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Khor YH, Ryerson CJ. Advancing Drug Development in Idiopathic Pulmonary Fibrosis: Tomorrow Is Now. Am J Respir Crit Care Med 2024; 209:1060-1062. [PMID: 38484134 DOI: 10.1164/rccm.202402-0381ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred
- School of Translational Medicine Monash University Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine Austin Health Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep Heidelberg, Victoria, Australia
- Faculty of Medicine University of Melbourne Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Department of Medicine University of British Columbia Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation St. Paul's Hospital Vancouver, British Columbia, Canada
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2
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Khor YH. Systemic lupus erythematosus: Adding another piece to the connective tissue disease-associated interstitial lung disease puzzle. Respirology 2024. [PMID: 38565300 DOI: 10.1111/resp.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
See related article
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Pitre T, Lupas D, Ebeido I, Colak A, Modi M, Kachkovski GV, Montesi SB, Khor YH, Kawano-Dourado L, Jenkins G, Fisher JH, Shapera S, Rochwerg B, Couban R, Zeraatkar D. Prognostic factors associated with mortality in acute exacerbations of idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Respir Med 2024; 222:107515. [PMID: 38154738 DOI: 10.1016/j.rmed.2023.107515] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) increases mortality risk, but which factors increase mortality is unknown. We aimed to perform a prognostic review of factors associated with mortality in patients with IPF. STUDY DESIGN and methods: We searched MEDLINE, EMBASE, and CINAHL for studies that reported on the association between any prognostic factor and AE-IPF. We assessed risk of bias using the QUIPS tool. We conduced pairwise meta-analyses using REML heterogeneity estimator, and GRADE approach to assess the certainty of the evidence. RESULTS We included 35 studies in our analysis. We found that long-term supplemental oxygen at baseline (aHR 2.52 [95 % CI 1.68 to 3.80]; moderate certainty) and a diagnosis of IPF compared to non-IPF ILD (aHR 2.19 [95 % CI 1.22 to 3.92]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. A diffuse pattern on high resolution computed tomography (HRCT) compared to a non-diffuse pattern (aHR 2.61 [95 % CI 1.32 to 2.90]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. We found that using corticosteroids prior to hospital admission (aHR 2.19 [95 % CI 1.26 to 3.82]; moderate certainty) and those with increased neutrophils (by % increase) in bronchoalveolar lavage (BAL) during the exacerbation is associated with a higher risk of death (aHR 1.02 [1.01 to 1.04]; moderate certainty). INTERPRETATION Our results have implications for healthcare providers in making treatment decisions and prognosticating the clinical trajectory of patients, for researchers to design future interventions to improve patient trajectory, and for guideline developers in making decisions about resource allocation.
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Affiliation(s)
- Tyler Pitre
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Daniel Lupas
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ibrahim Ebeido
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexander Colak
- Faculty of Medicine, University of British Columbia, BC, Canada
| | - Mihir Modi
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - George V Kachkovski
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yet H Khor
- Respiratory Research Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Kawano-Dourado
- Hcor Research Institute, Hospital do Coracao, Sao Paulo, Brazil; Pulmonary Division, University of Sao Paulo, Sao Paulo, Brazil; MAGIC Evidence Ecosystem, Oslo, Norway
| | - Gisli Jenkins
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, UK
| | - Jolene H Fisher
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shane Shapera
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesiology, McMaster University, Hamilton, ON, Canada
| | - Dena Zeraatkar
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Anesthesiology, McMaster University, Hamilton, ON, Canada
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Tikellis G, Corte T, Glaspole IN, Goh NSL, Khor YH, Wrobel J, Symons K, Fuhrmeister L, Glenn L, Chirayath S, Troy LK, King B, Holland AE. Navigating the COVID-19 pandemic: Experiences and self-management approaches adopted by people with interstitial lung disease. Chron Respir Dis 2024; 21:14799731231226236. [PMID: 38193428 PMCID: PMC10777803 DOI: 10.1177/14799731231226236] [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: 08/17/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND People with interstitial lung disease (ILD) were deemed more vulnerable to the SARS-CoV-2 virus and isolated as a means of reducing risk of infection. This study examined the impact of the pandemic on daily life, psychological wellbeing and access to healthcare and identified approaches undertaken to remain safe. METHODS Four specialist clinics in tertiary centres in Australia (Victoria: two sites; New South Wales: one site; Western Australia: one site) recruited patients with ILD during an 8-week period from March 2021. Semi-structured telephone interviews were conducted with transcripts analysed using principles of grounded theory. RESULTS Ninety participants were interviewed between April and December 2021. Participants were predominantly female, former smokers with an average age of 66 years. IPF and connective tissue-ILD being the most common subtypes. Five main themes were identified: vulnerability reduced social interaction and isolation, access to healthcare services and support, staying active, emotional and psychological impact. Self-management strategies included staying active both physically and mentally. DISCUSSION Self-management was key to managing the impact of the pandemic. In combination with advances in technology, implementation of strategies for monitoring wellbeing and support for self-management provides an opportunity to leverage the lessons learnt to ensure a more individualised model of care for people with ILD.
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Affiliation(s)
- Gabriella Tikellis
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ian N Glaspole
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole S L Goh
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yet H Khor
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Lisa Fuhrmeister
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Laura Glenn
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Shiji Chirayath
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Lauren K Troy
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Bill King
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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Lee JYT, Tikellis G, Dowman L, Jones AW, Hoffman M, Mellerick CR, Malaguti C, Khor YH, Holland AE. Self-management interventions for people with pulmonary fibrosis: a scoping review. Eur Respir Rev 2023; 32:230092. [PMID: 37914193 PMCID: PMC10618910 DOI: 10.1183/16000617.0092-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The most effective method for encouraging self-management in individuals with pulmonary fibrosis (PF) is unclear. This review aimed to identify common self-management components, the outcome measures used and the impact of these components in PF. METHODS A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis using Medline, Embase, PsychInfo, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible studies included those with educational, behavioural or support components aimed at facilitating self-management among adults with PF and employed quantitative and/or qualitative methods. RESULTS 87 studies were included. Common self-management components included education (78%), managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Components were predominantly delivered in a pulmonary rehabilitation setting (71%). No studies tested a PF-specific self-management package. Common outcome measures were 6-min walk distance (60%), St George's Respiratory Questionnaire (37%) and the Medical Research Council Dyspnoea scale (34%). Clinically significant improvements in these outcomes were seen in ≥50% of randomised controlled trials. Qualitative data highlighted the importance of healthcare professional and peer support and increased confidence in managing PF. CONCLUSION Self-management components are commonly incorporated into pulmonary rehabilitation programmes rather than being offered as standalone packages. Future research should focus on testing PF-specific self-management packages and employ standardised outcome assessments that include self-efficacy and health-related behaviours.
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Affiliation(s)
- Joanna Y T Lee
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Gabriella Tikellis
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Leona Dowman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Mariana Hoffman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Christie R Mellerick
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Carla Malaguti
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
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Saleem F, Ryerson CJ, Sarma N, Johannson K, Marcoux V, Fisher J, Assayag D, Manganas H, Khalil N, Morisset J, Glaspole IN, Goh N, Oldham JM, Cox G, Fell C, Gershon AS, Halayko A, Hambly N, Lok SD, Shapera S, To T, Wilcox PG, Wong AW, Kolb M, Khor YH. Predicting New-onset Exertional and Resting Hypoxemia in Fibrotic Interstitial Lung Disease. Ann Am Thorac Soc 2023; 20:1726-1734. [PMID: 37676933 DOI: 10.1513/annalsats.202303-208oc] [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: 03/08/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023] Open
Abstract
Rationale: Hypoxemia in fibrotic interstitial lung disease (ILD) indicates disease progression and is of prognostic significance. The onset of hypoxemia signifies disease progression and predicts mortality in fibrotic ILD. Accurately predicting new-onset exertional and resting hypoxemia prompts appropriate patient discussion and timely consideration of home oxygen. Objectives: We derived and externally validated a risk prediction tool for both new-onset exertional and new-onset resting hypoxemia. Methods: This study used ILD registries from Canada for the derivation cohort and from Australia and the United States for the validation cohort. New-onset exertional and resting hypoxemia were defined as nadir oxyhemoglobin saturation < 88% during 6-minute-walk tests, resting oxyhemoglobin saturation < 88%, or the initiation of ambulatory or continuous oxygen. Candidate predictors included patient demographics, ILD subtypes, and pulmonary function. Time-varying Cox regression was used to identify the top-performing prediction model according to Akaike information criterion and clinical usability. Model performance was assessed using Harrell's C-index and goodness-of-fit (GoF) likelihood ratio test. A categorized risk prediction tool was developed. Results: The best-performing prediction model for both new-onset exertional and new-onset resting hypoxemia included age, body mass index, a diagnosis of idiopathic pulmonary fibrosis, and percent predicted forced vital capacity and diffusing capacity of carbon monoxide. The risk prediction tool exhibited good performance for exertional hypoxemia (C-index, 0.70; GoF, P = 0.85) and resting hypoxemia (C-index, 0.77; GoF, P = 0.27) in the derivation cohort, with similar performance in the validation cohort except calibration for resting hypoxemia (GoF, P = 0.001). Conclusions: This clinically applicable risk prediction tool predicted new-onset exertional and resting hypoxemia at 6 months in the derivation cohort and a diverse validation cohort. Suboptimal GoF in the validation cohort likely reflected overestimation of hypoxemia risk and indicated that the model is not flawed because of underestimation of hypoxemia.
