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Majewski S, Białas AJ, Barczyk A, Batura-Gabryel H, Buchczyk M, Doboszyńska A, Górska K, Grabowska-Skudlarz L, Jagielska-Len H, Jarzemska A, Jassem E, Jastrzębski D, Kania A, Koprowski M, Krawczyk M, Krenke R, Lewandowska K, Mackiewicz B, Martusewicz-Boros MM, Milanowski J, Noceń-Piskorowska M, Nowicka A, Roszkowski-Śliż K, Siemińska A, Sładek K, Sobiecka M, Stachura T, Tomczak M, Tomkowski W, Trzaska-Sobczak M, Ziora D, Żołnowska B, Piotrowski WJ. A Real-World Multicenter Retrospective Observational Study on Polish Experience with Nintedanib Therapy in Patients with Idiopathic Pulmonary Fibrosis: The PolExNIB Study. J Clin Med 2023; 12:4635. [PMID: 37510750 PMCID: PMC10381008 DOI: 10.3390/jcm12144635] [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: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Nintedanib is a disease-modifying agent licensed for the treatment of IPF. Data on Polish experience with nintedanib in IPF are lacking. The present study aimed to describe the safety and efficacy profiles of nintedanib in a large real-world cohort of Polish patients with IPF. This was a multicenter, retrospective, observational study of IPF patients treated with nintedanib between March 2018 and October 2021. Data collection included baseline clinical characteristics, results of pulmonary function tests (PFTs), and a six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), and treatment persistence were also retrieved. A total of 501 patients (70% male) with a median age of 70.9 years (IQR 65-75.7) were included in this study. Patients were followed on treatment for a median of 15 months (7-25.5). The majority of patients (66.7%) were treated with the full recommended dose of nintedanib and 33.3% of patients were treated with a reduced dose of a drug. Intermittent dose reductions or drug interruptions were needed in 20% of patients. Over up to 3 years of follow-up, pulmonary function remained largely stable with the minority experiencing disease progression. The most frequent ADRs included diarrhea (45.3%), decreased appetite (29.9%), abdominal discomfort (29.5%), weight loss (32.1%), nausea (20.8%), fatigue (19.2%), increased liver aminotransferases (15.4%), and vomiting (8.2%). A total of 203 patients (40.5%) discontinued nintedanib treatment due to diverse reasons including ADRs (10.2%), death (11.6%), disease progression (4.6%), patient's request (6.6%), and neoplastic disease (2.2%). This real-world study of a large cohort of Polish patients with IPF demonstrates that nintedanib therapy is safe, and is associated with acceptable tolerance and disease stabilization. These data support the findings of previously conducted clinical trials and observational studies on the safety and efficacy profiles of nintedanib in IPF.
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Affiliation(s)
- Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam J Białas
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Małgorzata Buchczyk
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-032 Katowice, Poland
| | - Anna Doboszyńska
- Department of Pulmonology, University of Warmia and Mazury in Olsztyn, Pulmonology Hospital, 10-357 Olsztyn, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Luiza Grabowska-Skudlarz
- Department of Pulmonology, University of Warmia and Mazury in Olsztyn, Pulmonology Hospital, 10-357 Olsztyn, Poland
| | - Hanna Jagielska-Len
- Clinical Department of Lung Diseases, K. Marcinkowski University Hospital, 65-046 Zielona Gora, Poland
| | - Agnieszka Jarzemska
- Department of Rapid Pulmonary Diagnostics, Kuyavian and Pomeranian Pulmonology Center, 85-326 Bydgoszcz, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-032 Katowice, Poland
| | - Aleksander Kania
- Department of Pulmonology, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Marek Koprowski
- Department of Civilization Diseases and Lung Diseases, John Paul II Specialist Hospital, 31-202 Cracow, Poland
| | - Michał Krawczyk
- 1st Department of Lung Diseases and Respiratory Allergy, Voivodeship Center for Lung Disease Treatment and Rehabilitation, 91-520 Lodz, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Katarzyna Lewandowska
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Barbara Mackiewicz
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Magdalena M Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | | | - Agata Nowicka
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Kazimierz Roszkowski-Śliż
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Małgorzata Sobiecka
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Tomasz Stachura
- Department of Pulmonology, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Małgorzata Tomczak
- Department of Pulmonology, E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, 60-569 Poznan, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Marzena Trzaska-Sobczak
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-032 Katowice, Poland
| | - Beata Żołnowska
