute admission, and analyzed for time-to-first MACE within 36 months, using multivariable Cox proportional hazards models. In total, 299/318 participants had samples available for analysis. The risk of MACE for patients in the upper quartile of each biomarker versus the lower quartile was: X-FIB: HR 0.98 (95% CI 0.65–1.48), VWF-N: HR 1.56 (95% CI 1.07–2.27), and VWF-A: HR 0.78 (95% CI 0.52–1.16). Thus, in COPD patients with an acute exacerbation, VWF-N was associated with future MACE and warrants further studies in a larger population.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Correspondence:
| | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Christian Philip Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
| | | | | | - Sidse Graff Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
| | - Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Alexander G. Mathioudakis
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Therese Lapperre
- Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
- Department of Pulmonary Medicine, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2610 Antwerp, Belgium
| | - Elisabeth Bendstrup
- Department Respiratory Disease and Allergy, Aarhus University Hospital, 8000 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Daniel D. Murray
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Theis Itenov
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
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Byrjalsen A, Bygum A, Lautrup CK, Frederiksen AL, Fialla AD, Raaschou-Jensen K, Bendstrup E, Madsen TN, Klarskov M, Jelsig AM. [Telomere biology disorders]. Ugeskr Laeger 2022; 184:V03220220. [PMID: 35959813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The end of the chromosomes consists of DNA referred to as telomeres. The telomeres protect chromosomal DNA against shortening when cells divide. Patients with telomere biology disorders carry pathogenic germline variants in a gene involved in telomere function. New technologic advances have enabled us to identify more patients with telomere biology disorders, which in turn have increased our understanding of the phenotypic spectrum. The latter have proved wider than previously thought, and now we know that e.g. patients with isolated lung fibrosis can have an underlying telomere biology disorder.
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Affiliation(s)
- Anna Byrjalsen
- Afdeling for Genetik, Københavns Universitetshospital - Rigshospitalet
| | - Anette Bygum
- Klinisk Genetisk Afdeling, Odense Universitetshospital
| | | | | | | | | | - Elisabeth Bendstrup
- Center for Sjældne Lungesygdomme, Afdeling for Lungesygdomme, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Health, Aarhus Universitet
| | | | - Mette Klarskov
- Afdeling for Genetik, Københavns Universitetshospital - Rigshospitalet
| | - Anne Marie Jelsig
- Afdeling for Genetik, Københavns Universitetshospital - Rigshospitalet
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Hoyer N, Prior TS, Bendstrup E, Shaker SB. Diagnostic delay in IPF impacts progression-free survival, quality of life and hospitalisation rates. BMJ Open Respir Res 2022; 9:9/1/e001276. [PMID: 35798532 PMCID: PMC9263910 DOI: 10.1136/bmjresp-2022-001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The diagnosis of idiopathic pulmonary fibrosis (IPF) is often delayed up to several years. The objective of this study was to assess the impact of the diagnostic delay on progression-free survival, quality of life and hospitalisation rates. METHODS A total of 264 incident patients with IPF were included immediately after their diagnosis and followed for up to 5 years, with regular collection of clinical data, quality-of-life questionnaires and assessment of disease progression. Hospitalisation data were extracted from electronic patient records. Analyses were performed on the entire cohort and strata according to forced vital capacity (FVC) at diagnosis. RESULTS A long diagnostic delay (>1 year) was associated with worse progression-free survival compared with a short diagnostic delay (<1 year) (HR: 1.70, 95% CI: 1.18 to 2.46, p=0.004) especially in patients with mild disease at the time of diagnosis (FVC>80% predicted). Mean total scores of the St. George's respiratory questionnaire (SGRQ), a derived IPF-specific version of the SGRQ and the chronic obstructive pulmonary disease assessment test (CAT) were consistently higher in patients with long diagnostic delays, indicating worse quality of life. Mean hospitalisation rates were higher during the first year after diagnosis (Incidence rate ratio [IRR]: 3.28, 95% CI: 1.35 to 8.55, p=0.01) and during the entire follow-up (IRR: 1.74, 95% CI: 1.01 to 3.02, p=0.04). CONCLUSION A diagnostic delay of more than 1 year negatively impacts progression-free survival, quality of life and hospitalisation rates in patients with IPF. These findings highlight the importance of an early diagnosis for proper management of IPF. TRIAL REGISTRATION NUMBER NCT02755441.