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Affiliation(s)
- Ferhan Saleem
- Department of Medicine and
- Department of Medicine, St. Martinus University, Willemstad, Curaçao, Netherlands Antilles
| | - Christopher J Ryerson
- Department of Medicine and
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nandini Sarma
- Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kerri Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ian N Glaspole
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Justin M Oldham
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Gerard Cox
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Fell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Halayko
- Departmentof Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan Hambly
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Stacey D Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Alyson W Wong
- Department of Medicine and
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Kolb
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Yet H Khor
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia; and
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
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Khor YH, Ryerson CJ. Reply: The concept and application of the treatable traits approach in interstitial lung disease and other chronic respiratory diseases. Eur Respir J 2023; 62:2301744. [PMID: 37945043 DOI: 10.1183/13993003.01744-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Joosten SA, Landry SA, Mann DL, Sands SA, Ryerson CJ, Sidhu C, Hamilton GS, Howard ME, Edwards BA, Khor YH. Understanding the Physiological Endotypes Responsible for Comorbid Obstructive Sleep Apnea in Patients with Interstitial Lung Disease. Am J Respir Crit Care Med 2023; 208:624-627. [PMID: 37311238 DOI: 10.1164/rccm.202301-0185le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Simon A Joosten
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences
- Epworth Partners, The University of Queensland, Richmond, Victoria, Australia
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Biomedicine Discovery Institute
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, and
| | - Dwayne L Mann
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
- The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation and Department of Medicine, Providence Health Care and University of British Columbia, Vancouver, British Columbia, Canada
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences
- Epworth Partners, The University of Queensland, Richmond, Victoria, Australia
| | - Mark E Howard
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, and
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; and
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Biomedicine Discovery Institute
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, and
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; and
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Chan RK, Horrigan M, Goh NSL, Khor YH. Clinical assessment for pulmonary hypertension in interstitial lung disease. Intern Med J 2023; 53:1415-1422. [PMID: 35848362 DOI: 10.1111/imj.15887] [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: 02/26/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is an important complication of interstitial lung disease (ILD), as its development confers a poor prognosis. There are no specific recommendations for methods of assessment for PH in ILD populations. AIMS To determine current assessment practices for PH in an Australian ILD centre. METHODS In the Austin Health ILD database, 162 consecutive patients with idiopathic pulmonary fibrosis or connective tissue disease-associated ILD were identified and retrospectively evaluated for methods of PH assessment with transthoracic echocardiography (TTE), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart catheterisation (RHC) in relation to patient demographic and physiological parameters. RESULTS The median follow-up was 30 (14.4-56.4) months. At baseline, vital capacity was 80.0 ± 18.4% predicted, and diffusing capacity for carbon monoxide was 59.6 ± 15.2% predicted. Evaluation for PH was performed in 147 (90.7%) patients, among whom 105 (64.8%) had TTE performed at least once. At the initial TTE, 33.7% patients had high probability of PH, defined as RVSP >40 mmHg + RAp and/or right ventricular dysfunction. At the time of the most recent TTE, these criteria were met in 45 (52.3%) patients. Elevated serum NT-proBNP levels during the first year were observed in 47 (38.8%) patients. Only 14 (8.6%) patients had RHC. CONCLUSION Our institutional PH assessment practice in ILD demonstrates a substantial prevalence of probable PH at baseline. As new therapies emerge for the treatment of PH in ILD, well-defined screening practices are important in this population for early identification and optimal management.
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Affiliation(s)
- Roseanne K Chan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Khor YH, Cottin V, Holland AE, Inoue Y, McDonald VM, Oldham J, Renzoni EA, Russell AM, Strek ME, Ryerson CJ. Treatable traits: a comprehensive precision medicine approach in interstitial lung disease. Eur Respir J 2023; 62:2300404. [PMID: 37263752 PMCID: PMC10626565 DOI: 10.1183/13993003.00404-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/08/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Interstitial lung disease (ILD) is a diverse group of inflammatory and fibrotic lung conditions causing significant morbidity and mortality. A multitude of factors beyond the lungs influence symptoms, health-related quality of life, disease progression and survival in patients with ILD. Despite an increasing emphasis on multidisciplinary management in ILD, the absence of a framework for assessment and delivery of comprehensive patient care poses challenges in clinical practice. The treatable traits approach is a precision medicine care model that operates on the premise of individualised multidimensional assessment for distinct traits that can be targeted by specific interventions. The potential utility of this approach has been described in airway diseases, but has not been adequately considered in ILD. Given the similar disease heterogeneity and complexity between ILD and airway diseases, we explore the concept and potential application of the treatable traits approach in ILD. A framework of aetiological, pulmonary, extrapulmonary and behavioural and lifestyle treatable traits relevant to clinical care and outcomes for patients with ILD is proposed. We further describe key research directions to evaluate the application of the treatable traits approach towards advancing patient care and health outcomes in ILD.
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Vincent Cottin
- National Coordinating Reference Centre for Rare Pulmonary Diseases, OrphaLung, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, Lyon, France
- UMR 754, Claude Bernard University Lyon 1, INRAE, Lyon, France
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Treatable Traits, New Lambton Heights, Australia
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Justin Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Anne Marie Russell
- Exeter Respiratory Innovation Centre, University of Exeter, Exeter, UK
- Royal Devon University Hospitals, NHS Foundation Trust, Devon, UK
- Faculty of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Mary E Strek
- Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Khor YH, Ryerson CJ. Gait speed in idiopathic pulmonary fibrosis: Quickly stepping in the right direction. Respirology 2023; 28:594-596. [PMID: 37017098 DOI: 10.1111/resp.14504] [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: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
See related article
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW Telerehabilitation is an alternative delivery model for pulmonary rehabilitation, an evidence-based nonpharmacological intervention, in people with chronic pulmonary disease. This review synthesizes current evidence regarding the telerehabilitation model for pulmonary rehabilitation with an emphasis on its potential and implementation challenges, as well as the clinical experiences from the COVID-19 pandemic. RECENT FINDINGS Different models of telerehabilitation for delivering pulmonary rehabilitation exist. Current studies comparing telerehabilitation to centre-based pulmonary rehabilitation primarily focus on the evaluation in people with stable chronic obstructive pulmonary disease, which demonstrated equivalent improvements in exercise capacity, health-related quality of life and symptoms with improved programme completion rates. Although telerehabilitation may improve access to pulmonary rehabilitation by addressing travel burden, improving schedule flexibility and geographic disparity, there are challenges of ensuring satisfaction of healthcare interactions and delivering core components of initial patient assessment and exercise prescription remotely. SUMMARY Further evidence is needed on the role of telerehabilitation in various chronic pulmonary diseases, as well as the effectiveness of different modalities in delivering telerehabilitation programmes. Economic and implementation evaluation of currently available and emerging models of telerehabilitation in delivering pulmonary rehabilitation are needed to ensure sustainable adoption into clinical management for people with chronic pulmonary disease.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
- Institute for Breathing and Sleep
| | - Yet H Khor
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
- Institute for Breathing and Sleep
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Mann JM, Holland AE, Goh NS, Khor YH. Understanding patient experience of chronic cough in interstitial lung disease. ERJ Open Res 2023; 9:00039-2023. [PMID: 37228271 PMCID: PMC10204822 DOI: 10.1183/23120541.00039-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Rationale Chronic cough is a common symptom in patients with interstitial lung disease (ILD), negatively contributing to health-related quality of life. Despite this, there is limited information and understanding on the experience of this group of patients with chronic cough. This study aimed to explore the symptom experiences for chronic cough in patients with ILD to identify its characteristics and impacts. Methods A qualitative study using semi-structured telephone interviews was undertaken in 16 adults with a diagnosis of ILD of any type and severity. Patients were recruited from a quaternary referral centre in Melbourne, Australia. Interviews were transcribed verbatim and coded by two researchers using thematic analysis. Results Patients (age range: 39-87 years, forced vital capacity: 53-107% predicted and diffusing capacity of the lung for carbon monoxide: 28-89% predicted) experienced a spectrum of cough severity and characteristics, including both dry and productive coughs. The impact of chronic cough included physical symptoms, social and emotional difficulties, and interference with work and vocational participation. Management strategies used to relieve cough included mucolytics, opiates, throat lozenges, warm drinks, pacing, breath control, relaxation exercises, movement, continuous positive airways pressure and supplemental oxygen. Patients expressed a need for further information and education regarding chronic cough, including its triggers and management. Conclusions This study highlights the experience and significance of chronic cough in patients with ILD. The nature and severity of chronic cough in patients with ILD appears to be more heterogeneous than previously described, with physical, social and emotional impacts contributing to symptom burden.
