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Heriot DA, Stock CJW, Mumtaz ZUA, Jenkins RG, Chua F, Molyneaux PL, Devaraj A, Kouranos V, Wells AU, Renzoni EA, Padley SPG, Desai SR, George PM. The impact of hiatus hernia in hypersensitivity pneumonitis. Respirology 2024; 29:421-425. [PMID: 38479405 DOI: 10.1111/resp.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024]
Affiliation(s)
| | - Carmel J W Stock
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - R Gisli Jenkins
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Felix Chua
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Phillip L Molyneaux
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasilis Kouranos
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Athol U Wells
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elizabetta A Renzoni
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Simon P G Padley
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sujal R Desai
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter M George
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Stock CJW, Bray WG, Kouranos V, Jacob J, Kokosi M, George PM, Chua F, Wells AU, Sestini P, Renzoni EA. Serum C-reactive protein is associated with earlier mortality across different interstitial lung diseases. Respirology 2024; 29:228-234. [PMID: 37779266 DOI: 10.1111/resp.14609] [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: 06/05/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The acute-phase protein C-reactive protein (CRP) is known to be associated with poor outcomes in cancer and cardiovascular disease, but there is limited evidence of its prognostic implications in interstitial lung diseases (ILDs). We therefore set out to test whether baseline serum CRP levels are associated with mortality in four different ILDs. METHODS In this retrospective study, clinically measured CRP levels, as well as baseline demographics and lung function measures, were collected for ILD patients first presenting to the Royal Brompton Hospital between January 2010 and December 2019. Cox regression analysis was used to determine the relationship with 5-year mortality. RESULTS Patients included in the study were: idiopathic pulmonary fibrosis (IPF) n = 422, fibrotic hypersensitivity pneumonitis (fHP) n = 233, rheumatoid arthritis associated ILD (RA-ILD) n = 111 and Systemic Sclerosis associated ILD (SSc-ILD) n = 86. Patients with a recent history of infection were excluded. Higher CRP levels were associated with shorter 5-year survival in all four disease groups on both univariable analyses, and after adjusting for age, gender, smoking history, immunosuppressive therapy and baseline disease severity (IPF: HR (95% CI): 1.3 (1.1-1.5), p = 0.003, fHP: 1.5 (1.2-1.9), p = 0.001, RA-ILD: 1.4 (1.1-1.84), p = 0.01 and SSc-ILD: 2.7 (1.6-4.5), p < 0.001). CONCLUSION Higher CRP levels are independently associated with reduced 5-year survival in IPF, fHP, RA-ILD and SSc-ILD.
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Affiliation(s)
- Carmel J W Stock
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - William G Bray
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
- UCL Respiratory, UCL, London, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
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Dixon G, Hague S, Mulholland S, Adamali H, Khin AMN, Thould H, Connon R, Minnis P, Murtagh E, Khan F, Toor S, Lawrence A, Naqvi M, West A, Coker RK, Ward K, Yazbeck L, Hart S, Garfoot T, Newman K, Rivera-Ortega P, Stranks L, Beirne P, Bradley J, Rowan C, Agnew S, Ahmad M, Spencer LG, Aigbirior J, Fahim A, Wilson AM, Butcher E, Chong SG, Saini G, Zulfikar S, Chua F, George PM, Kokosi M, Kouranos V, Molyneaux P, Renzoni E, Vitri B, Wells AU, Nicol LM, Bianchi S, Kular R, Liu H, John A, Barth S, Wickremasinghe M, Forrest IA, Grimes I, Simpson AJ, Fletcher SV, Jones MG, Kinsella E, Naftel J, Wood N, Chalmers J, Crawshaw A, Crowley LE, Dosanjh D, Huntley CC, Walters GI, Gatheral T, Plum C, Bikmalla S, Muthusami R, Stone H, Rodrigues JC, Tsaneva-Atanasova K, Scotton CJ, Gibbons MA, Barratt SL. Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK. ERJ Open Res 2024; 10:00529-2023. [PMID: 38226064 PMCID: PMC10789269 DOI: 10.1183/23120541.00529-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.
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Affiliation(s)
- Giles Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Samuel Hague
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Sarah Mulholland
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Huzaifa Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Aye Myat Noe Khin
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Hannah Thould
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Roisin Connon
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Paul Minnis
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Eoin Murtagh
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Fasihul Khan
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sameen Toor
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Marium Naqvi
- Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Alex West
- Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Robina K. Coker
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Katie Ward
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Leda Yazbeck
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Hart
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Theresa Garfoot
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kate Newman
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Pilar Rivera-Ortega
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lachlan Stranks
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul Beirne
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Sarah Agnew
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Mahin Ahmad
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Lisa G. Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Joshua Aigbirior
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Ahmed Fahim
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Andrew M. Wilson
- Norfolk and Norwich University Hospital NHS Foundation Trust, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sy Giin Chong
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gauri Saini
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Felix Chua
- Royal Brompton and Harefield Hospitals, London, UK
| | | | - Maria Kokosi
- Royal Brompton and Harefield Hospitals, London, UK
| | | | | | | | | | | | | | - Stephen Bianchi
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Raman Kular
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - HuaJian Liu
- Southern Health and Social Care Trust, Portadown, UK
| | | | - Sarah Barth
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian A. Forrest
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ian Grimes
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A. John Simpson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Sophie V. Fletcher
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Centre and School of Clinical and Experimental Sciences, Faulty of Medicine, University of Southampton, Southampton, UK
| | - Mark G. Jones
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Centre and School of Clinical and Experimental Sciences, Faulty of Medicine, University of Southampton, Southampton, UK
| | - Emma Kinsella
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Jennifer Naftel
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Wood
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Jodie Chalmers
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anjali Crawshaw
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise E. Crowley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Davinder Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher C. Huntley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gareth I. Walters
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Gatheral
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire and South Cumbria ILD Service, Lancaster, UK
| | - Catherine Plum
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire and South Cumbria ILD Service, Lancaster, UK
| | - Shiva Bikmalla
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raja Muthusami
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Helen Stone
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jonathan C.L. Rodrigues
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Health, University of Bath, Bath, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
| | - Chris J. Scotton
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Michael A. Gibbons
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
- These authors contributed equally
| | - Shaney L. Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- These authors contributed equally
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Margaritopoulos GA, Proklou A, Trachalaki A, Badenes Bonet D, Kokosi M, Kouranos V, Chua F, George P, Renzoni EA, Devaraj A, Desai S, Nicholson AG, Antoniou KM, Wells AU. Overnight desaturation in interstitial lung diseases: links to pulmonary vasculopathy and mortality. ERJ Open Res 2024; 10:00740-2023. [PMID: 38348245 PMCID: PMC10860199 DOI: 10.1183/23120541.00740-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
Background Overnight desaturation predicts poor prognosis across interstitial lung diseases (ILDs). The aim of the present study was to investigate whether nocturnal desaturation is associated with pulmonary vasculopathy and mortality. Methods A retrospective single centre study of 397 new ILD patients was carried out including patients with idiopathic pulmonary fibrosis (IPF) (n=107) and patients with non-IPF fibrotic ILD (n=290). This is the largest study to date of the effect of significant nocturnal desaturation (SND) (≥10% of total sleep time with oxygen saturation ≤90% measured by pulse oximetry). Results The prevalence of SND was 28/107 (26.2%) in IPF and 80/290 (27.6%) in non-IPF ILD. The prevalence of SND was higher in non-IPF ILDs than in IPF (p=0.025) in multivariate analysis. SND was associated with noninvasive markers of pulmonary hypertension (PH): tricuspid regurgitation velocity (TRV) (p<0.0001), brain natriuretic peptide (p<0.007), carbon monoxide transfer coefficient (p<0.0001), A-a gradient (p<0.0001), desaturation >4% in 6-min walking test (p<0.03) and pulmonary artery diameter (p<0.005). SND was independently associated with high echocardiographic PH probability in the entire cohort (OR 2.865, 95% CI 1.486-5.522, p<0.002) and in non-IPF fibrotic ILD (OR 3.492, 95% CI 1.597-7.636, p<0.002) in multivariate analysis. In multivariate analysis, SND was associated with mortality in the entire cohort (OR 1.734, 95% CI 1.202-2.499, p=0.003) and in IPF (OR 1.908, 95% CI 1.120-3.251, p=0.017) and non-IPF fibrotic ILD (OR 1.663, 95% CI 1.000-2.819, p=0.041). Separate models with exclusion of each one of the diagnostic subgroups showed that no subgroup was responsible for this finding in non-IPF ILDs. SND was a stronger marker of 5-year mortality than markers of PH. Conclusion SND was associated with high echocardiographic probability and mortality and was a stronger predictor of mortality in IPF and non-IPF ILDs grouped together to power the study.
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Affiliation(s)
- George A. Margaritopoulos
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athanasia Proklou
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Intensive Care Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athina Trachalaki
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
| | - Diana Badenes Bonet
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Peter George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | - Anand Devaraj
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Sujal Desai
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Andrew G. Nicholson
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Katerina M. Antoniou
- Interstitial Lung Disease Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
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Hannah JR, Lawrence A, Martinovic J, Naqvi M, Chua F, Kouranos V, Ali SS, Stock C, Owens C, Devaraj A, Pollard L, Agarwal S, Atienza-Mateo B, González-Gay MA, Patel A, West A, Tinsley K, Robbie H, Lams B, Wells AU, Norton S, Galloway J, Renzoni EA, Gordon PA. Antibody predictors of mortality and lung function trends in myositis spectrum interstitial lung disease. Rheumatology (Oxford) 2023:kead638. [PMID: 38039151 DOI: 10.1093/rheumatology/kead638] [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: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES The impact of autoantibody profiles on prognosis of idiopathic inflammatory myositis associated interstitial lung disease (IIM-ILD) and myositis spectrum ILD with Myositis Specific Antibodies (MSA) remains unclear. This retrospective cohort study examines whether serological profiles are associated with mortality and longitudinal lung function change. METHODS Baseline clinical/demographic characteristics and follow-up lung function of consecutive adult patients with IIM-ILD or Interstitial Pneumonia with Autoimmune Features (IPAF) positive for MSAs were extracted from three hospitals. Univariate and multi-variate Cox-Proportional Hazards analyses were used to compare mortality between autoantibodies. Regression models were used to analyse lung function trends. RESULTS Of 430 included patients, 81% met IIM criteria, 19% were IPAF-MSA. On univariate analysis, risk factors associated with mortality included higher age, Charlson Co-morbidity Index and CRP; and lower BMI, baseline TLCO% and FEV1%. Compared to anti-MDA5-negativity, anti-MDA5-positivity (MDA5+) was associated with high mortality in the first 3 months (HR 65.2. 95%CI 14.1, 302.0), while no significant difference was seen thereafter (HR 0.55, 95%CI 0.14, 2.28). On multi-variate analysis, combined anti-synthetase antibodies carried a reduced risk of mortality (HR 0.63), although individually, mortality was reduced in anti-Jo1 + (HR 0.61, 95%CI 0.4-0.87) and increased in anti-PL7+ patients (HR 2.07, 95%CI 1.44-2.99). Anti-MDA5+ was associated with slow improvement in %FVC over the first 3 years, while anti-PL7+ was linked with a slow decline from 12 months onwards. CONCLUSIONS Among autoantibody profiles in myositis spectrum disorders, anti-MDA5+ and anti-PL7+ confer higher mortality risks. Survivors of an early peak of mortality in anti-MDA5+ disease appear to have a favourable prognosis.