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Affiliation(s)
- Nils Hoyer
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Hovedstaden, Denmark
| | - Thomas Skovhus Prior
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Hovedstaden, Denmark
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Sperling S, Fløe A, Leth S, Hyldgaard C, Gissel T, Topcu A, Kristensen L, Sønderskov LD, Schmid JM, Jensen-Fangel S, Bendstrup E. Fatigue Is a Major Symptom at COVID-19 Hospitalization Follow-Up. J Clin Med 2022; 11:jcm11092411. [PMID: 35566536 PMCID: PMC9106038 DOI: 10.3390/jcm11092411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 12/23/2022] Open
Abstract
Persistent symptoms after hospitalization with COVID-19 are common, but the frequency and severity of these symptoms are insufficiently understood. We aimed to describe symptoms and pulmonary function after hospitalization with COVID-19. Patients hospitalized with COVID-19 in Central Denmark Region were invited for follow-up 3 months after discharge. Clinical characteristics, patient reported outcomes (Fatigue Assessment Scale (FAS), anxiety and depression (HADS)), symptoms, pulmonary function test and 6-min walk test were collected. We included 218 patients (mean age 59.9 (95% CI: 58.2, 61.7), 59% males). Fatigue, dyspnea and impaired concentration were the most prevalent symptoms at follow-up. Using FAS, 47% reported mild-to-moderate fatigue and 18% severe fatigue. Mean HADS was 7.9 (95% CI: 6.9, 8.9). FAS was correlated to HADS (β = 0.52 (95% CI: 0.44, 0.59, p < 0.001)). Mean DLCO was 80.4% (95% CI: 77.8, 83.0) and 45% had DLCO ˂ 80%. Mean DLCO was significantly reduced in patients treated in the ICU (70.46% (95% CI 65.13, 75.79)). The highest FAS and HADS were seen in patients with the shortest period of hospitalization (2.1 days (95% CI: 1.4, 2.7)) with no need for oxygen. In conclusion, fatigue is a common symptom after hospitalization for COVID-19 and ICU treatment is associated to decreased diffusion capacity.
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Affiliation(s)
- Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.F.); (J.M.S.); (E.B.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; (S.L.); (S.J.-F.)
- Correspondence: ; Tel.: +45-7846-2106
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.F.); (J.M.S.); (E.B.)
| | - Steffen Leth
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; (S.L.); (S.J.-F.)
- Department of Infectious Diseases, Regional Hospital West Jutland, 7400 Goedstrup, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
| | | | - Tina Gissel
- Department of Respiratory Diseases, Viborg Regional Hospital, 8800 Viborg, Denmark;
| | - Ayfer Topcu
- Department of Respiratory Diseases, Horsens Regional Hospital, 8700 Horsens, Denmark;
| | - Lars Kristensen
- Department of Respiratory Diseases, Regional Hospital West Jutland, 7400 Goedstrup, Denmark;
| | - Lene Dahl Sønderskov
- Department of Respiratory Diseases, Randers Regional Hospital, 8900 Randers, Denmark;
| | - Johannes Martin Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.F.); (J.M.S.); (E.B.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; (S.L.); (S.J.-F.)
| | - Søren Jensen-Fangel
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; (S.L.); (S.J.-F.)
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.F.); (J.M.S.); (E.B.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; (S.L.); (S.J.-F.)