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Affiliation(s)
- Jennifer M.V. Mann
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Anne E. Holland
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Nicole S.L. Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Yet H. Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Tikellis G, Corte T, Glaspole IN, Goh N, Khor YH, Wrobel J, Symons K, Fuhrmeister L, Glenn L, Chirayath S, Troy L, Holland AE. Understanding the telehealth experience of care by people with ILD during the COVID-19 pandemic: what have we learnt? BMC Pulm Med 2023; 23:113. [PMID: 37024848 PMCID: PMC10078026 DOI: 10.1186/s12890-023-02396-6] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in a rapid transformation of health services. This study aimed to understand the experiences of healthcare by people with interstitial lung disease (ILD), to inform future service delivery. METHODS Four specialist clinics in tertiary centres in Australia (Victoria:2 sites; New South Wales: 1 site; Western Australia: 1 site) recruited patients with ILD during an 8-week period from March 2021. Participants completed a COVID-specific questionnaire focused on health-related experiences during 2020. RESULTS Ninety nine (65% of 153) participants completed the questionnaire. 47% had idiopathic pulmonary fibrosis or connective tissue disease-associated ILD, 62% were female and the average age was 66 years. Whilst 56% rated their overall health in 2020 as the same as months prior, 38% indicated a worsening in health attributed to reduced physical activity and fear of contracting the virus. Access to healthcare professionals was 'good' in 61%, and 'fair-to-poor' for 37% due to missed respiratory assessments, with telehealth (mainly telephone) being perceived as less effective. 89% had contact with respiratory physicians, 68% with general practitioners, predominantly via telephone, with few video consultations. High satisfaction with care was reported by 78%, with lower satisfaction attributed to delays in assessments, disruption to usual services such as pulmonary rehabilitation, and dissatisfaction with telehealth. CONCLUSION People with ILD were generally satisfied with their care during 2020, however reduced access to healthcare professionals was challenging for those experiencing a deterioration in health. Telehealth was largely well received but did not always meet the needs of people with ILD particularly when unwell.
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Affiliation(s)
- Gabriella Tikellis
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ian N Glaspole
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole Goh
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Jeremy Wrobel
- Fiona Stanley Hospital, Perth, WA, Australia
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Lisa Fuhrmeister
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Laura Glenn
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Lauren Troy
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
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Khor YH, Schulte M, Johannson KA, Marcoux V, Fisher JH, Assayag D, Manganas H, Khalil N, Kolb M, Ryerson CJ. Eligibility criteria from pharmaceutical randomised controlled trials of idiopathic pulmonary fibrosis: A registry-based study. Eur Respir J 2023; 61:13993003.02163-2022. [PMID: 36858445 DOI: 10.1183/13993003.02163-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Little is known about generalisability of randomised controlled trials (RCTs) for idiopathic pulmonary fibrosis (IPF). We evaluated eligibility criteria for phase III IPF RCTs to determine their representativeness in clinical registries, and calculated forced vital capacity (FVC) changes according to eligibility criteria. METHODS Common eligibility criteria used in >60% of IPF RCTs were identified from a literature search and applied to patients with IPF from prospective Australian and Canadian registries. Additional pre-specified criteria of 6-min walk distance (6 MWD) and different measures of preceding disease progression were also evaluated. Joint longitudinal-survival modelling was used to compare FVC decline according to eligibility for individual and composite criteria. RESULTS Of 990 patients with IPF, 527 (53%) met all common RCT eligibility criteria at the first clinic visit, including 343 with definite IPF and 184 with radiological probable usual interstitial pneumonia pattern without histological confirmation (i.e., provisional IPF). The percentages of eligible patients for landmark RCTs of nintedanib and pirfenidone were 19-50%. Adding 6 MWD ≥150 m and different measures of preceding disease progression to the composite common criteria reduced the percentages of patients meeting eligibility to 52% (n=516) and 4-18% (n=12-61), respectively. Patients meeting the composite common criteria had less rapid 1-year FVC decline than those who did not (-90 versus -103 ml, p=0.01). Definite IPF generally had more rapid 1-year FVC decline compared to provisional IPF. CONCLUSIONS Eligibility criteria of previous IPF RCTs have limited generalisability to clinical IPF populations, with FVC decline differing between eligible and ineligible populations.
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia .,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Max Schulte
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Khor YH, Farooqi M, Hambly N, Johannson KA, Marcoux V, Fisher JH, Assayag D, Manganas H, Khalil N, Kolb M, Ryerson CJ. Trajectories and Prognostic Significance of 6-Minute Walk Test Parameters in Fibrotic Interstitial Lung Disease: A Multicenter Study. Chest 2023; 163:345-357. [PMID: 36089070 DOI: 10.1016/j.chest.2022.08.2233] [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: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Functional capacity, as measured by the 6-min walk test (6MWT), is often reduced in fibrotic interstitial lung disease (ILD). This study evaluated longitudinal changes and the prognostic significance of 6MWT parameters, and explored change in oxygenation status as a physiological criterion to define disease progression in patients with fibrotic ILD. RESEARCH QUESTIONS What are the trajectories and prognostic value of 6MWT parameters in patients with fibrotic ILD? STUDY DESIGN AND METHODS Using prospective registries in Australia and Canada, patients with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic ILD were stratified by the presence of criteria for progressive pulmonary fibrosis (PPF). The cumulative incidence of exertional and resting hypoxemia and changes in 6-min walk distance (6MWD) and composite indices (distance-saturation product and distance-saturation-oxygen product) were determined, with prognostic significance evaluated at the time of meeting criteria for PPF. New-onset exertional or resting hypoxemia was evaluated as another potential criterion for PPF. RESULTS Patients with IPF/PPF (n = 126) and non-IPF/PPF (n = 227) had a similar cumulative incidence of exertional hypoxemia and annualized decline in 6MWD and composite indices, which varied across each PPF criterion. Patients with IPF/non-PPF (n = 231) and non-IPF/non-PPF (n = 531) had a significantly lower incidence of hypoxemia than those with IPF/PPF, with an annualized increase in 6MWD and composite indices in the non-IPF/non-PPF group. Exertional or resting hypoxemia at the time of meeting criteria for PPF was independently associated with reduced transplant-free survival in IPF and non-IPF, adjusting for patient demographics and lung function. Adding new-onset exertional or resting hypoxemia as a physiological criterion reduced the median time to development of PPF from 11.2 to 6.7 months in IPF and from 11.7 to 5.6 months in non-IPF in patients who eventually met both definitions (P < .001 for both). INTERPRETATION Patients with IPF/PPF and non-IPF/PPF have comparable deterioration in functional capacity. Oxygenation status provides prognostic information in PPF and may assist in defining disease progression in fibrotic ILD.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia.