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Affiliation(s)
- Jennifer R Hannah
- Department of Academic Rheumatology, King's College London, London, UK
- Deparment of Rheumatology, King's College Hospital, London, UK
| | - Alexandra Lawrence
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Jennifer Martinovic
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Marium Naqvi
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Saadia Sasha Ali
- Department of Academic Rheumatology, King's College London, London, UK
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Carmel Stock
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Cara Owens
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise Pollard
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
- Department of Rheumatology, University Hospital Lewisham, London, UK
| | - Sangita Agarwal
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Belén Atienza-Mateo
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Rheumatology, Marques de Valdecilla University Hospital, Santander, Spain
| | - Miguel Angel González-Gay
- Department of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria; Santander, Spain
| | - Amit Patel
- Department of Academic Rheumatology, King's College London, London, UK
| | - Alex West
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Kate Tinsley
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Hasti Robbie
- Department of Academic Rheumatology, King's College London, London, UK
| | - Boris Lams
- Department of Respiratory Medicine, Guys and St Thomas' NHS Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sam Norton
- Deparment of Rheumatology, King's College Hospital, London, UK
| | - James Galloway
- Department of Academic Rheumatology, King's College London, London, UK
- Deparment of Rheumatology, King's College Hospital, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Patrick A Gordon
- Department of Academic Rheumatology, King's College London, London, UK
- Deparment of Rheumatology, King's College Hospital, London, UK
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Barnett JL, Maher TM, Quint JK, Adamson A, Wu Z, Smith DJF, Rawal B, Nair A, Walsh SLF, Desai SR, George PM, Kokosi M, Jenkins G, Kouranos V, Renzoni EA, Rice A, Nicholson AG, Chua F, Wells AU, Molyneaux PL, Devaraj A. Combination of BAL and Computed Tomography Differentiates Progressive and Non-progressive Fibrotic Lung Diseases. Am J Respir Crit Care Med 2023; 208:975-982. [PMID: 37672028 DOI: 10.1164/rccm.202305-0796oc] [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: 05/02/2023] [Accepted: 09/05/2023] [Indexed: 09/07/2023] Open
Abstract
Rationale: Identifying patients with pulmonary fibrosis (PF) at risk of progression can guide management. Objectives: To explore the utility of combining baseline BAL and computed tomography (CT) in differentiating progressive and nonprogressive PF. Methods: The derivation cohort consisted of incident cases of PF for which BAL was performed as part of a diagnostic workup. A validation cohort was prospectively recruited with identical inclusion criteria. Baseline thoracic CT scans were scored for the extent of fibrosis and usual interstitial pneumonia (UIP) pattern. The BAL lymphocyte proportion was recorded. Annualized FVC decrease of >10% or death within 1 year was used to define disease progression. Multivariable logistic regression identified the determinants of the outcome. The optimum binary thresholds (maximal Wilcoxon rank statistic) at which the extent of fibrosis on CT and the BAL lymphocyte proportion could distinguish disease progression were identified. Measurements and Main Results: BAL lymphocyte proportion, UIP pattern, and fibrosis extent were significantly and independently associated with disease progression in the derivation cohort (n = 240). Binary thresholds for increased BAL lymphocyte proportion and extensive fibrosis were identified as 25% and 20%, respectively. An increased BAL lymphocyte proportion was rare in patients with a UIP pattern (8 of 135; 5.9%) or with extensive fibrosis (7 of 144; 4.9%). In the validation cohort (n = 290), an increased BAL lymphocyte proportion was associated with a significantly lower probability of disease progression in patients with nonextensive fibrosis or a non-UIP pattern. Conclusions: BAL lymphocytosis is rare in patients with extensive fibrosis or a UIP pattern on CT. In patients without a UIP pattern or with limited fibrosis, a BAL lymphocyte proportion of ⩾25% was associated with a lower likelihood of progression.
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Affiliation(s)
- Joseph L Barnett
- Department of Radiology, Royal Free Hospital, London, United Kingdom
| | - Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alex Adamson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - David J F Smith
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | | | - Arjun Nair
- Department of Radiology, University College Hospital, London, United Kingdom
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sujal R Desai
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Radiology
| | - Peter M George
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Radiology
| | - Maria Kokosi
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Gisli Jenkins
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Vasilis Kouranos
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Elisabetta A Renzoni
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Alex Rice
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Histopathology, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; and
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Histopathology, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; and
| | - Felix Chua
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Athol U Wells
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Interstitial Lung Disease Unit, and
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Radiology
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7
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Nikoletou D, Chis Ster I, Lech CY, MacNaughton IS, Chua F, Aul R, Jones PW. Comparison of high-intensity interval training versus moderate-intensity continuous training in pulmonary rehabilitation for interstitial lung disease: a randomised controlled pilot feasibility trial. BMJ Open 2023; 13:e066609. [PMID: 37607782 PMCID: PMC10445364 DOI: 10.1136/bmjopen-2022-066609] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the feasibility and efficacy of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) in pulmonary rehabilitation (PR) for people with interstitial lung disease (ILD). DESIGN Single-centre, randomised controlled feasibility, pilot trial. SETTING Patients were recruited from the chest clinic of a tertiary ILD centre and attended circuit-based PR in the hospital's gym, followed by a personalised 6-month community programme. PARTICIPANTS 58 patients, stratified per ILD type, were randomised into two groups: 33 to HIIT (18 males:15 females) (mean age (SD): 70.2 (11.4) years) and 25 to the MICT exercise mode (14 males:11 females) (mean age (SD): 69.8 (10.8) years). INTERVENTIONS 8-week, twice weekly, circuit-based PR programme of exercise and education, followed by a personalised 6-month community exercise programme. OUTCOME MEASURES Feasibility outcomes included staff-to-patient ratio and dropout rates per group. Primary outcome was the 6 min walk distance (6MWD). Secondary outcomes included the sniff nasal pressure, mouth inspiratory and expiratory pressures, handgrip and quadriceps strength and health status. Random-effects models were used to evaluate average variation in outcomes through time across the two groups. RESULTS The 6MWD peaked earlier with HIIT compared with MICT (at 4 months vs 5 months) but values were lower at peak (mean (95% CI): 26.3 m (3.5 to 49.1) vs 51.6 m (29.2 to 73.9)) and declined faster at 6 months post-PR. Secondary outcomes showed similar faster but smaller improvements with HIIT over MICT and more consistent maintenance 6 months post-PR with MICT than HIIT. CONCLUSIONS HIIT is feasible in circuit-based ILD PR programmes and provides quick improvements but requires closer supervision of training and resources than MICT and benefits may be less well sustained. This would make it a less attractive option for clinical PR programmes. A definitive, multicentre randomised controlled trial is required to address the role of HIIT in ILD. TRIAL REGISTRATION NUMBER ISRCTN55846300.
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Affiliation(s)
- Dimitra Nikoletou
- Centre for Allied Health, Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Faculty of Health, Science, Social Care and Education, Kingston University, Kingston-Upon-Thames, London, UK
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Carmen Y Lech
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Iain S MacNaughton
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Raminder Aul
- Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul W Jones
- Infection and Immunity Research Institute, St George's University of London, London, UK
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8
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Kho SS, Aziz AA, Sia TLL, Ramarmuty HY, Sirol Aflah SS, Mohamed Gani Y, Lee HG, Leong CL, Adul Hamid Z, Chua F. Performance of the World Health Organisation suspected COVID-19 case definition in cluster-associated and sporadic SARS-CoV-2 transmission in Malaysia. Med J Malaysia 2023; 78:279-286. [PMID: 37271836] [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] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Cluster-associated transmission has contributed to the majority of COVID-19 cases in Malaysia. Although widely used, the performance of the World Health Organization (WHO) case definition for suspected COVID19 in environments with high numbers of such cases has not been reported. MATERIALS AND METHODS All suspected cases of COVID-19 that self-presented to hospitals or were cluster screened from 1st April to 31st May 2020 were included. Positive SARS-CoV-2 rRT-PCR was used as the diagnostic reference for COVID-19. RESULTS 540 individuals with suspected COVID-19 were recruited. Two-third of patients were identified through contact screening, while the rest presented sporadically. Overall COVID-19 positivity rate was 59.4% (321/540) which was higher in the cluster screened group (85.6% vs. 11.6%, p<0.001). Overall, cluster-screened COVID-19 cases were significantly younger, had fewer comorbidities and were less likely to be symptomatic than those present sporadically. Mortality was significantly lower in the cluster-screened COVID-19 cases (0.3% vs. 4.5%, p<0.05). A third of all chest radiographs in confirmed COVID-19 cases were abnormal, with consolidation, ground-glass opacities or both predominating in the peripheral lower zones. The WHO suspected case definition for COVID-19 accurately classified 35.4% of all COVID-19 patients, a rate not improved by the addition of baseline radiographic data. Misclassification rate was higher among the cluster-associated cases (80.6%) compared to sporadic cases (35.3%). CONCLUSION COVID-19 cases in Malaysia identified by active tracing of community cluster outbreaks had lower mortality rate. The WHO suspected COVID-19 performed poorly in this setting even when chest radiographic information was available, a finding that has implications for future spikes of the disease in countries with similar transmission characteristics.
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Affiliation(s)
- S S Kho
- Hospital Umum Sarawak, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia.
| | - A A Aziz
- Hospital Sungai Buloh, Ministry of Health Malaysia, Selangor, Malaysia
| | - T L L Sia
- Hospital Umum Sarawak, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - H Y Ramarmuty
- Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - S S Sirol Aflah
- Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Y Mohamed Gani
- Hospital Sungai Buloh, Ministry of Health Malaysia, Selangor, Malaysia
| | - H G Lee
- Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - C L Leong
- Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Z Adul Hamid
- Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - F Chua
- The Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
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9
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Chua F, Low S, Chai GT, Inoue Y, Ong V, Wongkarnjana A, Kawkitinarong K, Song JW, Hamid ZA, Aziz AA, Campomanes M, Maher TM, Molyneaux PL, Syakirin S. Knowledge gaps in fibrotic interstitial lung disease in pan-Asian populations: data not missing at random? The Lancet Respiratory Medicine 2023:S2213-2600(23)00125-X. [PMID: 37028437 DOI: 10.1016/s2213-2600(23)00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
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10
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Dawes TJW, McCabe C, Dimopoulos K, Stewart I, Bax S, Harries C, Samaranayake CB, Kempny A, Molyneaux PL, Seitler S, Semple T, Li W, George PM, Kouranos V, Chua F, Renzoni EA, Kokosi M, Jenkins G, Wells AU, Wort SJ, Price LC. Phosphodiesterase 5 inhibitor treatment and survival in interstitial lung disease pulmonary hypertension: A Bayesian retrospective observational cohort study. Respirology 2023; 28:262-272. [PMID: 36172951 DOI: 10.1111/resp.14378] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 04/12/2022] [Accepted: 09/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary hypertension is a life-limiting complication of interstitial lung disease (ILD-PH). We investigated whether treatment with phosphodiesterase 5 inhibitors (PDE5i) in patients with ILD-PH was associated with improved survival. METHODS Consecutive incident patients with ILD-PH and right heart catheterisation, echocardiography and spirometry data were followed from diagnosis to death, transplantation or censoring with all follow-up and survival data modelled by Bayesian methods. RESULTS The diagnoses in 128 patients were idiopathic pulmonary fibrosis (n = 74, 58%), hypersensitivity pneumonitis (n = 17, 13%), non-specific interstitial pneumonia (n = 12, 9%), undifferentiated ILD (n = 8, 6%) and other lung diseases (n = 17, 13%). Final outcomes were death (n = 106, 83%), transplantation (n = 9, 7%) and censoring (n = 13, 10%). Patients treated with PDE5i (n = 50, 39%) had higher mean pulmonary artery pressure (median 38 mm Hg [interquartile range, IQR: 34, 43] vs. 35 mm Hg [IQR: 31, 38], p = 0.07) and percentage predicted forced vital capacity (FVC; median 57% [IQR: 51, 73] vs. 52% [IQR: 45, 66], p=0.08) though differences did not reach significance. Patients treated with PDE5i survived longer than untreated patients (median 2.18 years [95% CI: 1.43, 3.04] vs. 0.94 years [0.69, 1.51], p = 0.003) independent of all other prognostic markers by Bayesian joint-modelling (HR 0.39, 95% CI: 0.23, 0.59, p < 0.001) and propensity-matched analyses (HR 0.38, 95% CI: 0.22, 0.58, p < 0.001). Survival difference with treatment was significantly larger if right ventricular function was normal, rather than abnormal, at presentation (+2.55 years, 95% CI: -0.03, +3.97 vs. +0.98 years, 95% CI: +0.47, +2.00, p = 0.04). CONCLUSION PDE5i treatment in ILD-PH should be investigated by a prospective randomized trial.