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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Martusewicz-Boros MM, Boros PW, Piotrowska-Kownacka D, Paciorek M. Myocarditis after COVID-19 pneumonia: incidence and risk factors. Pol Arch Intern Med 2023; 133:16510. [PMID: 37227751 DOI: 10.20452/pamw.16510] [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] [Indexed: 05/26/2023]
Affiliation(s)
- Magdalena M Martusewicz-Boros
- Third Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
| | - Piotr W Boros
- Department of Lung Pathophysiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Marcin Paciorek
- Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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3
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Piotrowski WJ, Martusewicz-Boros MM, Białas AJ, Barczyk A, Batko B, Błasińska K, Boros PW, Górska K, Grzanka P, Jassem E, Jastrzębski D, Kaczyńska J, Kowal-Bielecka O, Kucharz E, Kuś J, Kuźnar-Kamińska B, Kwiatkowska B, Langfort R, Lewandowska K, Mackiewicz B, Majewski S, Makowska J, Miłkowska-Dymanowska J, Puścińska E, Siemińska A, Sobiecka M, Soroka-Dąda RA, Szołkowska M, Wiatr E, Ziora D, Śliwiński P. Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis. Adv Respir Med 2022; 90:425-450. [PMID: 36285980 PMCID: PMC9717335 DOI: 10.3390/arm90050052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2023]
Abstract
The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.
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Affiliation(s)
| | - Magdalena M. Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Adam J. Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland
| | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Piotr W. Boros
- Lung Pathophysiology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Grzanka
- Department of Radiology, Voivodeship Hospital in Opole, 45-061 Opole, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland
| | - Eugeniusz Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, 40-635 Katowice, Poland
| | - Jan Kuś
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, University of Medical Sciences in Poznan, 61-701 Poznan, Poland
| | - Brygida Kwiatkowska
- Department of Rheumatology, Eleonora Reicher Rheumatology Institute, 02-637 Warszawa, Poland
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Katarzyna Lewandowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Mackiewicz
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, 20-090 Lublin, Poland
| | - Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, 92-213 Lodz, Poland
| | | | - Elżbieta Puścińska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology, Medical University of Gdańsk, 80-214 Gdansk, Poland
| | - Małgorzata Sobiecka
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | | | - Małgorzata Szołkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
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Górska K, Maskey-Warzęchowska M, Barnaś M, Białas A, Barczyk A, Jagielska-Len H, Jassem E, Kania A, Lewandowska K, Majewski S, Martusewicz-Boros MM, Piotrowski WJ, Siemińska A, Sładek K, Sobiecka M, Trzaska-Sobczak M, Tomkowski W, Żołnowska B, Krenke R. Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland. Ther Adv Chronic Dis 2022; 13:20406223221117982. [PMID: 36052286 PMCID: PMC9425901 DOI: 10.1177/20406223221117982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Pirfenidone and nintedanib are considered as the standard of care in idiopathic pulmonary fibrosis (IPF), but there is no consensus as to which of these two agents should be regarded as first-line treatment. Objective To provide real-world data on therapeutic decisions of pulmonary specialists, particularly the choice of the antifibrotic drug in patients with IPF. Methods This was a multicenter, prospective survey collecting clinical data of patients with IPF considered as candidates for antifibrotic treatment between September 2019 and December 2020. Clinical characteristics and information on the therapeutic approach were retrieved. Statistical evaluation included multiple logistic regression analysis with stepwise model selection. Results Data on 188 patients [74.5% male, median age 73 (interquartile range, 68-78) years] considered for antifibrotic therapy were collected. Treatment was initiated in 138 patients, while 50 patients did not receive an antifibrotic, mainly due to the lack of consent for treatment and IPF severity. Seventy-two patients received pirfenidone and 66 received nintedanib. Dosing protocol (p < 0.01) and patient preference (p = 0.049) were more frequently associated with the choice of nintedanib, while comorbidity profile (p = 0.0003) and concomitant medication use (p = 0.03) were more frequently associated with the choice of pirfenidone. Age (p = 0.002), lung transfer factor for carbon monoxide (TLCO) (p = 0.001), and gastrointestinal bleeding (p = 0.03) were significantly associated with the qualification for the antifibrotic treatment. Conclusion This real-world prospective study showed that dose protocol and patient preference were more frequently associated with the choice of nintedanib, while the comorbidity profile and concomitant medication use were more frequently associated with the choice of pirfenidone. Age, TLCO, and history of gastrointestinal bleeding were significant factors influencing the decision to initiate antifibrotic therapy.