| | - Malik Farooqi
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Nathan Hambly
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | | | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Khor YH, Farooqi M, Hambly N, Kolb M, Ryerson CJ. Patient Characteristics and Survival for Progressive Pulmonary Fibrosis Using Different Definitions. Am J Respir Crit Care Med 2023; 207:102-105. [PMID: 35943331 PMCID: PMC9952865 DOI: 10.1164/rccm.202205-0910le] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Yet H. Khor
- Monash UniversityMelbourne, Victoria, Australia,Austin HealthHeidelberg, Victoria, Australia,Institute for Breathing and SleepHeidelberg, Victoria, Australia,University of MelbourneMelbourne, Victoria, Australia,Corresponding author (e-mail: )
| | | | | | - Martin Kolb
- McMaster UniversityHamilton, Ontario, Canada
| | - Christopher J. Ryerson
- University of British ColumbiaVancouver, British Columbia, Canada,St. Paul’s HospitalVancouver, British Columbia, Canada
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Wijsenbeek MS, Moor CC, Johannson KA, Jackson PD, Khor YH, Kondoh Y, Rajan SK, Tabaj GC, Varela BE, van der Wal P, van Zyl-Smit RN, Kreuter M, Maher TM. Home monitoring in interstitial lung diseases. Lancet Respir Med 2023; 11:97-110. [PMID: 36206780 DOI: 10.1016/s2213-2600(22)00228-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
The widespread use of smartphones and the internet has enabled self-monitoring and more hybrid-care models. The COVID-19 pandemic has further accelerated remote monitoring, including in the heterogenous and often vulnerable group of patients with interstitial lung diseases (ILDs). Home monitoring in ILD has the potential to improve access to specialist care, reduce the burden on health-care systems, improve quality of life for patients, identify acute and chronic disease worsening, guide treatment decisions, and simplify clinical trials. Home spirometry has been used in ILD for several years and studies with other devices (such as pulse oximeters, activity trackers, and cough monitors) have emerged. At the same time, challenges have surfaced, including technical, analytical, and implementational issues. In this Series paper, we provide an overview of experiences with home monitoring in ILD, address the challenges and limitations for both care and research, and provide future perspectives. VIDEO ABSTRACT.
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Affiliation(s)
- Marlies S Wijsenbeek
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
| | - Catharina C Moor
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kerri A Johannson
- Department of Medicine and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Peter D Jackson
- Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yet H Khor
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Sujeet K Rajan
- Department of Chest Medicine, Bombay Hospital Institute of Medical Sciences, Bhatia Hospital, Mumbai, India
| | - Gabriela C Tabaj
- Department of Respiratory Medicine, Cetrángolo Hospital, Buenos Aires, Argentina
| | - Brenda E Varela
- Department of Respiratory Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Pieter van der Wal
- Patient expert, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases and Interdisciplinary Center for Sarcoidosis, Thoraxklinik, University Hospital Heidelberg, Germany; German Center for Lung Research, Heidelberg, Germany; Department of Pneumology, RKH Clinics Ludwigsburg, Ludwigsburg, Germany
| | - Toby M Maher
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; National Heart and Lung Institute, Imperial College London, London, UK
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Lee JY, Tikellis G, Khor YH, Holland AE. Developing a self-management package for pulmonary fibrosis: an international Delphi study. ERJ Open Res 2022; 8:00349-2022. [PMID: 36578632 PMCID: PMC9793247 DOI: 10.1183/23120541.00349-2022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022] Open
Abstract
Rationale Self-management is considered as an important part of disease management for people with pulmonary fibrosis (PF), but there is a lack of consensus regarding what components should be included. This study aimed to attain consensus from experts in PF and people living with the disease on the essential components and format of a PF self-management package. Methods A two-round Delphi process was conducted. In each round, a panel of experts completed an online survey to rate a range of components, formats and delivery methods, followed by an online patient focus group to integrate patient perspectives. Consensus was defined a priori. Results 45 experts participated in Round 1 and 51 in Round 2. Both focus groups included six people with PF. 12 components were considered essential for self-management in PF: 1) understanding treatment options; 2) understanding and accessing clinical trials; 3) managing medications; 4) role of oxygen therapy; 5) role and importance of pulmonary rehabilitation and regular physical activity; 6) managing shortness of breath; 7) managing fatigue; 8) managing mood; 9) managing comorbidities; 10) smoking cessation advice and support; 11) accessing community support; and 12) how to communicate with others when living with PF. Both groups agreed that self-management in PF required individualisation, goal setting and feedback. Conclusion This study identified 12 essential components and highlighted individualisation, goal setting and feedback in self-management of PF. The findings provide a basis for the development of PF self-management interventions.
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Affiliation(s)
- Joanna Y.T. Lee
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gabriella Tikellis
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yet H. Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia,Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Anne E. Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia,Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia,Corresponding author: Anne E. Holland ()
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 683] [Impact Index Per Article: 341.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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Lee JYT, Tikellis G, Glaspole I, Khor YH, Symons K, Holland AE. Self-management for pulmonary fibrosis: Insights from people living with the disease and healthcare professionals. Patient Educ Couns 2022; 105:956-964. [PMID: 34272128 DOI: 10.1016/j.pec.2021.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE People with pulmonary fibrosis (PF) consider self-management essential for maintaining health. This study aims to explore the needs and expectations of PF self-management from the patient and healthcare professionals (HCPs) perspectives. METHODS Semi-structured interviews were conducted with people with PF and HCPs. Purposive sampling was used to recruit participants. Thematic analysis was performed using the principles of grounded theory. RESULTS 18 individuals with PF and 15 HCPs were interviewed. Common self-management components reported included exercise, nutrition, maintaining healthy mind, avoiding infections, recognising deterioration and seeking help, managing symptoms and treatments, social support, and end-of-life planning. Both groups felt that effective self-management required individualised strategies, supports, and reliable information. People with PF identified access to personal health data and self-acceptance as part of self-management. HCPs highlighted the importance of accessible supports and managing patient expectations of disease course and treatments. Some HCPs concerned about missed detection of deterioration and suggested that self-management strategies for PF may differ to other lung diseases. CONCLUSION This study identified components important for self-management in PF and provides a basis for designing a PF self-management package. PRACTICE IMPLICATIONS Self-management of PF can be facilitated with individualised support from HCPs and reliable information that is accessible.
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Affiliation(s)
- Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Ian Glaspole
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia.
| | - Yet H Khor
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
| | - Karen Symons
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia.
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
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22
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Lok SD, Wong AW, Khor YH, Ryerson CJ, Johannson KA. Malignancy Risk Associated with Mycophenolate Mofetil or Azathioprine in Patients with Fibrotic Interstitial Lung Disease. Chest 2021; 161:1594-1597. [PMID: 34921905 DOI: 10.1016/j.chest.2021.12.636] [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: 10/26/2021] [Revised: 11/19/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Some of these results were presented in abstract form at the 2021 American Thoracic Society International Conference, May 2021.
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Affiliation(s)
- Stacey D Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Yet H Khor
- Department of Respiratory and Sleep Medicine/Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Kerri A Johannson
- Departments of Medicine; Community Health Sciences; Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada.
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Khor YH. Antifibrotic Therapy for Idiopathic Pulmonary Fibrosis: Combining Real World and Clinical Trials for Totality of Evidence. Chest 2021; 160:1589-1591. [PMID: 34743840 DOI: 10.1016/j.chest.2021.07.033] [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] [Received: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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24
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Khor YH. Pulmonary fibrosis: Where from and where to? Respirology 2021; 26:837-839. [PMID: 34337823 DOI: 10.1111/resp.14125] [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: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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25
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Khor YH, Gutman L, Abu Hussein N, Johannson KA, Glaspole IN, Guler SA, Funke-Chambour M, Geiser T, Goh NSL, Ryerson CJ. Incidence and Prognostic Significance of Hypoxemia in Fibrotic Interstitial Lung Disease: An International Cohort Study. Chest 2021; 160:994-1005. [PMID: 33905679 DOI: 10.1016/j.chest.2021.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/15/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hypoxemia is a cardinal feature of fibrotic interstitial lung disease (ILD). The incidence, progression, and prognostic significance of hypoxemia in patients with fibrotic ILD currently is unknown. RESEARCH QUESTION What are the epidemiologic features of hypoxemia and its additive prognostic value in a current risk prediction model of fibrotic ILD? METHODS We identified 848 patients with fibrotic ILD (258 with idiopathic pulmonary fibrosis [IPF]) in five prospective ILD registries from Australia, Canada, and Switzerland. Cumulative incidence of exertional and resting hypoxemia from the time of diagnosis was estimated at 1-year intervals in patients with baseline 6-min walk tests, adjusted for competing risks of death and lung transplantation. Likelihood ratio tests were used to determine the prognostic significance of exertional and resting hypoxemia for 1-year mortality or transplantation when added to the ILD-GAP model. The cohort was divided into derivation and validation subsets to evaluate performance characteristics of the extended model (the ILD-GAP-O2 model), which included oxygenation status as a predictor. RESULTS The 1-, 2-, and 5-year overall cumulative incidence was 6.1%, 17.3%, and 40.1%, respectively, for exertional hypoxemia and 2.4%, 5.6%, and 16.5%, respectively, for resting hypoxemia, which were significantly higher in patients with IPF compared with patients without IPF (P < .001 for both). Addition of exertional or resting hypoxemia to the ILD-GAP model improved 1-year mortality and transplantation prediction (P < .001 for both). The ILD-GAP-O2 model showed improved discrimination (C-index, 0.80 vs 0.75) and model fit (Akaike information criteria, 400 vs 422) in the validation cohort, with comparable calibration. INTERPRETATION Patients with IPF have higher cumulative incidence of exertional and resting hypoxemia than patients without IPF. The extended ILD-GAP-O2 model provides additional risk stratification for 1-year prognosis in fibrotic ILD.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine/Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia; Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada.