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Affiliation(s)
- Timothy J W Dawes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Colm McCabe
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Konstantinos Dimopoulos
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Simon Bax
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carl Harries
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Aleksander Kempny
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Samuel Seitler
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas Semple
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Radiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wei Li
- National Heart and Lung Institute, Imperial College London, London, UK.,Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, UK.,Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vasileios Kouranos
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elisabetta A Renzoni
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Kokosi
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athol U Wells
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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11
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Raman L, Stewart I, Barratt SL, Chua F, Chaudhuri N, Crawshaw A, Gibbons M, Hogben C, Hoyles R, Kouranos V, Martinovic J, Mulholland S, Myall KJ, Naqvi M, Renzoni EA, Saunders P, Steward M, Suresh D, Thillai M, Wells AU, West A, Mitchell JA, George PM. Nintedanib for non-IPF progressive pulmonary fibrosis: 12-month outcome data from a real-world multicentre observational study. ERJ Open Res 2023; 9:00423-2022. [PMID: 36949962 PMCID: PMC10026008 DOI: 10.1183/23120541.00423-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background Nintedanib slows lung function decline for patients with non-idiopathic pulmonary fibrosis progressive pulmonary fibrosis (PPF) in clinical trials, but the real-world safety and efficacy are not known. Methods In this retrospective cohort study, standardised data were collected from patients in whom nintedanib was initiated for PPF between 2019 and 2020 through an early-access programme across eight centres in the United Kingdom. Rate of lung function change in the 12 months pre- and post-nintedanib initiation was the primary analysis. Symptoms, drug safety, tolerability and stratification by interstitial lung disease subtype and computed tomography pattern were secondary analyses. Results 126 patients were included; 67 (53%) females; mean±sd age 60±13 years. At initiation of nintedanib, mean forced vital capacity (FVC) was 1.87 L (58% predicted) and diffusing capacity of the lung for carbon monoxide (D LCO) was 32.7% predicted. 68% of patients were prescribed prednisolone (median dose 10 mg) and 69% were prescribed a steroid-sparing agent. In the 12 months after nintedanib initiation, lung function decline was significantly lower than in the preceding 12 months: FVC -88.8 mL versus -239.9 mL (p=0.004), and absolute decline in D LCO -2.1% versus -6.1% (p=0.004). Response to nintedanib was consistent in sensitivity and secondary analyses. 89 (71%) out of 126 patients reported side-effects, but 86 (80%) of the surviving 108 patients were still taking nintedanib at 12 months with patients reporting a reduced perception of symptom decline. There were no serious adverse events. Conclusion In PPF, the real-world efficacy of nintedanib replicated that of clinical trials, significantly attenuating lung function decline. Despite the severity of disease, nintedanib was safe and well tolerated in this real-world multicentre study.
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Affiliation(s)
- Lavanya Raman
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- These authors contributed equally
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
- These authors contributed equally
| | | | - Felix Chua
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nazia Chaudhuri
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Anjali Crawshaw
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Gibbons
- College of Medicine and Health, University of Exeter, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Rachel Hoyles
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | | | - Marium Naqvi
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Elisabetta A. Renzoni
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Saunders
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Corresponding author: Peter George ()
| | | | - Dharmic Suresh
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Muhunthan Thillai
- Royal Papworth Hospital NHS Foundation Trust, ILD unit Royal Papworth Hospital, Cambridge, UK
| | - Athol U. Wells
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alex West
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Jane A. Mitchell
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter M. George
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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12
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Pugashetti JV, Adegunsoye A, Wu Z, Lee CT, Srikrishnan A, Ghodrati S, Vo V, Renzoni EA, Wells AU, Garcia CK, Chua F, Newton CA, Molyneaux PL, Oldham JM. Validation of Proposed Criteria for Progressive Pulmonary Fibrosis. Am J Respir Crit Care Med 2023; 207:69-76. [PMID: 35943866 PMCID: PMC9952866 DOI: 10.1164/rccm.202201-0124oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [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: 01/18/2022] [Accepted: 08/09/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Criteria for progressive pulmonary fibrosis (PPF) have been proposed, but their prognostic value beyond categorical decline in FVC remains unclear. Objectives: To determine whether proposed PPF criteria predict transplant-free survival (TFS) in patients with non-idiopathic pulmonary fibrosis (IPF) forms of interstitial lung disease (ILD). Methods: A retrospective, multicenter cohort analysis was performed. Patients with diagnoses of fibrotic connective tissue disease-associated ILD, fibrotic hypersensitivity pneumonitis, and non-IPF idiopathic interstitial pneumonia from three U.S. centers and one UK center constituted the test and validation cohorts, respectively. Cox proportional hazards regression was used to test the association between 5-year TFS and ⩾10% FVC decline, followed by 13 additional PPF criteria satisfied in the absence of ⩾10% FVC decline. Measurements and Main Results: One thousand three hundred forty-one patients met the inclusion criteria. A ⩾10% relative FVC decline was the strongest predictor of reduced TFS and showed consistent TFS association across cohorts, ILD subtypes, and treatment groups, resulting in a phenotype that closely resembled IPF. Ten additional PPF criteria satisfied in the absence of 10% relative FVC decline were also associated with reduced TFS in the U.S. test cohort, with 6 maintaining TFS associations in the UK validation cohort. Validated PPF criteria requiring a combination of physiologic, radiologic, and symptomatic worsening performed similarly to their stand-alone components but captured a smaller number of patients. Conclusions: An FVC decline of ⩾10% and six additional PPF criteria satisfied in the absence of such decline identify patients with non-IPF ILD at increased risk for death or lung transplantation.
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Affiliation(s)
- Janelle Vu Pugashetti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Cathryn T. Lee
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Anand Srikrishnan
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Sahand Ghodrati
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Vivian Vo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Elisabetta A. Renzoni
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Athol U. Wells
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Christine Kim Garcia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Columbia University, New York, New York
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Chad A. Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin M. Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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13
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Nwankwo L, Periselneris J, Gilmartin D, Desai S, Shah A, Kouranos V, Renzoni E, Wells A, Molyneaux P, George P, Kokosi M, Devaraj A, Armstrong-James D, Chua F. P249 Predictors of adverse outcome in sarcoidosis complicated by chronic pulmonary aspergillosis. Med Mycol 2022. [PMCID: PMC9509881 DOI: 10.1093/mmy/myac072.p249] [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] [Indexed: 11/24/2022] Open
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction Aspergillosis complicating pulmonary sarcoidosis is associated with high mortality.1 The specific prognostic impact of fibrocavitary sarcoid disease, however, remains poorly understood. A better understanding of the factors that determine adverse outcomes in such patients may improve the management of both the underlying sarcoid disease and associated secondary fungal infection. Methods We implemented a clinical informatics pipeline to data-mine the hospital's clinical data warehouse and identify patients for inclusion in this study. Cases of pulmonary sarcoidosis with elevated Aspergillus IgG (>40 mgA/l) presenting between January 2009 and March 2021 were retrospectively identified. Controls (sarcoidosis with normal Aspergillus IgG titer) were case matched by baseline percentage-predicted gas transfer factor (TLco; ±5% variance). CPA cases were identified by using ISHAM criteria for diagnosing CPA, that is Aspergillus IgG >40 mgA/l plus keyword search for cavities or fungal ball in the CT reports based on search terms for aspergilloma, cavity, intra-cavitary, and mycetoma. Computed tomography (CT), baseline lung function, and survival data were analyzed. Results Among 179 cases (high Aspergillus IgG) and 477 controls (normal Aspergillus IgG), no inter-group difference was evident in the median age at presentation [48 (IQR 40-58) vs 50 (IQR 42-59)] or gender (proportion female: 45.5% vs 51.1%). Amongst the cases, 80/179 (45%) had fibrocavitary changes, compared with 14/477 (2.9%) of the controls (P <.001). Radiologically-evident aspergilloma was present in 80% (64/80) of the cases with fibrocavitary sarcoidosis. Evidence of fibrocavitary destruction was associated with higher overall mortality (60% vs 9.1% in the non-fibrocavitary subgroup; <.0001), and poorer median survival (Fig. 1). The median age at death was lower where there was fibrocavitary disease, and even lower with high Aspergillus IgG, and this was statistically significant. These cases also had poorer lung function compared to non-fibrocavitary disease (Fig. 2): mean %-predicted forced vital capacity (FVC) 71.3% vs 91.4% (P <.0001), and in the controls: 69.9% vs 86.0% (P <.01). A similar trend was observed in %-predicted TLco amongst the fibrocavitary cases: 45.8% vs 64.2% non-fibrocavitary (P <.0001) and in the fibrocavitary controls: 39.7% vs 59.0% non-fibrocavitary (P <.0001). Comparing only those with fibrocavitation, neither the percentage-predicted FVC (71.3% vs 69.9% predicted; P = .82) nor the percentage-predicted TLco (45.7% and 39.7% predicted; P = .16) differed between cases and controls. Conclusions Fibrocavitary sarcoidosis is associated with worse lung function and poorer median survival. In this group, elevated Aspergillus IgG highlights a greater incidence of aspergilloma. Implications Fibrotic transformation of pulmonary sarcoidosis heightens symptom burden, predisposes to chronic Aspergillus infection, and is prognostically important particularly when there is supervening fibrocavitary lung destruction. Sensitive stratification of such patients for the long-term outcomes may help identify particular individuals for earlier and more focused therapeutic intervention. Sources
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Affiliation(s)
- Lisa Nwankwo
- Royal Brompton and Harefield Hospital NHS Trust , London , United Kingdom
| | | | - Desmond Gilmartin
- Clinical informatics , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Sujal Desai
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Anand Shah
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Vasilis Kouranos
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Elisabetta Renzoni
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Athol Wells
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Phil Molyneaux
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Peter George
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - M. Kokosi
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Anand Devaraj
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Darius Armstrong-James
- MRC Centre for Molecular Bacteriology and Infection , Department of Infectious Diseases, Imperial College , United Kingdom
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
| | - Felix Chua
- Department of Respiratory Medicine , Royal Brompton Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London , United Kingdom
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14
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Hewitt RJ, Bartlett EC, Ganatra R, Butt H, Kouranos V, Chua F, Kokosi M, Molyneaux PL, Desai SR, Wells AU, Jenkins RG, Renzoni EA, Kemp SV, Devaraj A, George PM. Lung cancer screening provides an opportunity for early diagnosis and treatment of interstitial lung disease. Thorax 2022; 77:1149-1151. [PMID: 35940878 DOI: 10.1136/thorax-2022-219068] [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: 04/08/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Interstitial lung abnormalities (ILA) can be incidentally detected in patients undergoing low-dose CT screening for lung cancer. In this retrospective study, we explore the downstream impact of ILA detection on interstitial lung disease (ILD) diagnosis and treatment. Using a targeted approach in a lung cancer screening programme, the rate of de novo ILD diagnosis was 1.5%. The extent of abnormality on CT and severity of lung function impairment, but not symptoms were the most important factors in differentiating ILA from ILD. Disease modifying therapies were commenced in 39% of ILD cases, the majority being antifibrotic therapy for idiopathic pulmonary fibrosis.