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Affiliation(s)
- Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Maskey-Warzęchowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Barnaś
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Adam Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, Medical University of Silesia, Katowice, Poland
| | - Hanna Jagielska-Len
- Clinical Department of Lung Diseases, K. Marcinkowski University Hospital, Zielona Gora, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksander Kania
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Lewandowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Magdalena M Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Alicja Siemińska
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Sobiecka
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Witold Tomkowski
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Beata Żołnowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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Piotrowski WJ, Bestry I, Białas AJ, Boros PW, Grzanka P, Jassem E, Jastrzębski D, Klimczak D, Langfort R, Lewandowska K, Majewski S, Martusewicz-Boros MM, Onisch K, Puścińska E, Siemińska A, Sobiecka M, Szołkowska M, Wiatr E, Wilczyński G, Ziora D, Kuś J. Guidelines of the Polish Respiratory Society for diagnosis and treatment of idiopathic pulmonary fibrosis. Adv Respir Med 2021; 88:41-93. [PMID: 32153010 DOI: 10.5603/arm.2020.0081] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This document presents the guidelines of the Polish Respiratory Society (PTChP, Polskie Towarzystwo Chorób Płuc) for diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), developed by agroup of Polish experts. MATERIAL AND METHODS The recommendations were developed in the form of answers to previously formulated questions concer-ning everyday diagnostic and therapeutic challenges. They were developed based on acurrent literature review using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS We formulated 28 recommendations for diagnosis (8), pharmacological treatment (12) as well as non-pharma-cological and palliative therapy (8). The experts suggest that surgical lung biopsy (SLB) not be performed in patients with the probable usual interstitial pneumonia (UIP) pattern, with an appropriate clinical context and unanimous opinion of a multidisciplinary team. The experts recommend using antifibrotic agents in IPF patients and suggest their use irrespective of the degree of functional impairment. As regards non-pharmacological and palliative treatment, strong re-commendations were formulated regarding pulmonary rehabilitation, oxygen therapy (in patients with chronic respiratory failure), preventive vaccinations as well as referring IPF patients to transplant centres. Table 1 presents an aggregate list of recommendations. CONCLUSIONS The Polish Respiratory Society Working Group developed guidelines for IPF diagnosis and treatment.