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Jönsson ÅLM, Hernando N, Knöpfel T, Mogensen S, Bendstrup E, Hilberg O, Christensen JH, Simonsen U, Wagner CA. Impaired phosphate transport in SLC34A2 variants in patients with pulmonary alveolar microlithiasis. Hum Genomics 2022; 16:13. [PMID: 35443721 PMCID: PMC9019944 DOI: 10.1186/s40246-022-00387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Variants in SLC34A2 encoding the sodium-dependent phosphate transport protein 2b (NaPi-IIb) cause the rare lung disease pulmonary alveolar microlithiasis (PAM). PAM is characterised by the deposition of calcium-phosphate concretions in the alveoli usually progressing over time. No effective treatment is available. So far, 30 allelic variants in patients have been reported but only a few have been functionally characterised. This study aimed to determine the impact of selected SLC34A2 variants on transporter expression and phosphate uptake in cellular studies. Methods Two nonsense variants (c.910A > T and c.1456C > T), one frameshift (c.1328delT), and one in-frame deletion (c.1402_1404delACC) previously reported in patients with PAM were selected for investigation. Wild-type and mutant c-Myc-tagged human NaPi-IIb constructs were expressed in Xenopus laevis oocytes. The transport function was investigated with a 32Pi uptake assay. NaPi-IIb protein expression and localisation were determined with immunoblotting and immunohistochemistry, respectively. Results Oocytes injected with the wild-type human NaPi-IIb construct had significant 32Pi transport compared to water-injected oocytes. In addition, the protein had a molecular weight as expected for the glycosylated form, and it was readily detectable in the oocyte membrane. Although the protein from the Thr468del construct was synthesised and expressed in the oocyte membrane, phosphate transport was similar to non-injected control oocytes. All other mutants were non-functional and not expressed in the membrane, consistent with the expected impact of the truncations caused by premature stop codons. Conclusions Of four analysed SLC34A2 variants, only the Thr468del showed similar protein expression as the wild-type cotransporter in the oocyte membrane. All mutant transporters were non-functional, supporting that dysfunction of NaPi-IIb underlies the pathology of PAM. Supplementary Information The online version contains supplementary material available at 10.1186/s40246-022-00387-y.
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Affiliation(s)
- Åsa Lina M Jönsson
- Department of Biomedicine, Aarhus University, Aarhus, Denmark. .,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
| | - Nati Hernando
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Swiss National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Thomas Knöpfel
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Swiss National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Susie Mogensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Medical Department, Vejle Hospital, Vejle, Denmark
| | | | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Swiss National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
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Prior TS, Hyldgaard C, Torrisi SE, Kronborg-White S, Ganter C, Bendstrup E, Kreuter M. Comorbidities in unclassifiable interstitial lung disease. Respir Res 2022; 23:59. [PMID: 35296320 PMCID: PMC8925215 DOI: 10.1186/s12931-022-01981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidities are common in interstitial lung diseases (ILD) and have an important association with survival, but the frequency and prognostic impact of comorbidities in unclassifiable interstitial lung disease (uILD) remains elusive. We aimed to describe the prevalence of comorbidities and assess the impact on survival in patients with uILD. Furthermore, we aimed to identify and characterize potential phenotypes based on clusters of comorbidities and examine their association with disease progression and survival. METHODS Incident patients diagnosed with uILD were identified at two ILD referral centers in Denmark and Germany from 2003 to 2018. The diagnosis uILD was based on multidisciplinary team meetings. Clinical characteristics and comorbidities were extracted from ILD registries and patient case files. Survival analyses were performed using Cox regression analyses, disease progression was analyzed by linear mixed effects models, and clusters of comorbidities were analyzed using self-organizing maps. RESULTS A total of 249 patients with uILD were identified. The cohort was dominated by males (60%), former (49%) or current (15%) smokers, median age was 70 years, mean FVC was 75.9% predicted, and mean DLCO was 49.9% predicted. One-year survival was 89% and three-year survival was 73%. Eighty-five percent of the patients had ≥ 1 comorbidities, 33% had ≥ 3 comorbidities and 9% had ≥ 5 comorbidities. The only comorbidity associated with excess mortality was dyslipidemia. No association between survival and number of comorbidities or the Charlson comorbidity index was observed. Three clusters with different comorbidities profiles and clinical characteristics were identified. A significant annual decline in FVC and DLCO % predicted was observed in cluster 1 and 2, but not in cluster 3. No difference in mortality was observed between the clusters. CONCLUSIONS The comorbidity burden in uILD is lower than reported in other types of ILD and the impact of comorbidities on mortality needs further clarification. Three clusters with distinct comorbidity profiles were identified and could represent specific phenotypes. No difference in mortality was observed between clusters, but slower disease progression was observed in cluster 3. Better understanding of disease behavior and mortality will require further studies of subgroups of uILD with longer observation time.