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Affiliation(s)
- Richard J Hewitt
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
| | - Emily C Bartlett
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK
| | - Rea Ganatra
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK
| | - Haroun Butt
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - R Gisli Jenkins
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Samuel V Kemp
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK.,Airways Disease Section, Imperial College London National Heart and Lung Institute, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK.,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK .,The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, London, UK
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15
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Molyneaux PL, Fahy WA, Byrne AJ, Braybrooke R, Saunders P, Toshner R, Albers G, Chua F, Renzoni EA, Wells AU, Karkera Y, Oballa E, Saini G, Nicholson AG, Jenkins RG, Maher TM. CYFRA 21-1 Predicts Progression in Idiopathic Pulmonary Fibrosis: A Prospective Longitudinal Analysis of the PROFILE Cohort. Am J Respir Crit Care Med 2022; 205:1440-1448. [PMID: 35363592 PMCID: PMC9875897 DOI: 10.1164/rccm.202107-1769oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/27/2021] [Accepted: 04/01/2022] [Indexed: 01/29/2023] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) is a progressive and inevitably fatal condition for which there are a lack of effective biomarkers to guide therapeutic decision making. Objectives: To determine the relationship between serum concentrations of the cytokeratin fragment CYFRA 21-1 and disease progression and mortality in individuals with IPF enrolled in the Prospective Observation of Fibrosis in the Lung Clinical Endpoints (PROFILE) study. Methods: CYFRA 21-1 was identified by immunohistochemistry in samples of human lung obtained at surgery. Concentrations of CYFRA 21-1 were measured using an ELISA-based assay in serum samples collected at baseline, 1 month, and 3 months from 491 individuals with an incident diagnosis of IPF who were enrolled in the PROFILE study and from 100 control subjects at baseline. Study subjects were followed for a minimum of 3 years after their first blood draw. Measurements and Main Results: CYFRA 21-1 localizes to hyperplastic epithelium in IPF lung tissue. Peripheral CYFRA 21-1 concentrations were significantly higher in subjects with IPF than in healthy control subjects in both the discovery (n = 132) (control: 0.96 ± 0.81 ng/ml; vs. IPF: 2.34 ± 2.15 ng/ml; P < 0.0001) and validation (n = 359) (control: 2.21 ± 1.54 ng/ml; and IPF: 4.13 ± 2.77 ng/ml; P < 0.0001) cohorts. Baseline concentrations of CYFRA 21-1 were able to distinguish individuals at risk of 12-month disease progression (C-statistic, 0.70; 95% confidence interval, 0.61-0.79; P < 0.0001) and were predictive of overall mortality (hazard ratio, 1.12 [95% confidence interval, 1.06-1.19] per 1 ng/ml increase in CYFRA 21-1; P = 0.0001). Furthermore, 3-month change in concentrations of CYFRA 21-1 separately predicted 12-month and overall survival in both the discovery and validation cohorts. Conclusions: CYFRA 21-1, a marker of epithelial damage and turnover, has the potential to be an important prognostic and therapeutic biomarker in individuals with IPF.
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Affiliation(s)
- Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - William A. Fahy
- Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom
| | - Adam J. Byrne
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rebecca Braybrooke
- Division of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Peter Saunders
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Richard Toshner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gesa Albers
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Elisabetta A. Renzoni
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Athol U. Wells
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Eunice Oballa
- Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom
| | - Gauri Saini
- Division of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrew G. Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - 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
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Hastings Centre for Pulmonary Research and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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16
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Oldham JM, Lee CT, Wu Z, Bowman WS, Pugashetti JV, Dao N, Tonkin J, Seede H, Echt G, Adegunsoye A, Chua F, Maher TM, Garcia CK, Strek ME, Newton CA, Molyneaux PL. Lung function trajectory in progressive fibrosing interstitial lung disease. Eur Respir J 2022; 59:13993003.01396-2021. [PMID: 34737223 PMCID: PMC10039317 DOI: 10.1183/13993003.01396-2021] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Proposed criteria for progressive fibrosing interstitial lung disease (PF-ILD) have been linked to increased mortality risk, but lung function trajectory after satisfying individual criteria remains unknown. Because survival is rarely employed as the primary end-point in therapeutic trials, identifying PF-ILD criteria that best predict subsequent change in forced vital capacity (FVC) could improve clinical trial design. METHODS A retrospective, multicentre longitudinal cohort analysis was performed in consecutive patients with fibrotic connective tissue disease-associated ILD (CTD-ILD), chronic hypersensitivity pneumonitis and idiopathic interstitial pneumonia at three US centres (test cohort) and one UK centre (validation cohort). 1-year change in FVC after satisfying proposed PF-ILD criteria was estimated using joint modelling. Subgroup analyses were performed to determine whether results varied across key subgroups. RESULTS 1227 patients were included, with CTD-ILD predominating. Six out of nine PF-ILD criteria were associated with differential 1-year change in FVC, with radiological progression of fibrosis, alone and in combination with other features, associated with the largest subsequent decline in FVC. Findings varied significantly by ILD subtype, with CTD-ILD demonstrating little change in FVC after satisfying most PF-ILD criteria, while other ILDs showed significantly larger changes. Findings did not vary after stratification by radiological pattern or exposure to immunosuppressant therapy. Near-term change in FVC after satisfying proposed PF-ILD criteria was heterogeneous depending on the criterion assessed and was strongly influenced by ILD subtype. CONCLUSIONS These findings may inform future clinical trial design and suggest ILD subtype should be taken into consideration when applying PF-ILD criteria.
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Affiliation(s)
- Justin M Oldham
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
- These authors contributed equally
| | - Cathryn T Lee
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
- These authors contributed equally
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Willis S Bowman
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - Janelle Vu Pugashetti
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - Nam Dao
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - James Tonkin
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Hasan Seede
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gabrielle Echt
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Toby M Maher
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine K Garcia
- Dept of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University, New York, NY, USA
| | - Mary E Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- These authors contributed equally
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
- These authors contributed equally
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17
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Macaluso C, Boccabella C, Kokosi M, Sivarasan N, Kouranos V, George PM, Margaritopoulos G, Molyneaux PL, Chua F, Maher TM, Jenkins GR, Nicholson AG, Desai SR, Devaraj A, Wells AU, Renzoni EA, Stock CJW. Short-term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis. Respirology 2022; 27:202-208. [PMID: 35023231 PMCID: PMC9302621 DOI: 10.1111/resp.14204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/25/2021] [Revised: 11/26/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
Background and objective A proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of short‐term lung function changes in fHP on mortality. Methods Baseline demographics for 145 consecutive patients with a multi‐disciplinary team diagnosis of fHP, as well as baseline and 1‐year follow‐up of lung function, baseline echocardiographic findings, bronchoalveolar lavage (BAL) cellularity and all‐cause mortality were recorded. Changes in forced vital capacity (FVC) ≥ 5% and ≥10%, and diffusion capacity of the lung for carbon monoxide (DLCO) ≥ 10% and ≥15% at 1 year were calculated. Cox proportional hazards analysis was performed to test for associations with mortality. Results Baseline lung function severity, age, presence of honeycombing on computed tomography (CT) and echocardiographic pulmonary arterial systolic pressure (PASP) ≥ 40 mm Hg were associated with early mortality, while BAL lymphocytosis was associated with improved survival. A decline in FVC ≥ 5% (hazard ratio [HR]: 3.10, 95% CI: 2.00–4.81, p < 0.001), FVC ≥ 10% (HR: 3.11, 95% CI: 1.94–4.99, p < 0.001), DLCO ≥ 10% (HR: 2.80, 95% CI: 1.78–4.42, p < 0.001) and DLCO ≥ 15% (HR: 2.92, 95% CI: 1.18–4.72, p < 0.001) at 1 year was associated with markedly reduced survival on univariable and multivariable analyses after correcting for demographic variables, disease severity, honeycombing on CT and treatment, as well as BAL lymphocytosis and PASP ≥ 40 mm Hg on echocardiography, in separate models. Conclusion Worsening in FVC and DLCO at 1 year, including a marginal decline in FVC ≥ 5% and DLCO ≥ 10%, is predictive of markedly reduced survival in fHP.
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Affiliation(s)
- Claudio Macaluso
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Pneumology, INRCA/IRCCS, "L.Mandic" Hospital Merate (LC), Merate, Italy
| | - Cristina Boccabella
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, University of the Sacred Heart, Rome, Italy
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nishanth Sivarasan
- Department of Radiology, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,ILD Unit, London North West University Hospital Healthcare Trust, London, UK.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Hastings Centre for Pulmonary Research and Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gisli R Jenkins
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew G Nicholson
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Histopathology, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Carmel J W Stock
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
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18
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Mehta M, Ghani H, Chua F, Draper A, Calmonson S, Prabhakar M, Shah R, Navarra A, Vaghela T, Barlow A, Vancheeswaran R. Retrospective case-control study to evaluate hypocalcaemia as a distinguishing feature of COVID-19 compared with other infective pneumonias and its association with disease severity. BMJ Open 2021; 11:e053810. [PMID: 34876435 PMCID: PMC8655344 DOI: 10.1136/bmjopen-2021-053810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate whether calcium derangement was a specific feature of COVID-19 that distinguishes it from other infective pneumonias, and its association with disease severity. DESIGN A retrospective observational case-control study looking at serum calcium on adult patients with COVID-19, and community-acquired pneumonia (CAP) or viral pneumonia (VP). SETTING A district general hospital on the outskirts of London, UK. PARTICIPANTS 506 patients with COVID-19, 95 patients with CAP and 152 patients with VP. OUTCOME MEASURES Baseline characteristics including hypocalcaemia in patients with COVID-19, CAP and VP were detailed. For patients with COVID-19, the impact of an abnormally low calcium level on the maximum level of hospital care, as a surrogate of COVID-19 severity, was evaluated. The primary outcome of maximal level of care was based on the WHO Clinical Progression Scale for COVID-19. RESULTS Hypocalcaemia was a specific and common clinical finding in patients with COVID-19 that distinguished it from other respiratory infections. Calcium levels were significantly lower in those with severe disease. Ordinal regression of risk estimates for categorised care levels showed that baseline hypocalcaemia was incrementally associated with OR of 2.33 (95% CI 1.5 to 3.61) for higher level of care, superior to other variables that have previously been shown to predict worse COVID-19 outcome. Serial calcium levels showed improvement by days 7-9 of admission, only in survivors of COVID-19. CONCLUSION Hypocalcaemia is specific to COVID-19 and may help distinguish it from other infective pneumonias. Hypocalcaemia may independently predict severe disease and warrants detailed prognostic investigation. The fact that decreased serum calcium is observed at the time of clinical presentation in COVID-19, but not other infective pneumonias, suggests that its early derangement is pathophysiological and may influence the deleterious evolution of this disease. TRIAL REGISTRATION NUMBER 20/HRA/2344.