| | - Lawrence Gutman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nebal Abu Hussein
- Department of Pulmonary Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Ian N Glaspole
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia; Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Sabina A Guler
- Department of Pulmonary Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine/Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia; Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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26
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Khor YH. Preoperative pirfenidone in idiopathic pulmonary fibrosis: A wound and injury enigma. Respirology 2021; 26:524-526. [PMID: 33890384 DOI: 10.1111/resp.14068] [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: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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27
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Khor YH, Saravanan K, Holland AE, Lee JYT, Ryerson CJ, McDonald CF, Goh NSL. A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease. Sci Rep 2021; 11:6874. [PMID: 33767311 PMCID: PMC7994303 DOI: 10.1038/s41598-021-86326-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/21/2020] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspnoeic with a modified Medical Research Council Dyspnoea grade ≥ 2 were randomised to a HHF for symptom control or no intervention for 2 weeks. Primary outcomes were trial feasibility, change in Dyspnoea-12 scores at Week 2, and participants’ perspectives on using a HHF for dyspnoea management. Study recruitment was completed within nine months at a single site. Successful assessor blinding was achieved in the fan group [Bang’s Blinding Index − 0.08 (95% CI − 0.45, 0.30)] but not the control group [0.47 (0.12, 0.81)]. There were no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes. During qualitative interviews, participants reported that using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit. Oxygen-experienced participants described the HHF being easier to use, but not as effective for symptomatic relief, compared to oxygen therapy. Our results confirmed the feasibility of a clinical trial of a HHF in fibrotic ILD. There was a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia. .,Institute for Breathing and Sleep, Heidelberg, VIC, Australia. .,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia. .,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.
| | | | - Anne E Holland
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
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28
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Khor YH, Ryerson CJ, Landry SA, Howard ME, Churchward TJ, Edwards BA, Hamilton GS, Joosten SA. Interstitial lung disease and obstructive sleep apnea. Sleep Med Rev 2021; 58:101442. [PMID: 33561604 DOI: 10.1016/j.smrv.2021.101442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common comorbidities in patients with interstitial lung disease (ILD). Growing evidence highlights the significance of sleep disturbance on health outcomes in this population. The relationships between ILD and OSA are complex and possibly bidirectional, with multiple mechanisms postulated for the pathogenic and physiologic links. This review synthesizes current evidence and hypotheses regarding different aspects of the relationships between ILD and OSA, emphasizing the interactions between epidemiology, pathogenesis, and pathophysiology.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Thomas J Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia.
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29
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Holland AE, Corte T, Chambers DC, Palmer AJ, Ekström MP, Glaspole I, Goh NSL, Hepworth G, Khor YH, Hoffman M, Vlahos R, Sköld M, Dowman L, Troy LK, Prasad JD, Walsh J, McDonald CF. Ambulatory oxygen for treatment of exertional hypoxaemia in pulmonary fibrosis (PFOX trial): a randomised controlled trial. BMJ Open 2020; 10:e040798. [PMID: 33318119 PMCID: PMC7737108 DOI: 10.1136/bmjopen-2020-040798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interstitial lung diseases are characterised by scarring of lung tissue that leads to reduced transfer of oxygen into the blood, decreased exercise capacity and premature death. Ambulatory oxygen therapy may be used to treat exertional oxyhaemoglobin desaturation, but there is little evidence to support its efficacy and there is wide variation in clinical practice. This study aims to compare the clinical efficacy and cost-effectiveness of ambulatory oxygen versus ambulatory air in people with fibrotic interstitial lung disease and exertional desaturation. METHODS AND ANALYSIS A randomised, controlled trial with blinding of participants, clinicians and researchers will be conducted at trial sites in Australia and Sweden. Eligible participants will be randomised 1:1 into two groups. Intervention participants will receive ambulatory oxygen therapy using a portable oxygen concentrator (POC) during daily activities and control participants will use an identical POC modified to deliver air. Outcomes will be assessed at baseline, 3 months and 6 months. The primary outcome is change in physical activity measured by number of steps per day using a physical activity monitor (StepWatch). Secondary outcomes are functional capacity (6-minute walk distance), health-related quality of life (St George Respiratory Questionnaire, EQ-5D-5L and King's Brief Interstitial Lung Disease Questionnaire), breathlessness (Dyspnoea-12), fatigue (Fatigue Severity Scale), anxiety and depression (Hospital Anxiety and Depression Scale), physical activity level (GENEActive), oxygen saturation in daily life, POC usage, and plasma markers of skeletal muscle metabolism, systematic inflammation and oxidative stress. A cost-effectiveness evaluation will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been granted in Australia by Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/42) with governance approval at all Australian sites, and in Sweden (Lund Dnr: 2019-02963). The results will be published in peer-reviewed scientific journals, presented at conferences and disseminated to consumers in publications for lay audiences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03737409).
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew J Palmer
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Health Economics Research Group, Menzies Institute for Medical Research, The University of Tasmania, Hobart, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Per Ekström
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole S L Goh
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Yet H Khor
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross Vlahos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, Australia
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Lauren K Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jyotika D Prasad
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Walsh
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
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30
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Sweeney DJ, Khor YH, Goh NS. The unmet care needs of progressive fibrosing interstitial lung disease. Respirology 2020; 25:1231-1232. [DOI: 10.1111/resp.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Duncan J. Sweeney
- Department of Respiratory and Sleep Medicine Austin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Yet H. Khor
- Department of Respiratory and Sleep Medicine Austin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
- Faculty of Medicine University of Melbourne Melbourne VIC Australia
| | - Nicole S.L. Goh
- Department of Respiratory and Sleep Medicine Austin Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
- Faculty of Medicine University of Melbourne Melbourne VIC Australia
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31
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Khor YH, Harrison A, Robinson J, Goh NSL, Glaspole I, McDonald CF. Moderate resting hypoxaemia in fibrotic interstitial lung disease. Eur Respir J 2020; 57:13993003.01563-2020. [PMID: 32859672 DOI: 10.1183/13993003.01563-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/09/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Yet H Khor
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Amelia Harrison
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Julien Robinson
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Nicole S L Goh
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Ian Glaspole
- Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Christine F McDonald
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Australia
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Khor YH, Ng Y, Barnes H, Goh NSL, McDonald CF, Holland AE. Prognosis of idiopathic pulmonary fibrosis without anti-fibrotic therapy: a systematic review. Eur Respir Rev 2020; 29:29/157/190158. [PMID: 32759374 PMCID: PMC9488716 DOI: 10.1183/16000617.0158-2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 01/17/2023] Open