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Affiliation(s)
| | - Iwona Bestry
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | - Adam J Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Poland
| | - Piotr W Boros
- Lung Pathophysiology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | - Piotr Grzanka
- Department of Radiology, Voivodeship Hospital in Opole, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, Zabrze, Poland
| | | | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw
| | - Katarzyna Lewandowska
- First Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | - Sebastian Majewski
- Department of Pneumology and Allergy, Medical University of Lodz, Poland
| | | | - Karina Onisch
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | - Elżbieta Puścińska
- Second Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | | | - Małgorzata Sobiecka
- First Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
| | - Małgorzata Szołkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw
| | - Elżbieta Wiatr
- Third Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw
| | | | - Dariusz Ziora
- Department of Allergology and Pneumonology, Medical University of Gdansk, Poland
| | - Jan Kuś
- First Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland
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Majewski S, Białas AJ, Buchczyk M, Gomółka P, Górska K, Jagielska-Len H, Jarzemska A, Jassem E, Jastrzębski D, Kania A, Koprowski M, Krenke R, Kuś J, Lewandowska K, Martusewicz-Boros MM, Roszkowski-Śliż K, Siemińska A, Sładek K, Sobiecka M, Szewczyk K, Tomczak M, Tomkowski W, Wiatr E, Ziora D, Żołnowska B, Piotrowski WJ. A multicentre retrospective observational study on Polish experience of pirfenidone therapy in patients with idiopathic pulmonary fibrosis: the PolExPIR study. BMC Pulm Med 2020; 20:122. [PMID: 32366291 PMCID: PMC7199354 DOI: 10.1186/s12890-020-1162-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pirfenidone is an antifibrotic agent approved for the treatment of idiopathic pulmonary fibrosis (IPF). The drug is available for Polish patients with IPF since 2017. The PolExPIR study aimed to describe the real-world data (RWD) on the Polish experience of pirfenidone therapy in IPF with respect to safety and efficacy profiles. METHODS This was a multicentre, retrospective, observational study collecting clinical data of patients with IPF receiving pirfenidone from January 2017 to September 2019 across 10 specialized pulmonary centres in Poland. Data collection included baseline characteristics, pulmonary function tests (PFTs) results and six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), treatment persistence, and survival were also collected up to 24 months post-inclusion. RESULTS A total of 307 patients receiving pirfenidone were identified for analysis. The mean age was 68.83 (8.13) years and 77% were males. The median time from the first symptoms to IPF diagnosis was 15.5 (9.75-30) months and from diagnosis to start of pirfenidone treatment was 6 (2-23) months. Patients were followed on treatment for a median of 17 (12-22.75) months. Seventy-four patients (24.1%) required dose adjustments and 35 (11.4%) were chronically treated with different than the full recommended dose. A total of 141 patients (45.92%) discontinued therapy due to different reasons including ADRs (16.61%), death (8.79%), disease progression (6.51%), patient's own request (5.54%), neoplastic disease (3.91%) and lung transplantation (0.33%). Over up to 24 months of follow-up, the pulmonary function remained largely stable. The median annual decline in forced vital capacity (FVC) during the first year of pirfenidone therapy was -20 ml (-200-100) and during the second year was -120 ml (-340-30). Over a study period, 33 patients (10.75%) died. CONCLUSIONS The PolExPIR study is a source of longitudinal RWD on pirfenidone therapy in the Polish cohort of patients with IPF supporting its long-term acceptable safety and efficacy profiles and reinforce findings from the previous randomised clinical trials and observational studies.
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Affiliation(s)
- Sebastian Majewski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.
| | - Adam J Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Buchczyk
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paweł Gomółka
- Department of Pulmonology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Hanna Jagielska-Len
- Clinical Department of Lung Diseases, K. Marcinkowski University Hospital, Zielona Gora, Poland
| | - Agnieszka Jarzemska
- Department of Pneumonology, Oncology and Tuberculosis, Kuyavian and Pomeranian Pulmonology Centre, Bydgoszcz, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aleksander Kania
- Department of Pulmonology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Koprowski