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Affiliation(s)
- Meera Mehta
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Hakim Ghani
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | - Sam Calmonson
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Meghna Prabhakar
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rijul Shah
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Alessio Navarra
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Tejal Vaghela
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Andrew Barlow
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rama Vancheeswaran
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
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19
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Jee AS, Chua F. Delays in idiopathic pulmonary fibrosis diagnosis and treatment: Time for change. Respirology 2021; 27:10-11. [PMID: 34846086 DOI: 10.1111/resp.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Adelle S Jee
- Interstitial Lung Disease Unit, Department of Respiratory, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London School of Medicine, London, UK
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20
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Chua F, Vancheeswaran R, Draper A, Vaghela T, Knight M, Mogal R, Singh J, Spencer LG, Thwaite E, Mitchell H, Calmonson S, Mahdi N, Assadullah S, Leung M, O'Neill A, Popat C, Kumar R, Humphries T, Talbutt R, Raghunath S, Molyneaux PL, Schechter M, Lowe J, Barlow A. Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score. Thorax 2021; 76:696-703. [PMID: 33692174 PMCID: PMC7948158 DOI: 10.1136/thoraxjnl-2020-216425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking. METHODS Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290). RESULTS 983 patients (median age 70, IQR 53-83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0-1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%). CONCLUSION The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.
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Affiliation(s)
- Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rama Vancheeswaran
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Adrian Draper
- Respiratory Medicine, St. George's Hospital, London, UK
| | - Tejal Vaghela
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Matthew Knight
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rahul Mogal
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Jaswinder Singh
- Radiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Lisa G Spencer
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Erica Thwaite
- Radiology, Aintree site, Liverpool Hospitals NHS Foundation Trust, UK, Liverpool, UK
| | - Harry Mitchell
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sam Calmonson
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Noor Mahdi
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Matthew Leung
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Aisling O'Neill
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Chhaya Popat
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Radhika Kumar
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Thomas Humphries
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rebecca Talbutt
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarika Raghunath
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam Schechter
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Jeremy Lowe
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Andrew Barlow
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
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21
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Nolan CM, Patel S, Barker RE, Walsh JA, Polgar O, Maddocks M, George PM, Renzoni EA, Wells AU, Molyneaux PL, Kouranos V, Chua F, Maher TM, Man WDC. Muscle stimulation in advanced idiopathic pulmonary fibrosis: a randomised placebo-controlled feasibility study. BMJ Open 2021; 11:e048808. [PMID: 34083348 PMCID: PMC8174518 DOI: 10.1136/bmjopen-2021-048808] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the acceptability of neuromuscular electrical stimulation (NMES) of the quadriceps muscles in people with idiopathic pulmonary fibrosis (IPF) and to identify whether a future definitive trial is feasible. DESIGN A randomised, parallel, two-group, participant and assessor-blinded, placebo-controlled feasibility trial with embedded qualitative interviews. SETTING Outpatient department, Royal Brompton and Harefield Hospitals. PARTICIPANTS Twenty-two people with IPF: median (25th, 75th centiles) age 76 (74, 82) years, forced vital capacity 62 (50, 75) % predicted, 6 min walk test distance 289 (149, 360) m. INTERVENTIONS Usual care (home-based exercise, weekly telephone support, breathlessness management leaflet) with either placebo or active NMES for 6 weeks, with follow-up at 6 and 12 weeks. PRIMARY OUTCOME MEASURES Feasibility of recruitment and retention, treatment uptake and adherence, outcome assessments, participant and outcome assessor blinding and adverse events related to interventions. SECONDARY OUTCOME MEASURES Outcome measures with potential to be primary or secondary outcomes in a definitive clinical trial. In addition, purposively sampled participants were interviewed to capture their experiences and acceptability of the trial. RESULTS Out of 364 people screened, 23 were recruited: 11 were allocated to each group and one was withdrawn prior to randomisation. Compared with the control group, a greater proportion of the intervention group completed the intervention, remained in the trial blinded to group allocation and experienced intervention-related adverse events. Assessor blinding was maintained. The secondary outcome measures were feasible with most missing data associated with the accelerometer. Small participant numbers precluded identification of an outcome measure suitable for a definitive trial. Qualitative findings demonstrated that trial process and active NMES were acceptable but there were concerns about the credibility of placebo NMES. CONCLUSIONS Primarily owing to recruitment difficulties, a definitive trial using the current protocol to evaluate NMES in people with IPF is not feasible. TRIAL REGISTRATION NUMBER NCT03499275.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elisabetta A Renzoni
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athol U Wells
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vasilis Kouranos
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Keck Medicine, University of Southern California, Los Angeles, California, USA
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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22
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Invernizzi R, Wu BG, Barnett J, Ghai P, Kingston S, Hewitt RJ, Feary J, Li Y, Chua F, Wu Z, Wells AU, George PM, Renzoni EA, Nicholson AG, Rice A, Devaraj A, Segal LN, Byrne AJ, Maher TM, Lloyd CM, Molyneaux PL. The Respiratory Microbiome in Chronic Hypersensitivity Pneumonitis Is Distinct from That of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2021; 203:339-347. [PMID: 32692582 PMCID: PMC7874329 DOI: 10.1164/rccm.202002-0460oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/14/2022] Open
Abstract
Rationale: Chronic hypersensitivity pneumonitis (CHP) is a condition that arises after repeated exposure and sensitization to inhaled antigens. The lung microbiome is increasingly implicated in respiratory disease, but, to date, no study has investigated the composition of microbial communities in the lower airways in CHP. Objectives: To characterize and compare the airway microbiome in subjects with CHP, subjects with idiopathic pulmonary fibrosis (IPF), and control subjects. Methods: We prospectively recruited individuals with a CHP diagnosis (n = 110), individuals with an IPF diagnosis (n = 45), and control subjects (n = 28). Subjects underwent BAL and bacterial DNA was isolated, quantified by quantitative PCR and the 16S ribosomal RNA gene was sequenced to characterize the bacterial communities in the lower airways. Measurements and Main Results: Distinct differences in the microbial profiles were evident in the lower airways of subjects with CHP and IPF. At the phylum level, the prevailing microbiota of both subjects with IPF and subjects with CHP included Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. However, in IPF, Firmicutes dominated, whereas the percentage of reads assigned to Proteobacteria in the same group was significantly lower than the percentage found in subjects with CHP. At the genus level, the Staphylococcus burden was increased in CHP, and Actinomyces and Veillonella burdens were increased in IPF. The lower airway bacterial burden in subjects with CHP was higher than that in control subjects but lower than that of those with IPF. In contrast to IPF, there was no association between bacterial burden and survival in CHP. Conclusions: The microbial profile of the lower airways in subjects with CHP is distinct from that of IPF, and, notably, the bacterial burden in individuals with CHP fails to predict survival.
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Affiliation(s)
- Rachele Invernizzi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Benjamin G Wu
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Joseph Barnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Poonam Ghai
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Shaun Kingston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Richard J Hewitt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Yonghua Li
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Felix Chua
- Royal Brompton Hospital, London, United Kingdom
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | | | | | | | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | | | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Leopoldo N Segal
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Adam J Byrne
- 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
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
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23
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Molyneaux PL, Smith JJ, Saunders P, Chua F, Wells AU, Renzoni EA, Nicholson AG, Fahy WA, Jenkins RG, Maher TM. BAL Is Safe and Well Tolerated in Individuals with Idiopathic Pulmonary Fibrosis: An Analysis of the PROFILE Study. Am J Respir Crit Care Med 2021; 203:136-139. [PMID: 32857629 DOI: 10.1164/rccm.202004-1138le] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Philip L Molyneaux
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom
| | - Jonathan J Smith
- National Heart and Lung Institute, Imperial College London London, United Kingdom
| | - Peter Saunders
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom
| | - Felix Chua
- Royal Brompton Hospital London, United Kingdom
| | - Athol U Wells
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom
| | - Elisabetta A Renzoni
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom
| | - Andrew G Nicholson
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom
| | | | | | - Toby M Maher
- Royal Brompton Hospital London, United Kingdom.,National Heart and Lung Institute, Imperial College London London, United Kingdom.,University of Southern California Los Angeles, California
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24
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Drake TM, Docherty AB, Harrison EM, Quint JK, Adamali H, Agnew S, Babu S, Barber CM, Barratt S, Bendstrup E, Bianchi S, Villegas DC, Chaudhuri N, Chua F, Coker R, Chang W, Crawshaw A, Crowley LE, Dosanjh D, Fiddler CA, Forrest IA, George PM, Gibbons MA, Groom K, Haney S, Hart SP, Heiden E, Henry M, Ho LP, Hoyles RK, Hutchinson J, Hurley K, Jones M, Jones S, Kokosi M, Kreuter M, MacKay LS, Mahendran S, Margaritopoulos G, Molina-Molina M, Molyneaux PL, O'Brien A, O'Reilly K, Packham A, Parfrey H, Poletti V, Porter JC, Renzoni E, Rivera-Ortega P, Russell AM, Saini G, Spencer LG, Stella GM, Stone H, Sturney S, Thickett D, Thillai M, Wallis T, Ward K, Wells AU, West A, Wickremasinghe M, Woodhead F, Hearson G, Howard L, Baillie JK, Openshaw PJM, Semple MG, Stewart I, Jenkins RG. Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study. Am J Respir Crit Care Med 2020; 202:1656-1665. [PMID: 33007173 PMCID: PMC7737581 DOI: 10.1164/rccm.202007-2794oc] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rationale: The impact of coronavirus disease (COVID-19) on patients with interstitial lung disease (ILD) has not been established.Objectives: To assess outcomes in patients with ILD hospitalized for COVID-19 versus those without ILD in a contemporaneous age-, sex-, and comorbidity-matched population.Methods: An international multicenter audit of patients with a prior diagnosis of ILD admitted to the hospital with COVID-19 between March 1 and May 1, 2020, was undertaken and compared with patients without ILD, obtained from the ISARIC4C (International Severe Acute Respiratory and Emerging Infection Consortium Coronavirus Clinical Characterisation Consortium) cohort, admitted with COVID-19 over the same period. The primary outcome was survival. Secondary analysis distinguished idiopathic pulmonary fibrosis from non-idiopathic pulmonary fibrosis ILD and used lung function to determine the greatest risks of death.Measurements and Main Results: Data from 349 patients with ILD across Europe were included, of whom 161 were admitted to the hospital with laboratory or clinical evidence of COVID-19 and eligible for propensity score matching. Overall mortality was 49% (79/161) in patients with ILD with COVID-19. After matching, patients with ILD with COVID-19 had significantly poorer survival (hazard ratio [HR], 1.60; confidence interval, 1.17-2.18; P = 0.003) than age-, sex-, and comorbidity-matched controls without ILD. Patients with an FVC of <80% had an increased risk of death versus patients with FVC ≥80% (HR, 1.72; 1.05-2.83). Furthermore, obese patients with ILD had an elevated risk of death (HR, 2.27; 1.39-3.71).Conclusions: Patients with ILD are at increased risk of death from COVID-19, particularly those with poor lung function and obesity. Stringent precautions should be taken to avoid COVID-19 in patients with ILD.