Abstract
In addition to facilitating healthcare delivery planning, reliable information about prognosis is essential for treatment decisions in patients with idiopathic pulmonary fibrosis (IPF). This review aimed to evaluate the prognosis of patients with IPF without anti-fibrotic therapy. We included all cohort studies and the placebo arms of randomised controlled trials (RCTs) in IPF and follow-up of ≥12 months. Two reviewers independently evaluated studies for inclusion, assessed risk of bias and extracted data. A total of 154 cohort studies and 16 RCTs were included. The pooled proportions of mortality were 0.12 (95% CI 0.09–0.14) at 1–2 years, 0.38 (95% CI 0.34–0.42) between 2–5 years, and 0.69 (95% CI 0.59–0.78) at ≥5 years. The pooled mean overall survival was 4 years (95% CI 3.7–4.6) for studies with a follow-up duration of 10 years. At <2 years, forced vital capacity and diffusing capacity of the lung for carbon monoxide declined by a mean of 6.76% predicted (95% CI −8.92 −4.61) and 3% predicted (95% CI −5.14 −1.52), respectively. Although heterogeneity was high, subgroup analyses revealed lower pooled proportions of mortality at 1 year in the RCT participants (0.07 (95% CI 0.05–0.09)) versus cohort study participants (0.14 (95% CI 0.12–0.17)). This review provides comprehensive information on the prognosis of IPF, which can inform treatment discussions with patients and comparisons for future studies with new therapies. Without anti-fibrotic therapy, patients with IPF have a mortality rate of 31% at ≥5 years, and a mean overall survival of 4 years over 10 years of follow-uphttp://bit.ly/2SDiZSb
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Affiliation(s)
- Yet H Khor
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia .,Institute for Breathing and Sleep, Heidelberg, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Yvonne Ng
- Monash Lung and Sleep, Monash Health, Clayton, Australia
| | - Hayley Barnes
- Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Nicole S L Goh
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Christine F McDonald
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia
| | - Anne E Holland
- Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Physiotherapy, Alfred Health and Monash University, Melbourne, Australia
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Khor YH, Holland AE, Goh NS, Miller BR, Vlahos R, Bozinovski S, Lahham A, Glaspole I, McDonald CF. Ambulatory Oxygen in Fibrotic Interstitial Lung Disease. Chest 2020; 158:234-244. [DOI: 10.1016/j.chest.2020.01.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022] Open
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Lee JYT, Tikellis G, Corte TJ, Goh NS, Keir GJ, Spencer L, Sandford D, Khor YH, Glaspole I, Price J, Hey-Cunningham AJ, Maloney J, Teoh AKY, Watson AL, Holland AE. The supportive care needs of people living with pulmonary fibrosis and their caregivers: a systematic review. Eur Respir Rev 2020; 29:29/156/190125. [PMID: 32350085 DOI: 10.1183/16000617.0125-2019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND People with pulmonary fibrosis often experience a protracted time to diagnosis, high symptom burden and limited disease information. This review aimed to identify the supportive care needs reported by people with pulmonary fibrosis and their caregivers. METHODS A systematic review was conducted according to PRISMA guidelines. Studies that investigated the supportive care needs of people with pulmonary fibrosis or their caregivers were included. Supportive care needs were extracted and mapped to eight pre-specified domains using a framework synthesis method. RESULTS A total of 35 studies were included. The most frequently reported needs were in the domain of information/education, including information on supplemental oxygen, disease progression and prognosis, pharmacological treatments and end-of-life planning. Psychosocial/emotional needs were also frequently reported, including management of anxiety, anger, sadness and fear. An additional domain of "access to care" was identified that had not been specified a priori; this included access to peer support, psychological support, specialist centres and support for families of people with pulmonary fibrosis. CONCLUSION People with pulmonary fibrosis report many unmet needs for supportive care, particularly related to insufficient information and lack of psychosocial support. These data can inform the development of comprehensive care models for people with pulmonary fibrosis and their loved ones.
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Affiliation(s)
- Joanna Y T Lee
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Gabriella Tikellis
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Nicole S Goh
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | | | - Lissa Spencer
- The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Debra Sandford
- Royal Adelaide Hospital, Adelaide, Australia.,The University of Adelaide, Adelaide, Australia
| | - Yet H Khor
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Ian Glaspole
- Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Alfred Health, Melbourne, Australia
| | - John Price
- Institute for Respiratory Health, Nedlands, Australia
| | - Alison J Hey-Cunningham
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | | | - Alan K Y Teoh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alice L Watson
- Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy, La Trobe University, Melbourne, Australia .,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Tikellis G, Lee JYT, Corte TJ, Maloney J, Bartlett M, Crawford T, Glaspole IN, Goh N, Herrmann K, Hey-Cunningham AJ, Keir G, Khor YH, Price J, Sandford DG, Spencer L, Teoh A, Walsh J, Webster S, Holland AE. Peer Connect Service for people with pulmonary fibrosis in Australia: Participants' experiences and process evaluation. Respirology 2020; 25:1053-1059. [PMID: 32207225 DOI: 10.1111/resp.13807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/05/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE People living with pulmonary fibrosis (PF) report unmet needs for information and support. Lung Foundation Australia (LFA) have developed the Peer Connect Service to facilitate telephone support for people with PF across Australia. This project documented the experiences of participants and the resources required to support the service. METHODS Consenting participants took part in semi-structured interviews by telephone. Primary peers (peers who agreed to initiate contact) and secondary peers (eligible patients who sought a peer match) were interviewed. Thematic analysis was undertaken by two independent researchers. Data were collected on the number of matches and contacts required to establish each match. RESULTS Interviews were conducted with 32 participants (16 primary peers, 15 secondary peers and 1 who was both), aged from 53 to 89 years with 56% being male. Major themes included the value of shared experiences, providing mutual support and the importance of shared personal characteristics (e.g. gender and hobbies) in allowing information and emotional support needs to be met. Participants saw face-to-face contact with peers as highly desirable whilst acknowledging the practical difficulties. Primary peers were cognizant that their role was not to provide medical advice but to listen and share experiences. In the 12-month period, 60 peer matches were made, each match requiring a minimum of seven staff contacts. CONCLUSION The Peer Connect Service provides a unique opportunity for people with PF to share experiences and offer mutual support. This telephone matching model may be useful in providing peer support for individuals with rare diseases who are geographically dispersed.
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Affiliation(s)
- Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | | | - Ian N Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Alison J Hey-Cunningham
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia
| | - Greg Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yet H Khor
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - John Price
- Institute for Respiratory Health, Perth, WA, Australia
| | - Debra G Sandford
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lissa Spencer
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Alan Teoh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jennifer Walsh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia
| | - Susanne Webster
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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Azizan NZ, Ambrose D, Sabeera B, Mohsin SS, Pf W, Mohd Affandi A, Cc C, Gopinathan LP, Taib T, Tan WC, Khor YH, Heah SS, Wl L, Zainuri Z, Ainol Haniza KH, Yusof M, Tukimin S. Management of Atopic Eczema in primary care. Malays Fam Physician 2020; 15:39-43. [PMID: 32284803 PMCID: PMC7136679] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction : Atopic eczema (AE) is a common inflammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. The Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.