- Department of Civilization Diseases and Lung Diseases, John Paul II Specialist Hospital, Cracow, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kuś
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Katarzyna Lewandowska
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Magdalena M Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Kazimierz Roszkowski-Śliż
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology and Pneumonology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Sładek
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Sobiecka
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Karolina Szewczyk
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Tomczak
- Department of Pulmonology, E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Beata Żołnowska
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Martusewicz-Boros MM, Boros PW, Wiatr E, Zych J, Kempisty A, Kram M, Piotrowska-Kownacka D, Wesołowski S, Baughman RP, Roszkowski-Sliż K. Cardiac sarcoidosis: worse pulmonary function due to left ventricular ejection fraction?: A case-control study. Medicine (Baltimore) 2019; 98:e18037. [PMID: 31764823 PMCID: PMC6882660 DOI: 10.1097/md.0000000000018037] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dyspnea and exercise intolerance are usually attributed to pulmonary disease in sarcoidosis patients. However, cardiac involvement may also be responsible for these symptoms. Data regarding the impact of heart involvement on lung function in cardiac sarcoidosis (CS) is limited.The aim of study was to compare the results of pulmonary function tests (PFTs) in patients with and without heart involvement. We performed a retrospective analysis of PFTs in a group of sarcoidosis patients both with and without heart involvement evaluated by cardiovascular magnetic resonance (CMR) study. The study was performed in the period between May 2008 and April 2016.We included data of sarcoidosis patients who underwent testing for possible CS (including CMR study) at a national tertiary referral center for patients with interstitial lung diseases. All patients had histopathologicaly confirmed sarcoidosis and underwent standard evaluation with PFTs measurements including spirometry, plethysmography, lung transfer factor (TL,CO), and 6-minute walking test (6MWT) assessed using the most recent predicted values.We identified 255 sarcoidosis patients (93 women, age 42 ± 10.7 y): 103 with CS and 152 without CS (controls). CS patients had significantly lower left ventricular ejection fraction (LVEF; 56.9 ± 7.0 vs 60.4 ± 5.4, P < .001). Any type of lung dysfunction was seen in 63% of CS patients compared with 31% in the controls (P = .005). Ventilatory disturbances (obstructive or restrictive pattern) and low TL,CO were more frequent in CS group (52% vs 23%, P < .001 and 38% vs 18% P < .01 respectively). CS (OR = 2.13, 95% CI: 1.11-4.07, P = .02), stage of the disease (OR = 3.13, 95% CI: 1.4-7.0, P = .006) and LVEF (coefficient = -0.068 ± 0.027, P = .011) were independent factors associated with low FEV1 but not low TL,CO. There was a significant correlation between LVEF and FEV1 in CS group (r = 0.31, n = 89, P = .003). No significant difference in 6MWD between CS patients and controls was observed.Lung function impairment was more frequent in CS. Lower LVEF was associated with decreased values of FEV1. Relatively poor lung function may be an indication of cardiac sarcoidosis.
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Affiliation(s)
| | | | | | | | | | - Marek Kram
- Rehabilitation Department, National TB & Lung Diseases Research Institute, Warsaw
| | | | | | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
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Grabowska O, Martusewicz-Boros MM, Piotrowska-Kownacka D, Wiatr E. A case report of steroid resistant cardiac sarcoidosis successfully managed with methotrexate. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:178-181. [PMID: 32476900 DOI: 10.36141/svdld.v35i2.6554] [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] [Received: 06/17/2017] [Accepted: 08/08/2017] [Indexed: 11/02/2022]
Abstract
Up to one fourth of sarcoidosis patients may have cardiac involvement, what is potentially a life-threatening condition and requires aggressive treatment. Corticosteroids are generally effective in cardiac sarcoidosis, however may have significant short and long term adverse effects. We present a case of a 42-year-old male, who was diagnosed with pulmonary and cardiac sarcoidosis. He was treated initially with corticosteroids and satisfactory improvement was achieved in the lungs but not in the heart. Methotrexate was added as a second line therapy, being beneficial for the heart as well as steroid sparing agent. Cardiac improvement was documented during serial CMR imaging. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 178-181).