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Affiliation(s)
- Thomas Skovhus Prior
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Charlotte Hyldgaard
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Sebastiano Emanuele Torrisi
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
| | - Sissel Kronborg-White
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ganter
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
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Prior TS, Wälscher J, Gross B, Bendstrup E, Kreuter M. Clusters of comorbidities in fibrotic hypersensitivity pneumonitis. Respir Res 2022; 23:368. [PMID: 36539821 PMCID: PMC9768944 DOI: 10.1186/s12931-022-02291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a type of interstitial lung disease (ILD) with a variable disease course and prognosis ranging from inflammatory and self-limiting to irreversible and progressive pulmonary fibrosis. Comorbidities are common in HP and may have an impact on prognosis. Due to the heterogeneity of HP presentation and progression, the identification of specific phenotypes in relationship to disease course and outcome is essential. The aim of this study was to identify clusters of comorbidities which could represent phenotypes in fibrotic HP and examine their impact on prognosis. METHODS Patients diagnosed with fibrotic HP at a tertiary referral center for ILD were included. Comorbidities were systematically registered and clusters of comorbidities were identified using cluster analyses. Disease progression and survival was estimated for each cluster. RESULTS The cohort comprised 211 patients with 53.6% males, mean age 63.0, baseline FVC 72.7%, DLCO 44.1%. Median follow-up time was 1.8 years (IQR 0.7-3.9). Three clusters with distinct comorbidity profiles and clinical characteristics were identified. One cluster dominated by elder male patients with predominantly cardiovascular diseases was associated with more respiratory hospitalizations and a worse prognosis. Differences in pulmonary function or exercise capacity trajectories between clusters were not observed. CONCLUSIONS Three clusters with distinct comorbidities were identified and could represent phenotypes in fibrotic HP not previously recognized. The worst prognosis was observed in a cluster dominated by elder males with cardiovascular diseases. Increased focus on prevention and treatment of comorbidities could potentially improve the prognosis of patients with fibrotic HP.
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Affiliation(s)
- Thomas Skovhus Prior
- grid.154185.c0000 0004 0512 597XCentre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julia Wälscher
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany ,grid.5718.b0000 0001 2187 5445Centre for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany
| | - Benjamin Gross
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany
| | - Elisabeth Bendstrup
- grid.154185.c0000 0004 0512 597XCentre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Kreuter
- grid.7700.00000 0001 2190 4373Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research (DZL), Heidelberg, Germany
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42
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Knarborg M, Hyldgaard C, Bendstrup E, Davidsen JR, Løkke A, Shaker SB, Hilberg O. Incidence, prevalence and regional distribution of systemic sclerosis and related interstitial lung Disease: A nationwide retrospective cohort study. Chron Respir Dis 2022; 19:14799731221125559. [PMID: 36123773 PMCID: PMC9500307 DOI: 10.1177/14799731221125559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate incidence and prevalence of Systemic Sclerosis (SSc) and association with interstitial lung disease (SSc-ILD) in a nationwide population-based study. Methods Patients with an incident diagnosis of SSc in 2000–2016 were identified in the Danish National Patient Registry and categorised based on diagnosis of ILD. Incidence- and prevalence proportions were calculated based on the annual population estimates. A cox proportional hazards model was used to evaluate the association between age, sex, region and marital status and presence of ILD. Results In total, 1869 patients with SSc were identified; 275 patients (14.7%) had SSc-ILD. The majority of patients were females (75.5%). The percentage of males was higher in SSc-ILD than in SSc alone (30.9% and 23.4%, p = 0.008). Median time from SSc to ILD diagnosis was 1.4 years (range 0–14.2). ILD was diagnosed from ≤4 years before to ≥7 years after SSc. Development of ILD was associated with male gender (HR 1.75, 95% CI 1.15–2.66), age 41–50 (HR 1.81, 95% CI 1.07–3.05) and residency in the North Denmark Region (HR 1.95, 9 5% CI 1.12–3.40). Mean annual incidence proportion of SSc was 2.9/100,000 and mean annual prevalence proportion was 16.8/100,000. The incidence remained stable, but prevalence proportion increased from 14.1 – 16.5/100,000 in 2000–2008 to 17.9–19.2/100,000 in 2009–2016. Conclusion The prevalence of SSc increased during the study period, while the incidence remained stable. The prevalence of SSc-ILD was 14.7% and thus less frequent than expected. Male sex and age between 41 and 50 years were associated with ILD.