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Affiliation(s)
- N Z Azizan
- MB BCh (NUI), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - D Ambrose
- MD (UKM), MRCP (Ire), Fellowship in Derm (MOH, M'sia) Jabatan Dermatologi Hospital Ampang
| | - Bki Sabeera
- MBBS (Bangalore), Master of Paediatrics (UM), Fellowship in Paeds Derm (MOH, M'sia) Institut Pediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - S S Mohsin
- MBBS (MAHE), M. Med Family Medicine (UKM) Klinik Kesihatan Cheras, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Wong Pf
- MBBS (IMU), Dr Fam Med (UKM), MAFP (Mal), FRACGP (Aus) Klinik Kesihatan Cheras Baru Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - A Mohd Affandi
- MBChB (UK), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Ch'ng Cc
- MBBS (UM), MRCP (UK), AdvMDerm (UKM) Pusat Perubatan Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - L P Gopinathan
- MD (Ind), Master of Paediatrics (UM), MRCPCH (UK) Jabatan Pediatrik, Hospital Selayang, Batu Caves, Malaysia
| | - T Taib
- MD (UKM), MMed (UKM), AdvMDerm (UKM) Jabatan Perubatan, Fakulti Perubatan Universiti Teknologi MARA Kampus Selayang, Selangor
| | - W C Tan
- MD (USM), Dip STD/HIV (COTTISA) Dip Derm Glasgow), MRCP (Ire), Fellowship in Dermatology (Singapore), AdvMDerm (UKM) FAAD (US), AM (Malaysia) Jabatan Dermatologi, Hospital Pulau Pinang, Geogetown, Malaysia
| | - Y H Khor
- MD (UKM), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi, Hospital Pulau Pinang, Geogetown Malaysia
| | - S S Heah
- MBBS (UM), MRCPCH (UK), Fellowship in Paediatric Dermatology (MOH, M'sia) Institut Pediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Leow Wl
- BPharm (USM) Jabatan Farmasi, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Z Zainuri
- BSc in Dietetic (UKM), MMedSci in Human Nutrition (Sheffield) Institut Paediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - K H Ainol Haniza
- DDS (UGM) Cawangan Penilaian Teknologi Kesihatan, Kementerian Kesihatan Malaysia, Putrajaya Malaysia
| | - Mam Yusof
- MD (UKM), MPH (Epid) (UM) Cawangan Penilaian Teknologi Kesihatan, Bahagian Perkembangan Perubatan, Kementerian Kesihatan Malaysia Putrajaya, Malaysia
| | - Smt Tukimin
- BSc Hons in Dietetic (UKM) Institut Paediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Khor YH, Renzoni EA, Visca D, McDonald CF, Goh NSL. Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns. ERJ Open Res 2019; 5:00118-2019. [PMID: 31544111 PMCID: PMC6745413 DOI: 10.1183/23120541.00118-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Domiciliary oxygen therapy is often prescribed for patients with hypoxaemia due to advanced lung disease, most commonly chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Long-term oxygen therapy (LTOT) trials conducted in patients with COPD in the 1980s remain the basis for clinical decisions and guideline recommendations regarding LTOT for patients with non-COPD conditions as there is a lack of high-quality evidence concerning its use in the non-COPD population. There is also a lack of evidence for the use of ambulatory and nocturnal oxygen therapy in patients with isolated exertional and nocturnal hypoxaemia. These deficiencies pose significant challenges in patient care, with consequent discrepancies in guideline recommendations and clinical approaches. In recent years, new studies have been and are currently being conducted to fill the gaps in our understanding and use of domiciliary oxygen therapy for other indications, including ILD. This article provides a comparison of the epidemiology and significance of hypoxaemia in patients with COPD and ILD, with an up-to-date review of current evidence regarding the role of different types of domiciliary oxygen therapy in these conditions. Despite the significance of hypoxaemia in patients with chronic lung diseases, an up-to-date review shows current evidence for clinical use of domiciliary oxygen therapy remains limitedhttp://bit.ly/33aW31n
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Affiliation(s)
- Yet H Khor
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College London, London, UK
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Christine F McDonald
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia
| | - Nicole S L Goh
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Respiratory Medicine, Alfred Health, Melbourne, Australia
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Khor YH, Glaspole I, Goh NSL. Therapeutic burden in interstitial lung disease: Lessons to learn. Respirology 2019; 24:566-571. [PMID: 30790404 DOI: 10.1111/resp.13480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/15/2018] [Revised: 10/20/2018] [Accepted: 01/06/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with interstitial lung disease (ILD) are often prescribed disease-targeted and symptomatic therapies, both of which can cause significant treatment burden due to polypharmacy and drug-disease interactions. This study aimed to evaluate medication regimen complexity before and after introduction of ILD-specific therapies. Potential drug-disease interactions were evaluated for patients who were prescribed prednisolone. METHODS In this study, 214 patients with ILD were assessed for demographic information, co-morbidities and medication use. Medication lists were reviewed prior to and after the introduction of ILD-specific therapies. Complexity of treatment regimen was examined using the validated Medication Regimen Complexity Index (MRCI). RESULTS Of the 214 patients, 75 had idiopathic pulmonary fibrosis (IPF) while the rest had inflammatory ILD (chronic hypersensitivity pneumonitis: 45; connective tissue disease-related ILD: 41). Polypharmacy was common at baseline (IPF: 51%, inflammatory ILD: 63%). Following introduction of ILD-specific therapies, median total MRCI scores significantly increased from 8 (interquartile range (IQR) = 8-15) to 22.5 (17.5-27.5) and 14.5 (8.5-21) to 21.5 (16-30) for IPF and inflammatory ILD groups, respectively (P < 0.0001 for both). Complex dosing instructions contributed the most to total MRCI scores for ILD-specific therapies. Among patients receiving prednisolone (n = 113), 88% had ≥1 co-morbidity which may be impacted. Common co-morbidities included gastrointestinal diseases (56%), obesity (37%), osteoporosis (24%) and diabetes mellitus (18%). CONCLUSION Polypharmacy and complex medication regimen are common in patients with ILD of different aetiologies. There is a high frequency of potential drug-disease interactions among patients who are prescribed systemic corticosteroids. These findings highlight the need for careful evaluation of the impact of therapeutic complexity and burden in patients with ILD.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,School of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia.,School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
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Loo CH, Tan WC, Khor YH, Chan LC. A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia. Med J Malaysia 2018; 73:73-77. [PMID: 29703869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Severe cutaneous adverse drug reactions (SCARs) are not uncommon and potentially lifethreatening. Our objective is to study the patient characteristics, the pattern of implicated drugs and treatment outcome among patients with SCARs. METHODS A 10-year retrospective analysis of SCARs cases in Penang General Hospital was carried out from January 2006 to December 2015. Data collection is based on the Malaysian Adverse Drug Reactions Advisory Committee registry and dermatology clinic records. RESULTS A total of 189 cases of SCARs were encountered (F:M ratio; 1.2:1.0; mean age of 45 year). The commonest manifestation was Stevens-Johnson Syndrome [SJS] (55.0%), followed by toxic epidermal necrolysis [TEN] (23.8%), drug rash with eosinophilia and systemic symptoms [DRESS] (12.7%), acute generalised exanthematous pustulosis [AGEP] (4.8%), SJS/TEN overlap syndrome (2.6%) and generalised bullous fixed drug eruptions [GBFDE] (1.1%). Mean time to onset for TEN/SJS/Overlap syndrome was 10.5±13 days; AGEP, three days; GBFDE, 2.5±0.7 days, and DRESS, 29.4±5.7 days. The most common drugs implicated were antibiotics (33.3%), followed by allopurinol (18.9%) and anticonvulsant (18.4%). Out of 154 cases of SJS/TEN/overlap syndrome, allopurinol was the commonest causative agents (20.1%). In DRESS, allopurinol accounts for 45.8% of the cases. The mortality rate in SJS, TEN and DRESS were 1.9%, 13.3% and 12.5% respectively. No mortality was observed in AGEP and GBFDE. CONCLUSION The commonest manifestations of SCARs in our setting were SJS, TEN and DRESS. Allopurinol was the most common culprit. Thus, judicious allopurinol use is advocated and pre-emptive genetic screening for HLAB *5801 should be considered.
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Affiliation(s)
- C H Loo
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia.
| | - W C Tan
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
| | - Y H Khor
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
| | - L C Chan
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
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Khor YH, McDonald CF, Hazard A, Symons K, Westall G, Glaspole I, Goh NS, Holland AE. Portable oxygen concentrators versus oxygen cylinder during walking in interstitial lung disease: A randomized crossover trial. Respirology 2017; 22:1598-1603. [DOI: 10.1111/resp.13083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yet H. Khor
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Institute for Breathing and Sleep; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Institute for Breathing and Sleep; Melbourne Victoria Australia
| | - Anita Hazard
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Karen Symons
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Glen Westall
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Nicole S.L. Goh
- Department of Respiratory and Sleep Medicine; Austin Health; Melbourne Victoria Australia
- Institute for Breathing and Sleep; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
| | - Anne E. Holland
- Institute for Breathing and Sleep; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Health; Melbourne Victoria Australia
- Department of Physiotherapy; La Trobe University/Alfred Health; Melbourne Victoria Australia
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Khor YH, Ng Y, Goh NSL, McDonald CF, Holland AE. Prognosis of adults with idiopathic pulmonary fibrosis without treatment or without effective therapies. Hippokratia 2017. [DOI: 10.1002/14651858.cd012647] [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)
- Yet H Khor
- Austin Health; Department of Respiratory and Sleep Medicine; 145 Studley Road Melbourne Victoria Australia 3084
- Austin Health; Institute for Breathing and Sleep; Melbourne Australia
- The Alfred Hospital; Department of Allergy, Immunology and Respiratory Medicine; Melbourne Australia
- University of Melbourne; Department of Medicine; Melbourne Australia
| | - Yvonne Ng
- Austin Health; Institute for Breathing and Sleep; Melbourne Australia
| | - Nicole SL Goh
- Austin Health; Department of Respiratory and Sleep Medicine; 145 Studley Road Melbourne Victoria Australia 3084
- Austin Health; Institute for Breathing and Sleep; Melbourne Australia
- The Alfred Hospital; Department of Allergy, Immunology and Respiratory Medicine; Melbourne Australia
| | - Christine F McDonald
- Austin Health; Department of Respiratory and Sleep Medicine; 145 Studley Road Melbourne Victoria Australia 3084
- Austin Health; Institute for Breathing and Sleep; Melbourne Australia
- University of Melbourne; Department of Medicine; Melbourne Australia
| | - Anne E Holland
- Austin Health; Institute for Breathing and Sleep; Melbourne Australia
- School of Allied Health, Department of Rehabilitation, Nutrition and Sport, La Trobe University; Discipline of Physiotherapy; Melbourne Victoria Australia 3086
- The Alfred Hospital; Department of Physiotherapy; Melbourne Victoria Australia 3181
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Khor YH, Tolson J, Churchward T, Rochford P, Worsnop C. Patients' estimates of their sleep times: reliability and impact on diagnosis of obstructive sleep apnoea. Intern Med J 2016; 45:850-3. [PMID: 25944502 DOI: 10.1111/imj.12798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Home polysomnography (PSG) is an alternative method for diagnosis of obstructive sleep apnoea (OSA). Some types 3 and 4 PSG do not monitor sleep and so rely on patients' estimation of total sleep time (TST). AIM To compare patients' subjective sleep duration estimation with objective measures in patients who underwent type 2 PSG for probable OSA. METHODS A prospective clinical audit of 536 consecutive patients of one of the authors between 2006 and 2013. A standard questionnaire was completed by the patients the morning after the home PSG to record the time of lights being turned off and estimated time of sleep onset and offset. PSG was scored based on the guidelines of the American Academy of Sleep Medicine. RESULTS Median estimated sleep latency (SL) was 20 min compared with 10 min for measured SL (P < 0.0001). There was also a significant difference between the estimated and measured sleep offset time (median difference = -1 min, P = 0.01). Estimated TST was significantly shorter than the measured TST (median difference = -18.5 min, P = 0.002). No factors have been identified to affect patients' accuracy of sleep perception. Only 2% of patients had a change in their diagnosis of OSA based on calculated apnoea-hypopnoea index. CONCLUSIONS Overall estimated TST in the patients with probable OSA was significantly shorter than measured with significant individual variability. Collectively, inaccurate sleep time estimation had not resulted in significant difference in the diagnosis of OSA.