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Affiliation(s)
- Olga Grabowska
- Mazovian Center For Treatment of Lung Diseases and Tuberculosis, Otwock, Poland
| | | | | | - Elżbieta Wiatr
- 3 Lung Diseases Dept., National TB & Lung Diseases Research Institute, Warsaw, Poland
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Piotrowski WJ, Martusewicz-Boros MM, Białas AJ, Lewandowska K. Idiopathic pulmonary fibrosis (IPF) - common practice in Poland before the "antifibrotic drugs era". Adv Respir Med 2017; 85:136-142. [PMID: 28667654 DOI: 10.5603/arm.2017.0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and debilitating lung disease with a median survival time of 3-5 years. For now, pirfenidone (PIR) and nintedanib (NTB) are the only drugs that can slow down the disease's progression. In Poland, these drugs, although registered for legal use, had not been reimbursed for IPF patients until the end of the year 2016. Aim of the study was to assess what was common practice in terms of diagnosis and treatment in the period before antifibrotic drugs became available for IPF patients in Poland. MATERIAL AND METHODS We performed a survey among participants of two nationwide pulmonological congresses held in 2016. RESULTS One hundred and fifty physicians took part in the study. Only 55% of respondents would reach their final diagnosis in collaboration with a radiologist. Just 40% of those sending patients for surgical lung biopsy (SLB) would discuss the case directly with a pathologist. 22% would never refer the patient suspected of having IPF for SLB. 85% believed that bronchoalveolar lavage (BAL) may be useful for diagnosis. 41% of respiratory professionals would not use any drug for the treatment of IPF patients. 23% of physicians would prescribe corticosteroids in high doses (CS), either in monotherapy or in combination with other drugs. Only 43% of respondents would use antacid drugs in case of symptomatic gastro-oesophageal reflux disease (GERD), and only 11% would prescribe these drugs regardless of GERD diagnosis. CONCLUSIONS The majority of Polish pulmonologists were not supported by radiologists and pathologists in the diagnostic process. Treatment standards were unsatisfactory, mostly due to a lacking of reimbursement regulations. Further education is necessary to improve management of IPF patients in Poland.
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Affiliation(s)
- Wojciech Jerzy Piotrowski
- Department of Pneumology and Allergy, Medical University of Lodz, Kopcińskiego 22, 90-153, Łódź, Poland.
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Martusewicz-Boros MM, Piotrowska-Kownacka D, Wiatr E, Roszkowski-Śliż K. Cardiac sarcoidosis - silent destroyer. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:175-177. [PMID: 27537722] [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] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/18/2016] [Accepted: 01/07/2016] [Indexed: 06/06/2023]
Abstract
We report a case of histologically proven pulmonary sarcoidosis and cardiac involvement in a 53-year old woman with progression leading to the heart failure documented in cardiovascular magnetic resonsnce studies.
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Martusewicz-Boros MM, Boros PW, Wiatr E, Zych J, Piotrowska-Kownacka D, Roszkowski-Śliż K. Prevalence of cardiac sarcoidosis in white population: a case-control study: Proposal for a novel risk index based on commonly available tests. Medicine (Baltimore) 2016; 95:e4518. [PMID: 27512871 PMCID: PMC4985326 DOI: 10.1097/md.0000000000004518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/13/2022] Open
Abstract
Cardiac sarcoidosis (CS) is a life-threatening and underdiagnosed manifestation of the disease, which requires a complicated and expensive diagnostic pathway. There is a need for simple tool for practitioners to determine the risk of CS without access to specialized equipment.The aim of study was to determine the prevalence of CS in a group of patients diagnosed with or followed up because of sarcoidosis. A secondary objective was the search for factors associated with heart involvement.We performed a prospective case-control study (screening analysis) in consecutive sarcoidosis patients collected from October 2012 to September 2015. Cardiac magnetic resonance (CMR) imaging was performed to confirm or exclude cardiac involvement in all patients. The study was conducted in a hospital-based referral center for patients with sarcoidosis and other interstitial lung diseases.Analysis was performed in a group of 201 patients (all white) with biopsy-proven sarcoidosis, mean age 41.4 ± 10.2, 121 of them (60.2%) males. Four patients with previously recognized cardiac diseases, which make CMR imaging for CS inconclusive, were not included.Cardiac involvement was detected by CMR in 49 patients (24.4%). Factors associated with an increased risk of CS (univariate analyses) included male sex (odds ratio [OR]: 2.5; 1.21-5.16, P = 0.01), cardiac-related symptoms (OR: 3.53; 1.81-6.89, P = 0.0002), extrathoracic sarcoidosis (OR: 3.48; 1.77-6.84, P = 0.0003), elevated serum NT-proBNP (OR: 3.82; 1.55-9.42, P = 0.004), any electrocardiography abnormality (OR: 5.38; 2.48-11.67, P = 0.0001), and contemporary radiological progression sarcoidosis in the lungs (OR: 2.98; 1.52-5.84, P = 0.001). Abnormalities in echocardiography and Holter ECG were also risk factors, but not significant in multivariate analyses. A CS Risk Index was developed using a multivariate model to predict CS, achieving an accuracy of 82%, sensitivity of 50%, specificity of 94%, and likelihood ratio 8.1.CS was detected in one fourth of patients. A CS Risk Index based on the results of easily accessible tests is cost-effective and may help to identify patients who should be urgently referred for further diagnostic procedures.