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Affiliation(s)
- Malene Knarborg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Charlotte Hyldgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, 11297Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, 1006Aarhus University, Aarhus, Denmark
| | - Jesper R Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, 11286Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, 6174University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Saher B Shaker
- Department of Respiratory Medicine, 53147Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
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43
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Nielsen MH, Madsen LB, Bendstrup E. Exogenous lipoid pneumonia due to silent aspiration following surgery and radiotherapy for cancer of the tongue. Respir Med Case Rep 2022; 40:101767. [DOI: 10.1016/j.rmcr.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
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44
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Cerdan de las Heras J, Balbino F, Catalán-Matamoros D, Løkke A, Hilberg O, Bendstrup E. Effect of a Telerehabilitation program in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2022; 39:e2022003. [PMID: 35494172 PMCID: PMC9007024 DOI: 10.36141/svdld.v39i1.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022]
Abstract
Background Sarcoidosis can lead to variable periods of sickness and unemployment. Rehabilitation is recommended in sarcoidosis to improve exercise capacity. Therefore, focus on creating different and flexible rehabilitation options adapted to the needs of working patients is warranted to keep patients with sarcoidosis employed and to reduce the socioeconomic burden. Telerehabilitation (TR) might be an alternative. We investigated the usefulness and effectiveness of TR on exercise capacity in patients with sarcoidosis. Method Single-center, prospective, randomized study including stable patients with sarcoidosis who were enrolled in either a control group where they received the usual standard of care (not including rehabilitation) or in the 3 months TR group composed of video and chat-consultations with a physiotherapist and workout sessions with a virtual autonomous physiotherapist agent (VAPA) (1). 6-minute-walk-test (6MWT), forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), isometric voluntary contraction (MVC), 7 days pedometry, Saint George Respiratory Questionnaire for interstitial lung disease (SGRQ-I), The King's Brief Interstitial Lung Disease Questionnaire (KBILD) and General Anxiety Disorder-7 Questionnaire (GAD7) were tested before and after 3 months of TR, and after 3- and 6 months follow-up. Patient satisfaction was measured with a 5-point scale (5 very satisfied) and adherence was calculated as percent of tasks and time spent training. Adverse events were documented. Results Thirty patients aged 53.9±13.5 years, male 63.3%, FVC% 88.9±18.8, DLCO% 65.2±16.0, 6MWT 513.1±141.3 were included. Fifteen patients were randomized to TR with VAPA and 15 patients to the control group. Differences in meters walked (6MWTD) between groups was at baseline (-28.9 m (p=0.58)), after 3 (+25.8 m (p=0.57)), 6 (+48.4 m (p=0.39)) and 9 months (+77.3 m (p=0.18)) follow-up in favor of telerehabilitation. No differences were observed in MVC, 7 days pedometry, SGRQ-I, KBILD or GAD7. Exercise adherence in the intervention group was 64% and average exercise time was 28 minutes per exercise session during the first 3 months. Patient satisfaction scored 3.8 ± 0.7. No adverse events were reported. Conclusion VAPA TR did not result in any change in exercise capacity or patient-reported outcomes in this pilot study in patients with sarcoidosis. However, a statistically non-significant trend for improved 6MWTD was observed during follow-up. VAPA TR was safe, had high patient satisfaction and acceptable adherence. Further randomized studies including larger numbers of participants are needed.