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Affiliation(s)
- Thomas M Drake
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Huzaifa Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust and.,Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Sarah Agnew
- Liverpool Interstitial Lung Disease Service, Aintree site, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Suresh Babu
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Shaney Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust and.,Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Diego Castillo Villegas
- Interstitial Lung Disease (ILD) Unit, Respiratory Medicine Department, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | - Nazia Chaudhuri
- ILD Unit, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, United Kingdom.,University of Manchester, Manchester, United Kingdom
| | - Felix Chua
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Robina Coker
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - William Chang
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Anjali Crawshaw
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Davinder Dosanjh
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christine A Fiddler
- Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ian A Forrest
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter M George
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Michael A Gibbons
- South West Peninsula ILD Network, Royal Devon & Exeter Foundation NHS Trust, Exeter, United Kingdom
| | - Katherine Groom
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sarah Haney
- Northumbria Specialist Emergency Care Hospital, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, United Kingdom
| | - Emily Heiden
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Ling-Pei Ho
- Oxford Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rachel K Hoyles
- Oxford Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Killian Hurley
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - Mark Jones
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre & Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Steve Jones
- Action for Pulmonary Fibrosis, Stuart House, Peterborough, United Kingdom
| | - Maria Kokosi
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,Guys and St. Thomas' NHS Trust, London, United Kingdom
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Laura S MacKay
- Northumbria Specialist Emergency Care Hospital, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Siva Mahendran
- Kingston Hospital NHS Foundation Trust, Surrey, United Kingdom
| | - George Margaritopoulos
- ILD Unit, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, United Kingdom
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Katherine O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alice Packham
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Parfrey
- Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Venerino Poletti
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.,Department of Diseases of the Thorax, Morgagni Hospital, Forli, Italy
| | - Joanna C Porter
- UCL Respiratory, University College London and ILD Service, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Elisabetta Renzoni
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Pilar Rivera-Ortega
- ILD Unit, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, United Kingdom
| | - Anne-Marie Russell
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Imperial Healthcare NHS Trust, St. Mary's Hospital, The Bays, London, United Kingdom
| | - Gauri Saini
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree site, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Giulia M Stella
- Laboratory of Biochemistry and Genetics, Pneumology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Helen Stone
- University Hospital North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Sharon Sturney
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - David Thickett
- Birmingham Interstitial Lung Disease Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,University of Birmingham, Birmingham, United Kingdom
| | - Muhunthan Thillai
- Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Wallis
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Southampton Biomedical Research Centre & Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Katie Ward
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Athol U Wells
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Alex West
- Guys and St. Thomas' NHS Trust, London, United Kingdom
| | | | - Felix Woodhead
- Institute of Lung Health, Interstitial Lung Disease Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Glenn Hearson
- NIHR Biomedical Research Centre, Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Lucy Howard
- NIHR Biomedical Research Centre, Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom.,Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom
| | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; and.,Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Iain Stewart
- NIHR Biomedical Research Centre, Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - R Gisli Jenkins
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,NIHR Biomedical Research Centre, Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
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25
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Stock CJW, Hoyles RK, Daccord C, Kokosi M, Visca D, De Lauretis A, Alfieri V, Kouranos V, Margaritopoulos G, George PM, Molyneaux PL, Chua F, Maher TM, Abraham DJ, Ong V, Donovan J, Sestini P, Denton CP, Wells AU, Renzoni EA. Serum markers of pulmonary epithelial damage in systemic sclerosis-associated interstitial lung disease and disease progression. Respirology 2020; 26:461-468. [PMID: 33336433 DOI: 10.1111/resp.13988] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 07/28/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The course of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is highly variable, and accurate prognostic markers are needed. KL-6 is a mucin-like glycoprotein (MUC1) expressed by type II pneumocytes, while CYFRA 21-1 is expressed by alveolar and bronchiolar epithelial cells. Both are released into the blood from cell injury. METHODS Serum KL-6 and CYFRA 21-1 levels were measured in a retrospective (n = 189) and a prospective (n = 118) cohort of SSc patients. Genotyping of MUC1 rs4072037 was performed. Linear mixed-effect models were used to evaluate the relationship with change in lung function parameters over time, while association with survival was evaluated with Cox proportional hazard analysis. RESULTS In both cohorts, KL-6 and CYFRA 21-1 were highest in patients with lung involvement, and in patients with extensive rather than limited ILD. KL-6 was higher in patients carrying the MUC1 rs4072037 G allele in both cohorts. In patients with SSc-ILD, serum KL-6, but not CYFRA 21-1, was significantly associated with DLCO decline in both cohorts (P = 0.001 and P = 0.004, respectively), and with FVC decline in the retrospective cohort (P = 0.005), but not the prospective cohort. When combining the cohorts and subgrouping by severity (median CPI = 45.97), KL-6 remained predictive of decline in DLCO in both milder (P = 0.007) and more severe disease (P = 0.02) on multivariable analysis correcting for age, gender, ethnicity, smoking history and MUC1 allele carriage. CONCLUSION Our results suggest serum KL-6 predicts decline in lung function in SSc, suggesting its clinical utility in risk stratification for progressive SSc-ILD.
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Affiliation(s)
- Carmel J W Stock
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Rachel K Hoyles
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | - Cecile Daccord
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.,Division of Respiratory Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Dina Visca
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.,Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Angelo De Lauretis
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.,Unita' Operativa Malattie Respiratorie, Ospedale Guido Salvini, Milan, Italy
| | - Veronica Alfieri
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.,Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - David J Abraham
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, London, UK
| | - Voon Ong
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, London, UK
| | - Jackie Donovan
- Department of Biochemistry, Royal Brompton Hospital, London, UK
| | - Piersante Sestini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
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26
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Din S, Kent A, Pollok RC, Meade S, Kennedy NA, Arnott I, Beattie RM, Chua F, Cooney R, Dart RJ, Galloway J, Gaya DR, Ghosh S, Griffiths M, Hancock L, Hansen R, Hart A, Lamb CA, Lees CW, Limdi JK, Lindsay JO, Patel K, Powell N, Murray CD, Probert C, Raine T, Selinger C, Sebastian S, Smith PJ, Tozer P, Ustianowski A, Younge L, Samaan MA, Irving PM. Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel. Gut 2020; 69:1769-1777. [PMID: 32513653 PMCID: PMC7299646 DOI: 10.1136/gutjnl-2020-321927] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point. DESIGN We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey. RESULTS Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4-6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab. CONCLUSION We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.
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Affiliation(s)
- Shahida Din
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
- Gastroenterology and Hepatology Unit, University of Edinburgh, Edinburgh, UK
| | - Alexandra Kent
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK
- Institute of Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Susanna Meade
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter IBD Research Group, University of Exeter, Exeter, UK
| | - Ian Arnott
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Robin J Dart
- Department of Gastroenterology, Royal Free Hospital, London, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital, London, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Subrata Ghosh
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark Griffiths
- Peri-operative Medicine, Barts Health NHS Trust, London, UK
- Faculty of Medicine, National Heart and Lung Institute, London, UK
| | - Laura Hancock
- Department of General Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Hansen
- Paediatric Gastroenterology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, London, UK
- Antigen Presentation Research Group, Imperial College London, London, UK
| | - Christopher Andrew Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - James O Lindsay
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK
| | - Nick Powell
- Division of Digestive Diseases, Imperial College London, London, UK
| | | | - Chris Probert
- Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, University of Liverpool Institute of Translational Medicine, Liverpool, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Department of Immunuology and Inflammation, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Phil Tozer
- IBD Unit, St Mark's Hospital, London, UK
| | - Andrew Ustianowski
- Department of Infectious Disease, North Manchester General Hospital, Manchester, UK
| | - Lisa Younge
- IBD Unit, St Mark's Hospital, London, UK
- Crohn's and Colitis UK, Saint Albans, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
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27
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Stock CJ, Conti C, Montero-Fernandez Á, Caramori G, Molyneaux PL, George PM, Kokosi M, Kouranos V, Maher TM, Chua F, Rice A, Denton CP, Nicholson AG, Wells A, Sestini P, Renzoni EA. Interaction between the promoter MUC5B polymorphism and mucin expression: is there a difference according to ILD subtype? Thorax 2020; 75:901-903. [PMID: 32580994 DOI: 10.1136/thoraxjnl-2020-214579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/22/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/23/2022]
Abstract
The MUC5B promoter variant rs35705950 is associated with idiopathic pulmonary fibrosis (IPF). MUC5B glycoprotein is overexpressed in IPF lungs. We examined immunohistochemical expression of MUC5B in different interstitial lung disease patterns according to rs35705950 T-allele carriage. We observed increased expression of MUC5B in T-allele carriers in both distal airways and honeycomb cysts in patients with IPF (n=23), but no difference in MUC5B expression according to T-carrier status in the distal airways of patients with idiopathic non-specific interstitial pneumonitis (n=17), in scleroderma-associated non-specific interstitial pneumonitis (n=15) or in control lungs (n=20), suggesting that tissue overexpression in MUC5B rs35705950 T-carriers is specific to IPF.
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Affiliation(s)
- Carmel J Stock
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Caterina Conti
- Respiratory Unit ASST, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Ángeles Montero-Fernandez
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Gaetano Caramori
- UOC di Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Università di Messina, Messina, Italy
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Vaslis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Alexandra Rice
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Athol Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
| | - Piersante Sestini
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Toscana, Italy
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust/ National Heart and Lung Institute, Imperial College, London, UK
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28
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Bonifazi M, Sverzellati N, Negri E, Jacob J, Egashira R, Moser J, Piciucchi S, Mei F, De Lauretis A, Visca D, Goh N, Bonini M, Cirilli L, La Vecchia C, Chua F, Kouranos V, Margaritopoulos G, Kokosi M, Maher TM, Gasparini S, Gabrielli A, Wells AU, Renzoni EA. Pleuroparenchymal fibroelastosis in systemic sclerosis: prevalence and prognostic impact. Eur Respir J 2020; 56:1902135. [PMID: 32299855 PMCID: PMC7615192 DOI: 10.1183/13993003.02135-2019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022]
Abstract
Interstitial lung disease (ILD) in systemic sclerosis (SSc) is a major cause of morbidity and mortality, mostly presenting as non-specific interstitial pneumonia. Little is known about the prevalence of pleuroparenchymal fibroelastosis (PPFE), a specific entity affecting the visceral pleura and subpleural parenchyma. We set out to estimate PPFE prevalence in two large cohorts of SSc patients and to assess its impact on survival and functional decline.A total of 359 SSc patients, derived from two referral centres in two different countries (UK and Italy), were included. The first available high-resolution computed tomography scan was independently evaluated by two radiologists blind to clinical information, to quantify ILD extent, freestanding bronchial abnormalities, and lobar percentage involvement of PPFE on a four-point categorical scale. Discordant scores were adjudicated by a third scorer. PPFE extent was further classified as limited (≤2/18) or extensive (>2/18). Results were evaluated against functional decline and mortality.The overall prevalence of PPFE in the combined SSc population was 18% (11% with extensive PPFE), with no substantial difference between the two cohorts. PPFE was significantly linked to free-standing bronchial abnormalities (61% versus 25% in PPFE versus no PPFE; p<0.0001) and to worse survival, independently of ILD severity or short-term lung function changes (HR 1.89, 95% CI 1.10-3.25; p=0.005).In the current study, we provide an exhaustive description of PPFE prevalence and clinical impact in the largest cohort of SSc subjects published so far. PPFE presence should be carefully considered, due to its significant prognostic implications.