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Affiliation(s)
| | - Piotr W. Boros
- Lung Pathophysiology Department, National TB & Lung Diseases Research Institute
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Martusewicz-Boros MM, Boros PW, Wiatr E, Kempisty A, Piotrowska-Kownacka D, Roszkowski-Śliż K. Cardiac Sarcoidosis: Is it More Common in Men? Lung 2015; 194:61-6. [PMID: 26411590 PMCID: PMC4740513 DOI: 10.1007/s00408-015-9805-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease which predominantly affects the lungs, although granulomas can also involve all other organs, including the heart. Cardiac sarcoidosis (CS) may occur at any stage of the disease and may be the cause of sudden cardiac death, even in a previously asymptomatic patient. The aim of this study was to evaluate the incidence of CS in a large group of patients diagnosed or followed up due to sarcoidosis. METHODS We performed a retrospective analysis of patients at our institution discharged with the final diagnosis "sarcoidosis" (ICD-10: D86) from January 2008 to October 2012. Only those with biopsy (from respiratory tract or lymph nodes) confirmed diagnosis of sarcoidosis were included. We then selected the subset of patients with cardiac involvement due to sarcoidosis confirmed by positive magnetic resonance imaging. RESULTS The study covered 1375 consecutive sarcoidosis patients (51 % men), who were hospitalized during 5 years. Multiorgan disease was detected in 160 cases (11.7 %), and cardiac involvement was found in 64 patients (4.7 % of all), 70.3 % of whom were men. Twelve of those with CS were in stage I, 48 in stage II, and four in stage III. The odds ratio for having cardiac involvement in men compared to women was 2.3 (95 % CI 1.36-4.0, p = 0.002). CONCLUSIONS Cardiac involvement in sarcoidosis was diagnosed in the similar percentage as in previously published data but was significantly more frequently in men.
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Affiliation(s)
| | - Piotr W Boros
- Lung Pathophysiology Department, National Research Institute of TB & Lung Diseases, Plocka 26, 01-138, Warsaw, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases Department, National Research Institute of TB & Lung Diseases, Plocka 26, 01-138, Warsaw, Poland
| | - Anna Kempisty
- 1st Lung Diseases Department, National Research Institute of TB & Lung Diseases, Plocka 26, 01-138, Warsaw, Poland
| | - Dorota Piotrowska-Kownacka
- 1st Department of Clinical Radiology, Medical University of Warsaw, Chalubinskiego 5, 02-004, Warsaw, Poland
| | - Kazimierz Roszkowski-Śliż
- 3rd Lung Diseases Department, National Research Institute of TB & Lung Diseases, Plocka 26, 01-138, Warsaw, Poland
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Martusewicz-Boros MM, Boros PW, Wiatr E, Roszkowski-Śliż K. What comorbidities accompany sarcoidosis? A large cohort (n=1779) patients analysis. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:115-120. [PMID: 26278690] [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] [Received: 05/30/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous multiorgan disease with the most common manifestation is in the chest, although the granulomas can also involve all other organs causing variety of symptoms mimicking different diseases. OBJECTIVES To evaluate the incidence of comorbidity in a large group of patients with sarcoidosis diagnosed or followed in referral center for lung diseases in Poland. PATIENTS AND METHODS We performed a retrospective analysis in a group of 1779 patients discharged with the final diagnosis "sarcoidosis" (ICD-10: D86) from January 2008 to October 2011. RESULTS The majority (79.2%) were diagnosed as pulmonary and/or lymph node sarcoidosis (D86.0, D86.1, D86.2). Sarcoidosis of other and combined sites (D86.8) were diagnosed in 15.8% and unspecified (D86.9) in 5.0% of patients. At least one comorbid condition was noted in 54% of the patients, most frequently arterial hypertension (22.4%), thyroid disorders (5.6%), diabetes mellitus (5.0%), COPD (4.3%) and obesity (3.3%). Using linear regression models, the associations between the number of comorbidities and age and extent of the disease were found (p<0.001). Patients with multiorgan sarcoidosis were more likely to have a comorbid condition. CONCLUSIONS More than half of patients with sarcoidosis have a comorbid condition, which is more likely in older patients and those with multiorgan involvement.