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Affiliation(s)
- Jose Cerdan de las Heras
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark, Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark, Department of Research and Development, Physio R&D ApS, Frederiksberg, Denmark
| | - Fernanda Balbino
- Department of Research and Development, Physio R&D ApS, Frederiksberg, Denmark
| | - Daniel Catalán-Matamoros
- Department of Communication Studies, University Carlos III of Madrid, Madrid, Spain, Health Research Institute, University of Almeria, Almeria, Spain
| | - Anders Løkke
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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45
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Enemark A, Jönsson ÅLM, Kronborg-White S, Bendstrup E. Pulmonary Alveolar Microlithiasis - A Review. Yale J Biol Med 2021; 94:637-644. [PMID: 34970102 PMCID: PMC8686773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pulmonary Alveolar Microlithiasis (PAM) is a rare genetic disorder causing widespread deposition of calcium-phosphate crystals in the alveolar space. A hallmark of the disease is the discrepancy between perceived symptoms upon diagnosis compared with the extensive, sandstorm-like appearance of the microliths on chest X-ray or HRCT. Caused by a defective sodium-dependent phosphate transport protein due to loss-of-function variants of the SLC34A2 gene, PAM is an autosomal recessive transmitted disorder, and as such has a high correlation to consanguinity. The most common variants of the SLC34A2 gene are single nucleotide biallelic changes, but larger deletions are described. Initial suspicion of PAM on radiological examination should be followed by genetic testing to verify the diagnosis and identify the disease-causing variant. When not available, the diagnosis can be made by means of invasive techniques, such as transbronchial forceps or cryobiopsy, or a surgical lung biopsy. In families with a history of PAM, genetic counseling should be offered, as well as preimplantation/prenatal testing if necessary. As of writing this review, no definitive treatment exists, and PAM may in some cases progress to severe pulmonary disease with respiratory failure and potential death. Patients with PAM should be offered preventative and symptomatic treatments such as vaccinations and oxygen therapy when needed. In some cases, lung transplantation may be required.
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Affiliation(s)
- Asbjørn Enemark
- Department of Pulmonology, Aalborg University Hospital,
Aalborg, Denmark,To whom all correspondence should be addressed:
Asbjørn Enemark, MD, Department of Pulmonology, Aalborg University Hospital,
Hobrovej 18-22, 9100, Aalborg, Demark;
| | - Åsa Lina M. Jönsson
- Department of Clinical Genetics, Aarhus University
Hospital, Aarhus N, Denmark
| | - Sissel Kronborg-White
- Department of Medicine, Viborg Hospital, Viborg,
Denmark,Department of Respiratory Diseases and Allergy, Centre
for Rare Lung Diseases, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Centre
for Rare Lung Diseases, Aarhus, Denmark
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46
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Cerdán-de-las-Heras J, Balbino F, Løkke A, Catalán-Matamoros D, Hilberg O, Bendstrup E. Effect of a New Tele-Rehabilitation Program versus Standard Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2021; 11:jcm11010011. [PMID: 35011755 PMCID: PMC8745243 DOI: 10.3390/jcm11010011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), rehabilitation is recommended, but attendance rates are low. Tele-rehabilitation may be key. We evaluate the effect of a tele-rehabilitation program vs. standard rehabilitation on COPD. A randomized, non-inferiority study comparing eight weeks of tele-rehabilitation (physiotherapist video/chat-consultations and workout sessions with a virtual-autonomous-physiotherapist-agent (VAPA)) and standard rehabilitation in stable patients with COPD. At baseline, after 8 weeks and 3 and 6 months of follow-up, 6 min walk test distance (6MWTD), 7-day pedometry, quality of life, exercise tolerance, adherence, patient satisfaction and safety were assessed. Fifty-four patients (70 ± 9 years, male 57%, FEV1% 34.53 ± 11.67, FVC% 68.8 ± 18.81, 6MWT 376.23 ± 92.02) were included. Twenty-seven patients were randomized to tele-rehabilitation. Non-inferiority in Δ6MWTD at 8 weeks (47.4 ± 31.4), and at 3 (56.0 ± 38.0) and 6 (95.2 ± 47.1) months follow-up, was observed. No significant difference was observed in 7-day pedometry or quality of life. In the intervention group, 6MWTD increased by 25% and 66% at 3 and 6 months, respectively; adherence was 81%; and patient satisfaction was 4.27 ± 0.77 (Likert scale 0-5). Non-inferiority between groups and high adherence, patient satisfaction and safety in the intervention group were found after rehabilitation and at 3 and 6 months of follow-up. Tele-rehabilitation with VAPA seems to be a promising alternative.