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Affiliation(s)
- Y H Khor
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - J Tolson
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - T Churchward
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - P Rochford
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - C Worsnop
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
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Khor YH, Walker S, Rautela L, Chao C, Robinson A, Howard M. Successful pregnancy in ventilatory failure due to campomelic dysplasia with severe kyphoscoliosis. Intern Med J 2014; 44:712-3. [PMID: 25041778 DOI: 10.1111/imj.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Y H Khor
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
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Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2010; 37:902-10. [PMID: 20693253 DOI: 10.1183/09031936.00075310] [Citation(s) in RCA: 264] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Improved diagnostic sensitivity of bronchsocopy for the investigation of peripheral pulmonary lesions (PPLs) with the use of radial probe endobroncial ultrasound (EBUS) has been reported, although diagnostic performance varies considerably. A systematic review of published literature evaluating radial probe EBUS accuracy was performed to determine point sensitivity and specificity, and to construct a summary receiver-operating characteristic curve. Sub-group analysis and linear regression was used to identify possible sources of study heterogeneity. 16 studies with 1,420 patients fulfilled inclusion criteria. Significant inter-study variation in EBUS method was noted. EBUS had point specificity of 1.00 (95% CI 0.99-1.00) and point sensitivity of 0.73 (95% CI 0.70-0.76) for the detection of lung cancer, with a positive likelihood ratio of 26.84 (12.60-57.20) and a negative likelihood ratio of 0.28 (0.23-0.36). Significant inter-study heterogeneity for sensitivity was observed, with prevalence of malignancy, lesion size and reference standard used being possible sources. EBUS is a safe and relatively accurate tool in the investigation of PPLs. Diagnostic sensitivity of EBUS may be influenced by the prevalence of malignancy in the patient cohort being examined and lesion size. Further methodologically rigorous studies on well-defined patient populations are required to evaluate the generalisability of our results.
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Affiliation(s)
- D P Steinfort
- Dept Respiratory and Sleep Medicine, Centre for Medical Research, Royal Melbourne Hospital, Australia.
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Khor YH, Steinfort DP, Buchanan MR, Gunawardana D, Antippa P, Irving LB. A 69-year-old smoker with mediastinal and hilar lymphadenopathy. Thorax 2010; 65:132-8, 187. [PMID: 20147591 DOI: 10.1136/thx.2009.123828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Y H Khor
- Department of Respiratory Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Khor YH, Teoh AKY, Lam SM, Mo DCQ, Weston S, Reid DW, Walters EH. Increased vascular permeability precedes cellular inflammation as asthma control deteriorates. Clin Exp Allergy 2009; 39:1659-67. [PMID: 19860817 DOI: 10.1111/j.1365-2222.2009.03349.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Airway microcirculation is abnormal in asthma but the role of vascular changes in asthma deteriorations remains poorly defined. We prospectively assessed the vascular changes accompanying worsening of asthma control by using an inhaled corticosteroid (ICS) dose-reduction model. OBJECTIVES To evaluate airway vascularity, vascular permeability and expression of vascular endothelial growth factor (VEGF) in early asthma deterioration induced by ICS back-titration. METHODS Twenty mild-to-moderate persistent symptomatic asthmatics on low-to-moderate ICS were recruited and treated with 4 weeks of high-dose fluticasone propionate (1000 microg/day) to achieve symptom control. This was followed by dose reduction to half of the pre-study doses for 4-8 weeks until the symptoms began to return. Endobronchial biopsy and bronchoalveolar lavage (BAL) samples were obtained after both treatment periods. RESULTS Vascularity as measured by the number and size of blood vessels, as well as VEGF expression did not change following ICS reduction. Even on high-dose ICS, perivascular albumin staining and BAL microalbumin levels in asthmatic subjects, as markers of permeability, were elevated when compared with normal subjects and both further increased significantly after ICS reduction. There was a significant association between changes in vascular leakiness and clinical deterioration. Increases in airway albumin correlated with previously reported increases in airway wall infiltration with T lymphocytes. CONCLUSIONS Our results suggest that airway vascular leakage is a major pathophysiologic feature of early asthma deterioration, occurring before recrudescence of cellular inflammation.
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Affiliation(s)
- Y H Khor
- Respiratory Research Group, Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
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Khor YH, Feltis BN, Reid DW, Ward C, Johns DP, Wood-Baker R, Walters EH. Airway cell and cytokine changes in early asthma deterioration after inhaled corticosteroid reduction. Clin Exp Allergy 2007; 37:1189-98. [PMID: 17651149 DOI: 10.1111/j.1365-2222.2007.02762.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Back-titration of inhaled corticosteroid (ICS) dose in well-controlled asthma patients is emphasized in clinical guidelines, but there are few published data on the airway cell and cytokine changes in relation to ICS reduction. In our study, 20 mild-to-moderate persistent (inspite of low-moderate dose ICS treatment) asthmatic subjects prospectively rendered largely asymptomatic by high-dose ICS were assessed again by clinical, physiological, and airway inflammatory indices after 4-8 weeks of reduced ICS treatment. We aimed at assessing the underlying pathological changes in relation to clinical deterioration. METHODS Patients recorded daily symptom scores and peak expiratory flows (PEF). Spirometry and airways hyperreactivity (AHR) were measured and bronchoscopy was performed with assessment of airway biopsies (mast cells, eosinophils, neutrophils, and T lymphocytes), bronchoalveolar lavage (BAL) IL-5 and eotaxin levels and cellular profiles at the end of high-dose ICS therapy and again after ICS dose reduction. Baseline data were compared with symptomatic steroid-free asthmatics (n=42) and non-asthmatic controls (n=28). RESULTS After ICS reduction, subjects experienced a variable but overall significant increase in symptoms and reductions in PEF and forced expiratory volume in 1 s. There were no corresponding changes in AHR or airways eosinophilia. The most relevant pathogenic changes were increased CD4(+)/CD8(+) T cell ratio, and decreased sICAM-1 and CD18 macrophage staining (potentially indicating ligand binding). However, there was no relationship between the spectrum of clinical deterioration and the changes in cellular profiles or BAL cytokines. CONCLUSIONS These data suggest that clinical markers remain the most sensitive measures of early deterioration in asthma during back-titration of ICS, occurring at a time when AHR and conventional indices of asthmatic airway inflammation appear unchanged. These findings have major relevance to management and to how back-titration of ICS therapy is monitored.
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Affiliation(s)
- Y H Khor
- Respiratory Research Group, Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
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