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Affiliation(s)
- Martina Bonifazi
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Nicola Sverzellati
- Radiology, Dept of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Eva Negri
- Dept of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Joseph Jacob
- Dept of Respiratory Medicine, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Ryoko Egashira
- Dept of Radiology, Faculty of Medicine, Saga University, Saga city, Japan
| | - Joanna Moser
- Dept of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Federico Mei
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Angelo De Lauretis
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Pulmonary Diseases Unit, Azienda Ospedaliera "Guido Salvini", Garbagnate Milanese, Italy
| | - Dina Visca
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Division of Pulmonary Rehabilitation, Istituti Clinic Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Nicole Goh
- Dept of Respiratory Medicine, Austin Hospital, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
- Dept of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A.Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Cirilli
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo La Vecchia
- Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Interstitial Lung Disease Unit, Manchester University Hospital NHS FT, Wythenshawe Hospital, Manchester, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Stefano Gasparini
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Armando Gabrielli
- Dept of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
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29
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Kouranos V, Ward S, Kokosi MA, Castillo D, Chua F, Judge EP, Thomas S, Van Tonder F, Devaraj A, Nicholson AG, Maher TM, Renzoni EA, Wells AU. Mixed Ventilatory Defects in Pulmonary Sarcoidosis: Prevalence and Clinical Features. Chest 2020; 158:2007-2014. [PMID: 32534908 DOI: 10.1016/j.chest.2020.04.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/13/2019] [Revised: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In cohort studies of pulmonary sarcoidosis, abnormal ventilatory patterns have generally been subdivided into restrictive and obstructive defects. Mixed ventilatory defects have largely been overlooked in pulmonary sarcoidosis, as total lung capacity has seldom been taken into account in historical series. RESEARCH QUESTION This study evaluated the prevalence of mixed disease in pulmonary sarcoidosis and its clinical associations. STUDY DESIGN AND METHODS In patients with pulmonary sarcoidosis (N = 1,110), mixed defects were defined according to American Thoracic Society/European Respiratory Society criteria. Clinical data, pulmonary function variables, and vital status were abstracted from clinical records. Chest radiographs were evaluated independently by two experienced radiologists. RESULTS The prevalence of a mixed ventilatory defect was 10.4% in the whole cohort, rising to 25.9% in patients with airflow obstruction. Compared with isolated airflow obstruction, mixed defects were associated with lower diffusing lung capacity for carbon monoxide levels (50.7 ± 16.3 vs 70.8 ± 18.1; P < .0001), a higher prevalence of chest radiographic stage IV disease (63.5% vs 38.3%; P < .0001), and higher mortality (hazard ratio, 2.36; 95% CI, 1.34-4.15; P = .003). These findings were reproduced in all patient subgroup analyses, including patients with a histologic diagnosis, a clinical diagnosis, incident disease, and prevalent disease. INTERPRETATION Mixed disease is present in approximately 25% of patients with pulmonary sarcoidosis and airflow obstruction and is associated with lower diffusing lung capacity for carbon monoxide levels, a higher prevalence of stage IV disease, and higher mortality than seen in a pure obstructive defect. These observations identify a distinct phenotype associated with a mixed ventilatory defect, justifying future studies of its clinical and pathogenetic significance.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Simon Ward
- Lung Function Department, Royal Brompton Hospital, London, England
| | - Maria A Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Diego Castillo
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England; Interstitial Lung Disease Unit, Hospital de Sant Pau, Barcelona, Spain
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Eoin P Judge
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Suzie Thomas
- Lung Function Department, Royal Brompton Hospital, London, England
| | - Frans Van Tonder
- Department of Radiology, Royal Brompton Hospital, London, England; Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Arnand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, England
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England; NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, the Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, England
| | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England.
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30
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Chua F, Armstrong-James D, Desai SR, Barnett J, Kouranos V, Kon OM, José R, Vancheeswaran R, Loebinger MR, Wong J, Cutino-Moguel MT, Morgan C, Ledot S, Lams B, Yip WH, Li L, Lee YC, Draper A, Kho SS, Renzoni E, Ward K, Periselneris J, Grubnic S, Lipman M, Wells AU, Devaraj A. The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions. Lancet Respir Med 2020; 8:438-440. [PMID: 32220663 PMCID: PMC7104153 DOI: 10.1016/s2213-2600(20)30132-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
| | - Darius Armstrong-James
- Department of Infectious Disease and Medical Mycology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Onn Min Kon
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo José
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Rama Vancheeswaran
- Department of Integrated Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | | | - Cliff Morgan
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Boris Lams
- Respiratory Medicine and Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wing Ho Yip
- Division of Respiratory Medicine, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Leski Li
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Ying Cheong Lee
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Adrian Draper
- Department of Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sze Shyang Kho
- Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Katie Ward
- Department of Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jimstan Periselneris
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Sisa Grubnic
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
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31
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Invernizzi R, Barnett J, Rawal B, Nair A, Ghai P, Kingston S, Chua F, Wu Z, Wells AU, Renzoni ER, Nicholson AG, Rice A, Lloyd CM, Byrne AJ, Maher TM, Devaraj A, Molyneaux PL. Bacterial burden in the lower airways predicts disease progression in idiopathic pulmonary fibrosis and is independent of radiological disease extent. Eur Respir J 2020; 55:1901519. [PMID: 31980496 PMCID: PMC7136009 DOI: 10.1183/13993003.01519-2019] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/29/2019] [Indexed: 12/01/2022]
Abstract
Increasing bacterial burden in the lower airways of patients with idiopathic pulmonary fibrosis confers an increased risk of disease progression and mortality. However, it remains unclear whether this increased bacterial burden directly influences progression of fibrosis or simply reflects the magnitude of the underlying disease extent or severity.We prospectively recruited 193 patients who underwent bronchoscopy and received a multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Quantification of the total bacterial burden in bronchoalveolar lavage fluid was performed by 16S rRNA gene qPCR. Imaging was independently evaluated by two readers assigning quantitative scores for extent, severity and topography of radiographic changes and relationship of these features with bacterial burden was assessed.Increased bacterial burden significantly associated with disease progression (HR 2.1; 95% CI 1.287-3.474; p=0.0028). Multivariate stepwise regression demonstrated no relationship between bacterial burden and radiological features or extent of disease. When specifically considering patients with definite or probable usual interstitial pneumonia there was no difference in bacterial burden between these two groups. Despite a postulated association between pleuroparenchymal fibroelastosis and clinical infection, there was no relationship between either the presence or extent of pleuroparenchymal fibroelastosis and bacterial burden.We demonstrate that bacterial burden in the lower airways is not simply secondary to the extent of the underlying architectural destruction of the lung parenchyma seen in idiopathic pulmonary fibrosis. The independent nature of this association supports a relationship with the underlying pathogenic mechanisms and highlights the urgent need for functional studies.
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Affiliation(s)
- Rachele Invernizzi
- National Heart and Lung Institute, Imperial College London, London, UK
- Contributed equally as first authors
| | - Joseph Barnett
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
- Contributed equally as first authors
| | | | - Arjun Nair
- Dept of Radiology, University College Hospital, London, UK
| | - Poonam Ghai
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Shaun Kingston
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | | | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam J Byrne
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
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32
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Williams A, Kelleher WP, Nicholson AG, Devaraj A, Pavesio C, Chua F. Diffuse granulomatous disease: looking inside and outside the lungs. Thorax 2020; 75:189-191. [PMID: 31907202 PMCID: PMC7029226 DOI: 10.1136/thoraxjnl-2019-213797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Alan Williams
- Interstitial Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Felix Chua
- Interstitial Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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33
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Bax S, Jacob J, Ahmed R, Bredy C, Dimopoulos K, Kempny A, Kokosi M, Kier G, Renzoni E, Molyneaux PL, Chua F, Kouranos V, George P, McCabe C, Wilde M, Devaraj A, Wells A, Wort SJ, Price LC. Right Ventricular to Left Ventricular Ratio at CT Pulmonary Angiogram Predicts Mortality in Interstitial Lung Disease. Chest 2020; 157:89-98. [PMID: 31351047 PMCID: PMC7615159 DOI: 10.1016/j.chest.2019.06.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/19/2018] [Revised: 04/24/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism. METHODS Demographic characteristics, ILD subtype, echocardiography, and detailed CTPA measurements were collected in consecutive patients undergoing both CTPA and right heart catheterization at the Royal Brompton Hospital between 2005 and 2015. Fibrosis severity was formally scored according to CT criteria. The RV:LV ratio at CTPA was evaluated by using three different methods. Cox proportional hazards analysis was used to assess the relation of CTPA-derived parameters to predict death or lung transplantation. RESULTS A total of 92 patients were included (64% male; mean age 65 ± 11 years) with an FVC 57 ± 20% predicted, corrected transfer factor of the lung for carbon monoxide 22 ± 8% predicted, and corrected transfer coefficient of the lung for carbon monoxide 51 ± 17% predicted. PH was confirmed at right heart catheterization in 78%. Of all the CTPA-derived measures, an RV:LV ratio ≥ 1.0 strongly predicted mortality or transplantation at univariate analysis (hazard ratio, 3.26; 95% CI, 1.49-7.13; P = .003), whereas invasive hemodynamic data did not. The RV:LV ratio remained an independent predictor at multivariate analysis (hazard ratio, 3.19; 95% CI, 1.44-7.10; P = .004), adjusting for an ILD diagnosis of idiopathic pulmonary fibrosis and CT imaging-derived ILD severity. CONCLUSIONS An increased RV:LV ratio measured at CTPA provides a simple, noninvasive method of risk stratification in patients with suspected ILD-PH. This should prompt closer follow-up, more aggressive treatment, and consideration of lung transplantation.
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Affiliation(s)
- Simon Bax
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
- Surrey and Sussex Hospital, Redhill, Canada Ave, Redhill, Surrey, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Riaz Ahmed
- Surrey and Sussex Hospital, Redhill, Canada Ave, Redhill, Surrey, UK
| | - Charlene Bredy
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
- CHU Arnaud de Villeneuve, Montpellier, France
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
- National Heart and Lung Institute, Imperial College, London, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
| | - Maria Kokosi
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - Gregory Kier
- Princess Alexandra Hospital, Department of Respiratory Medicine, Woolloongabba, Australia
| | - Elisabetta Renzoni
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - Philip L Molyneaux
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Felix Chua
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - Vasilis Kouranos
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - Peter George
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
| | - Michael Wilde
- Surrey and Sussex Hospital, Redhill, Canada Ave, Redhill, Surrey, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Trust
| | - Athol Wells
- Department of Interstitial Lung Diseases, Royal Brompton and Harefield NHS Trust
| | - S John Wort
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
- National Heart and Lung Institute, Imperial College, London, UK
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Trust
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34
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Yazdani MF, Morris-Rosendahl D, Chen L, Devaraj A, Chua F. Images of the month 1: Cough before the storm: A case of pulmonary alveolar microlithiasis. Clin Med (Lond) 2020; 20:110-111. [DOI: 10.7861/clinmed.2019-0370] [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] [Indexed: 11/27/2022]
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35
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Mackintosh JA, Chua F. Familial lung disease presenting in reverse. Lancet Respir Med 2019; 7:1084. [PMID: 31777392 DOI: 10.1016/s2213-2600(19)30403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
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36
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Alfieri V, Crisafulli E, Visca D, Chong WH, Stock C, Mori L, de Lauretis A, Tsipouri V, Chua F, Kouranos V, Kokosi M, Hogben C, Molyneaux PL, George PM, Maher TM, Chetta AA, Sestini P, Wells AU, Renzoni EA. Physiological predictors of exertional oxygen desaturation in patients with fibrotic interstitial lung disease. Eur Respir J 2019; 55:13993003.01681-2019. [DOI: 10.1183/13993003.01681-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/25/2019] [Indexed: 11/05/2022]
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37
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Chua F, Desai SR, Nicholson AG, Devaraj A, Renzoni E, Rice A, Wells AU. Pleuroparenchymal Fibroelastosis. A Review of Clinical, Radiological, and Pathological Characteristics. Ann Am Thorac Soc 2019; 16:1351-1359. [PMID: 31425665 PMCID: PMC6945468 DOI: 10.1513/annalsats.201902-181cme] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [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: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is an unusual pulmonary disease with unique clinical, radiological, and pathological characteristics. Designated a rare idiopathic interstitial pneumonia in 2013, its name refers to a combination of fibrosis involving the visceral pleura and fibroelastotic changes predominating in the subpleural lung parenchyma. Although a number of disease associations have been described, no single cause of PPFE has been unequivocally identified. A diagnosis of PPFE is most commonly achieved by identifying characteristic abnormalities on computed tomographic scans. The earliest changes are consistently located in the upper lobes close to the lung apices, the same locations where subsequent disease progression is also most conspicuous. When sufficiently severe, the disease leads to progressive volume loss of the upper lobes, which, in combination with decreased body mass, produces platythorax. Once regarded as a slowly progressing entity, it is now acknowledged that some patients with PPFE follow an inexorably progressive course that culminates in irreversible respiratory failure and early death. In the absence of effective medical drug treatment, lung transplant remains the only therapeutic option for this disorder. This review focuses on improving early disease recognition and evaluating its pathophysiological impact and discusses working approaches for its management.