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Martusewicz-Boros MM, Wiatr E, Roszkowski-Sliz K. Cardiac sarcoidosis treatment revisited. Intern Med 2014; 53:2759. [PMID: 25447668 DOI: 10.2169/internalmedicine.53.2917] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Liver diseases are often associated with respiratory complications. They may manifest as pleural effusion, interstitial lung disease, as well as various combinations of symptoms affecting the pulmonary vasculature. The duration and severity of liver disease is not always reflected by the degree of lung function impairment. On the other hand, progressive damage to the lungs significantly worsens prognosis in the course of severe liver disease. The diagnosis is difficult and often requires multidisciplinary cooperation. The effects of pharmacological treatment are not always satisfactory. In numerous cases, liver transplantation proves to be the best option.
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Martusewicz-Boros MM, Boros WP, Wiatr E, Wesolowski S, Roszkowski-Sliz K. Bronchial hyperreactivity in sarcoidosis patients: correlation with airflow limitation indices. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29:99-106. [PMID: 23461071] [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: 06/01/2023]
Abstract
UNLABELLED Bronchial hyperreactivity (BHR) in sarcoidosis has been reported in 5 to 83% of patients, but the relationship between BHR and airway functional status being unclear. The aim of the study was to assess the prevalence and degree of BHR in a group of pulmonary sarcoidosis patients and how BHR does relate to the functional status of airways. MATERIAL AND METHODS 56 consecutive sarcoidosis outpatients (26 f, 30 m) were included. There were 14 (25%) patients in stage I, 32 (57.1%) patients in stage II and 10 (17.9%) patients in stage III. In all patients the standard evaluation included a history, physical examination, chest radiogram, serum ACE activity and lung function assessment were done. The provocation challenge test with doubling concentrations of histamine was performed in all patients using the standardized protocol recommended by the ERS. RESULTS 4 patients (7%) were restrictive, airway obstruction was detected in 7 (12.5%) cases. Up to 32% of patients had maximal expiratory flows at low lung volumes below the lower limit of normal (LLN). The histamine challenge test results: in 9 cases (16%) the fall in FEV1 was < 20% of the baseline; mean PC20H (n = 47) was 5.7 +/- 5.9 mg/mL, range: 0.56-26.7 mg/mL. The challenge test was regarded as positive (PC20H < or = 8 mg/mL) in 71.4% of the group. BHR expressed as ln(PC20H) correlated weakly but significantly with FEV1, FEV1%VC, MMEF and PEF. CONCLUSION BHR occurs frequently in sarcoidosis patients and should be considered especially in patients with airflow limitation.
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Affiliation(s)
- M M Martusewicz-Boros
- 3rd Lung Diseases Department, National Tuberculosis & Lung Diseases Research Institute, Warsaw, Poland.
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Abstract
Airway reversibility test (or bronchodilatation test) is performed routinely in the diagnosis of obstructive lung diseases. The results of this test may be helpful in the diagnosis and differential diagnosis of asthma and chronic obstructive pulmonary disease (COPD), but sometimes bring confusion. Unfortunately, the nomenclature used for test result is not uniform, which also leads to confusion. Next the reader will find an attempt to order the state of affairs and the introduction of a uniform nomenclature, which would be consistent with the logic and allow for unambiguous classification of reversibility test results to facilitate future decisions based on the differential diagnosis.
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Affiliation(s)
- Piotr W Boros
- Lung Function Lab, National Research Institute of TB & Lung Diseases, Warsaw, Poland.
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