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Affiliation(s)
- Jose Cerdán-de-las-Heras
- Department of Respiratory Diseases and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Research and Development, Physio R&D ApS, 2000 Frederiksberg, Denmark;
- Correspondence: ; Tel.: +45-30-64-82-83
| | - Fernanda Balbino
- Department of Research and Development, Physio R&D ApS, 2000 Frederiksberg, Denmark;
| | - Anders Løkke
- Department of Respiratory Medicine, Vejle Hospital, 7100 Vejle, Denmark; (A.L.); (O.H.)
| | - Daniel Catalán-Matamoros
- Department of Communication and Media Studies, UC3M Medialab, Madrid University Carlos III, 28903 Madrid, Spain;
- Health Research Centre, University of Almeria, 04120 Almeria, Spain
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, 7100 Vejle, Denmark; (A.L.); (O.H.)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark;
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47
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Sritharan SS, Kølner-Augustson L, Kronborg-White S, Prior TS, Møller J, Bendstrup E. [Antifibrotic therapy in other fibrotic interstitial lung diseases than idiopathic pulmonary fibrosis]. Ugeskr Laeger 2021; 183:V04210348. [PMID: 34895441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Numerous studies have shown that perioperative heparin bridging in patients treated with a vitamin K antagonist leads to an increased incidence of bleeding and so far, there is no evidence that it leads to a significant reduction in postoperative thromboembolism as summarised in this review. Prophylactic dosage of heparin is recommended after major surgery. Heparin bridging is not relevant in patients receiving a direct oral anticoagulant due to the rapid onset and offset of action of DOACs.
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48
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Hoffmann-Vold AM, Bendstrup E, Dimitroulas T, Hesselstrand R, Morais A, Peltomaa R, Smith V, Welling J, Vonk MC, Wuyts WA. Identifying unmet needs in SSc-ILD by semi-qualitative in-depth interviews. Rheumatology (Oxford) 2021; 60:5601-5609. [PMID: 33587103 PMCID: PMC8788003 DOI: 10.1093/rheumatology/keab154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Interstitial lung disease is frequent in SSc (SSc-ILD) and associates with significantly reduced quality of life. Here we aimed to analyse patient pathways, and experiences of patients and healthcare providers (HCPs) in order to identify unmet needs in the management of SSc-ILD patients. METHODS Semi-structured qualitative interviews conducted in eight European countries looked at HCP (n = 95) and patient perspectives (n = 47) using two sets of 70 research questions. Pre-diagnostic, diagnostic and post-diagnostic phases of the patient pathway were systematically explored. RESULTS (i) In the pre-diagnostic phase several gaps were identified by HCPs and patients in all participating countries: limited disease knowledge among primary care physicians and specialists, lack of accurate patient information, and delayed and/or inappropriate referral. (ii) The diagnostic phase is in most countries coordinated by rheumatologists, who are also the main point of care. Depending on the local health system, organization of multidisciplinary collaboration varies. HCPs issued lack of national guidelines, while patients stated difficulties obtaining disease-related information. (iii) In the post-diagnostic phase, HCPs and patients indicated lack of curative treatment, specialized nurses, and paramedical and psychological support. Patients and caregivers additionally expressed the need for clear information on SSc-ILD. CONCLUSION Lack of disease specific knowledge, gaps in national healthcare systems and insufficient information and support for patients and caregivers were identified as unmet needs to ensure timely diagnosis, provide better patient management and to improve quality of life in SSc-ILD patients.