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Affiliation(s)
| | | | | | | | | | - Alexandra Rice
- Department of Pathology, Royal Brompton Hospital, London, United Kingdom
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38
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Mackintosh JA, Desai SR, Adamali H, Patel K, Chua F, Devaraj A, Kouranos V, Kokosi M, Margaritopoulos G, Renzoni EA, Wells AU, Molyneaux PL, Kumar S, Maher TM, George PM. In patients with idiopathic pulmonary fibrosis the presence of hiatus hernia is associated with disease progression and mortality. Eur Respir J 2019; 53:13993003.02412-2018. [DOI: 10.1183/13993003.02412-2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/18/2019] [Indexed: 11/05/2022]
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39
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Macaluso C, Maritano Furcada J, Alzaher O, Chaube R, Chua F, Wells AU, Maher TM, George PM, Renzoni EA, Molyneaux PL. The potential impact of azithromycin in idiopathic pulmonary fibrosis. Eur Respir J 2019; 53:13993003.00628-2018. [PMID: 30442715 DOI: 10.1183/13993003.00628-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/27/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Claudio Macaluso
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,These authors contributed equally to the study
| | - Joaquín Maritano Furcada
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,These authors contributed equally to the study
| | - Omamah Alzaher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Ritesh Chaube
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
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40
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Whitworth HS, Badhan A, Boakye AA, Takwoingi Y, Rees-Roberts M, Partlett C, Lambie H, Innes J, Cooke G, Lipman M, Conlon C, Macallan D, Chua F, Post FA, Wiselka M, Woltmann G, Deeks JJ, Kon OM, Lalvani A. Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study. Lancet Infect Dis 2019; 19:193-202. [PMID: 30655049 DOI: 10.1016/s1473-3099(18)30613-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The clinical utility of interferon-γ release assays (IGRAs) for diagnosis of active tuberculosis is unclear, although they are commonly used in countries with a low incidence of tuberculosis. We aimed to resolve this clinical uncertainty by determining the accuracy and utility of commercially available and second-generation IGRAs in the diagnostic assessment of suspected tuberculosis in a low-incidence setting. METHODS We did a prospective cohort study of adults with suspected tuberculosis in routine secondary care in England. Patients were tested for Mycobacterium tuberculosis infection at baseline with commercially available (T-SPOT.TB and QuantiFERON-TB Gold In-Tube [QFT-GIT]) and second-generation (incorporating novel M tuberculosis antigens) IGRAs and followed up for 6-12 months to establish definitive diagnoses. Sensitivity, specificity, positive and negative likelihood ratios, and predictive values of the tests were determined. FINDINGS Of the 1060 adults enrolled in the study, 845 were included in the analyses and 363 were diagnosed with tuberculosis. Sensitivity of T-SPOT.TB for all tuberculosis diagnosis, including culture-confirmed and highly probable cases, was 81·4% (95% CI 76·6-85·3), which was higher than QFT-GIT (67·3% [62·0-72·1]). Second-generation IGRAs had a sensitivity of 94·0% (90·0-96·4) for culture-confirmed tuberculosis and 89·2% (85·2-92·2) when including highly probable tuberculosis, giving a negative likelihood ratio for all tuberculosis cases of 0·13 (95% CI 0·10-0·19). Specificity ranged from 86·2% (95% CI 82·3-89·4) for T-SPOT.TB to 80·0% (75·6-83·8) for second-generation IGRAs. INTERPRETATION Commercially available IGRAs do not have sufficient accuracy for diagnostic evaluation of suspected tuberculosis. Second-generation tests, however, might have sufficiently high sensitivity, low negative likelihood ratio, and correspondingly high negative predictive value in low-incidence settings to facilitate prompt rule-out of tuberculosis. FUNDING National Institute for Health Research.
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Affiliation(s)
- Hilary S Whitworth
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Amarjit Badhan
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | - Aime A Boakye
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Rees-Roberts
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK; Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Heather Lambie
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - John Innes
- Heart of England National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Graham Cooke
- Department of Infectious Diseases, St Mary's Hospital, Imperial College Healthcare Trust, London, UK
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK; University College London Respiratory, Division of Medicine, University College London, London, UK
| | - Christopher Conlon
- Nuffield Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Derek Macallan
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Felix Chua
- Department of Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Frank A Post
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Martin Wiselka
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerrit Woltmann
- Department of Infection, Immunity and Inflammation, Respiratory Biomedical Research Centre, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Onn Min Kon
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.
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41
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Fletcher SV, Jones MG, Renzoni EA, Parfrey H, Hoyles RK, Spinks K, Kokosi M, Kwok A, Warburton C, Titmuss V, Thillai M, Simler N, Maher TM, Brereton CJ, Chua F, Wells AU, Richeldi L, Spencer LG. Safety and tolerability of nintedanib for the treatment of idiopathic pulmonary fibrosis in routine UK clinical practice. ERJ Open Res 2018; 4:00049-2018. [PMID: 30364342 PMCID: PMC6194204 DOI: 10.1183/23120541.00049-2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/29/2018] [Accepted: 08/25/2018] [Indexed: 12/19/2022] Open
Abstract
Nintedanib, a tyrosine kinase inhibitor approved for the treatment of idiopathic pulmonary fibrosis (IPF), reduces annual forced vital capacity (FVC) decline in these patients by ∼50% with combined analysis of data from clinical trials showing a trend towards reduction in mortality [1–3]. Nintedanib prescription criteria for the treatment of IPF vary between countries and in 2016, the National Institute for Health and Care Excellence approved nintedanib in England and Wales for patients with an FVC between 50% and 80% predicted [4]. Prior to this approval, nintedanib was available through a manufacturer-funded programme with varying prescribing criteria. We investigated the safety and tolerability of nintedanib in UK clinical practice during this period in which FVC prescription criteria differed from those now available in routine practice. In IPF, commencement of antifibrotic therapy in patients with preserved lung volume may increase the duration of therapyhttp://ow.ly/4HeM30lFS67
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Affiliation(s)
- Sophie V Fletcher
- NIHR Southampton Respiratory Biomedical Research Centre University Hospital Southampton and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Mark G Jones
- NIHR Southampton Respiratory Biomedical Research Centre University Hospital Southampton and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Christopher J Brereton
- NIHR Southampton Respiratory Biomedical Research Centre University Hospital Southampton and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Felix Chua
- ILD Unit, Royal Brompton Hospital, London, UK
| | | | - Luca Richeldi
- NIHR Southampton Respiratory Biomedical Research Centre University Hospital Southampton and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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Visca D, Mori L, Tsipouri V, Fleming S, Firouzi A, Bonini M, Pavitt MJ, Alfieri V, Canu S, Bonifazi M, Boccabella C, De Lauretis A, Stock CJW, Saunders P, Montgomery A, Hogben C, Stockford A, Pittet M, Brown J, Chua F, George PM, Molyneaux PL, Margaritopoulos GA, Kokosi M, Kouranos V, Russell AM, Birring SS, Chetta A, Maher TM, Cullinan P, Hopkinson NS, Banya W, Whitty JA, Adamali H, Spencer LG, Farquhar M, Sestini P, Wells AU, Renzoni EA. Effect of ambulatory oxygen on quality of life for patients with fibrotic lung disease (AmbOx): a prospective, open-label, mixed-method, crossover randomised controlled trial. The Lancet Respiratory Medicine 2018; 6:759-770. [DOI: 10.1016/s2213-2600(18)30289-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023]
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43
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Robbie H, Daccord C, Chua F, Devaraj A. Evaluating disease severity in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 26:26/145/170051. [PMID: 28877976 DOI: 10.1183/16000617.0051-2017] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/16/2017] [Indexed: 12/27/2022] Open
Abstract
Accurate assessment of idiopathic pulmonary fibrosis (IPF) disease severity is integral to the care provided to patients with IPF. However, to date, there are no generally accepted or validated staging systems. There is an abundance of data on using information acquired from physiological, radiological and pathological parameters, in isolation or in combination, to assess disease severity in IPF. Recently, there has been interest in using serum biomarkers and computed tomography-derived quantitative lung fibrosis measures to stage disease severity in IPF. This review will focus on the suggested methods for staging IPF, at baseline and on serial assessment, their strengths and limitations, as well as future developments.
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Affiliation(s)
- Hasti Robbie
- Radiology Dept, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Cécile Daccord
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Centre for Academic Radiology, Royal Brompton Hospital, London, UK
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44
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Stolagiewicz NE, Draper A, Schomberg LEE, Chua F. Mycophenolate mofetil (MMF) for the treatment of connective tissue disease-associated interstitial lung disease (ILD). Hippokratia 2017. [DOI: 10.1002/14651858.cd009911.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Natalie E Stolagiewicz
- St George's Healthcare NHS Trust; Respiratory Medicine/Undergraduate Education Department; London UK SW17 0QT
| | - Adrian Draper
- St George's Hospital; Chest Clinic; Blackshaw Road Tooting UK SW17
| | - Lucy EE Schomberg
- Guy's and St Thomas' NHS Foundation Trust; Respiratory Medicine; London UK SE1 7EH
| | - Felix Chua
- St George's Hospital NHS Trust; Department of Respiratory Medicine; Blackshaw Road London UK SW17 0RE
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45
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Skevington-Postles L, Akers S, George P, Housley G, Beadle J, Devaraj A, Chua F. P166 The emerging role of airway clearance techniques in the treatment of interstitial lung disease. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.309] [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] [Indexed: 11/04/2022]
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Margaritopoulos GA, Proklou A, Bonet DB, Kokosi M, Maher TM, Renzoni EA, Wells AU, Chua F. P273 Baseline characteristics of patients with idiopathic pulmonary fibrosis aged over 80 years old. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.416] [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] [Indexed: 11/03/2022]
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Koulopoulou M, Greenwood S, Reilly C, Chua F. P279 Feasibility of an 8-week out-patient inspiratory muscle training (IMT) programme in patients with interstitial lung disease (ILD). Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.422] [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] [Indexed: 11/04/2022]
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Ward K, Spurr L, Goldman NR, Margaritopoulos GA, Kokosi M, Renzoni E, Chua F, Maher TM, Ward S, Wells AU. P248 Patient eligibility for anti-fibrotic therapy in idiopathic pulmonary fibrosis can be altered by use of different sets of reference values for calculation of fvc percent predicted. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cove J, Russell AM, Wright J, Hogben C, Kokosi M, Mak V, Chua F, Wells A, Doyle AM, Renzoni E. P3 Pilot study to test the feasibility of a psychological support workshop for patients newly diagnosed with Idiopathic Pulmonary Fibrosis (IPF) and their families: Abstract P3 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.140] [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] [Indexed: 11/03/2022]
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