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Affiliation(s)
| | - Elisabeth Bendstrup
- Department of Respiratory Disease and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roger Hesselstrand
- Section of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Antonio Morais
- Department of Pulmonology Centro Hospitalar, Universitário de São João, Faculdade de Medicina do Porto, Porto, Portugal
| | - Ritva Peltomaa
- Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Gent, Belgium
| | - Joep Welling
- FESCA Federation of European Scleroderma Associations, NVLE, Utrecht
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim A Wuyts
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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49
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Kronborg-White S, Madsen LB, Bendstrup E, Poletti V. PD-L1 Expression in Patients with Idiopathic Pulmonary Fibrosis. J Clin Med 2021; 10:jcm10235562. [PMID: 34884264 PMCID: PMC8658518 DOI: 10.3390/jcm10235562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form within the group of idiopathic interstitial pneumonias. It is characterized by repetitive alveolar injury in genetically susceptible individuals and abnormal wound healing, leading to dysregulated bronchiolar proliferation and excessive deposition of extracellular matrix, causing complete architectural distortion and fibrosis. Epithelial-to-mesenchymal transition is considered an important pathogenic event, a phenomenon also observed in various malignant neoplasms, in which tumor cells express programmed death-ligand one (PD-L1). The aim of this study was to assess the presence of PD-L1 in patients with IPF and other interstitial lung diseases (ILDs). Method: Patients with a clinically and radiologically suspected idiopathic interstitial pneumonia or other ILDs undergoing transbronchial cryobiopsy to confirm the diagnosis at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational study. Cellular membrane PD-L1 expression in epithelial cells was determined using the DAKO PD-L1 IHC 22C3 PharmDx Kit. Results: Membrane-bound PD-L1 (mPD-L1) was found in twelve (28%) of the forty-three patients with IPF and in five (9%) of the fifty-five patients with other ILDs (p = 0.015). When adjusting for age, gender and smoking status, the odds ratio of having IPF when expressing mPD-L1 in alveolar and/or bronchiolar epithelial cells was 4.3 (CI: 1.3–14.3). Conclusion: Expression of mPD-L1 in epithelial cells in the lung parenchymal zones was detected in a consistent subgroup of patients with IPF compared to other interstitial pneumonias. Larger studies are needed to explore the role of mPD-L1 in patients with IPF.
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Affiliation(s)
- Sissel Kronborg-White
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Correspondence:
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
| | - Venerino Poletti
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Department of the Diseases of the Thorax, Ospedale Morgagni, University of Bologna, 47121 Forli, Italy
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50
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Jessen H, Hoyer N, Prior TS, Frederiksen P, Rønnow SR, Karsdal MA, Leeming DJ, Bendstrup E, Sand JMB, Shaker SB. Longitudinal serological assessment of type VI collagen turnover is related to progression in a real-world cohort of idiopathic pulmonary fibrosis. BMC Pulm Med 2021; 21:382. [PMID: 34814865 PMCID: PMC8609852 DOI: 10.1186/s12890-021-01684-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Remodeling of the extracellular matrix (ECM) is a central mechanism in the progression of idiopathic pulmonary fibrosis (IPF), and remodeling of type VI collagen has been suggested to be associated with disease progression. Biomarkers that reflect and predict the progression of IPF would provide valuable information for clinicians when treating IPF patients. Methods Two serological biomarkers reflecting formation (PRO-C6) and degradation (C6M) of type VI collagen were evaluated in a real-world cohort of 178 newly diagnoses IPF patients. All patients were treatment naïve at the baseline visit. Blood samples and clinical data were collected from baseline, six months, and 12 months visit. The biomarkers were measured by competitive ELISA using monoclonal antibodies. Results Patients with progressive disease had higher (P = 0.0099) serum levels of PRO-C6 compared to those with stable disease over 12 months with an average difference across all timepoints of 12% (95% CI 3–22), whereas C6M levels tended (P = 0.061) to be higher in patients with progressive disease compared with stable patients over 12 months with an average difference across all timepoints of 12% (95% CI − 0.005–27). Patients who did not receive antifibrotic medicine had a greater increase of C6M (P = 0.043) compared to treated patients from baseline over 12 months with an average difference across all timepoints of 12% (95% CI − 0.07–47). There were no differences in biomarker levels between patients receiving pirfenidone or nintedanib. Conclusions Type VI collagen formation was related to progressive disease in patients with IPF in a real-world cohort and antifibrotic therapy seemed to affect the degradation of type VI collagen. Type VI collagen formation and degradation products might be potential biomarkers for disease progression in IPF. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01684-3.
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Affiliation(s)
- Henrik Jessen
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark. .,Department of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
| | - Nils Hoyer
- Department of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Thomas S Prior
- Department of Respiratory Disease and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Peder Frederiksen
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Sarah R Rønnow
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Morten A Karsdal
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Diana J Leeming
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Disease and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie M B Sand
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Saher B Shaker
- Department of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
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