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Troy LK, Young IH, Lau EM, Corte TJ. Exercise pathophysiology and the role of oxygen therapy in idiopathic interstitial pneumonia. Respirology 2015; 21:1005-14. [DOI: 10.1111/resp.12650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/29/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Lauren K. Troy
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Iven H. Young
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Edmund M.T. Lau
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Tamera J. Corte
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
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Abstract
Major risk factors for idiopathic pulmonary fibrosis (IPF) include older age and a history of smoking, which predispose to several pulmonary and extra-pulmonary diseases. IPF can be associated with additional comorbidities through other mechanisms as either a cause or a consequence of these diseases. We review the literature regarding the management of common pulmonary and extra-pulmonary comorbidities, including chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, venous thromboembolism, sleep-disordered breathing, gastroesophageal reflux disease, coronary artery disease, depression and anxiety, and deconditioning. Recent studies have provided some guidance on the management of these diseases in IPF; however, most treatment recommendations are extrapolated from studies of non-IPF patients. Additional studies are required to more accurately determine the clinical features of these comorbidities in patients with IPF and to evaluate conventional treatments and management strategies that are beneficial in non-IPF populations.
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Affiliation(s)
- Blair G Fulton
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada ; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
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53
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Tzouvelekis A, Bonella F, Spagnolo P. Update on therapeutic management of idiopathic pulmonary fibrosis. Ther Clin Risk Manag 2015; 11:359-70. [PMID: 25767391 PMCID: PMC4354471 DOI: 10.2147/tcrm.s69716] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive diffuse parenchymal lung disease of unknown origin, with a mortality rate exceeding that of many cancers. The diagnostic process is complex and relies on the clinician integrating clinical, laboratory, radiological, and histological data. In the last decade, major advances in our understanding of the pathogenesis of IPF have shifted the paradigm from a primarily inflammatory process evolving to fibrosis to a condition driven by aberrant wound healing following alveolar epithelial cell injury that results in scarring of the lung, architectural distortion, and irreversible loss of function. Improved understanding of disease pathogenesis has led to the identification of several therapeutic targets and the design of high-quality clinical trials evaluating novel compounds. However, the results of these studies have been mostly disappointing, probably due to the plethora of mediators, growth factors, and signaling pathways involved in the fibrotic process. Most recently, pirfenidone and nintedanib, two compounds with pleiotropic anti-fibrotic properties, have been proven effective in reducing functional decline and disease progression in IPF. This is a major breakthrough. Nevertheless, we still have a long way to go. In fact, neither pirfenidone nor nintedanib is a cure for IPF, and most patients continue to progress despite treatment. As such, comprehensive care of patients with IPF, including management of concomitant conditions and physical debility, as well as timely referral for lung transplantation, remains essential. Several agents with a high potential are currently being tested, and many more are ready for clinical trials. Their completion is critical for achieving the ultimate goal of curing patients with IPF.
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Affiliation(s)
- Argyris Tzouvelekis
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Germany
| | - Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland and University of Basel, Liestal, Switzerland
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Spagnolo P, Sverzellati N, Rossi G, Cavazza A, Tzouvelekis A, Crestani B, Vancheri C. Idiopathic pulmonary fibrosis: an update. Ann Med 2015; 47:15-27. [PMID: 25613170 DOI: 10.3109/07853890.2014.982165] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common and lethal form of idiopathic interstitial pneumonia. The disease, which occurs primarily in middle-aged and older adults, is thought to arise following an aberrant reparative response to alveolar epithelial cell injury characterized by secretion of excessive amounts of extracellular matrix components, resulting in scarring of the lung, architectural distortion, and irreversible loss of function. A complex interplay between environmental and host factors is thought to contribute to the development of the disease, although the cause of IPF remains elusive and its pathogenesis incompletely understood. Over the last decade, disease definition and diagnostic criteria have evolved significantly, and this has facilitated the design of a number of high-quality clinical trials evaluating novel therapeutic agents for IPF. This massive effort of the medical and industry community has led to the identification of two compounds (pirfenidone and nintedanib) able to reduce functional decline and disease progression. These promising results notwithstanding, IPF remains a major cause of morbidity and mortality and a largely unmet medical need. A real cure for this devastating disease has yet to emerge and will likely consist of a combination of drugs targeting the plethora of pathways potentially involved in disease pathogenesis.
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Affiliation(s)
- Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland, and University of Basel , Switzerland
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55
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Holland AE, Dowman LM, Hill CJ. Principles of rehabilitation and reactivation: interstitial lung disease, sarcoidosis and rheumatoid disease with respiratory involvement. Respiration 2015; 89:89-99. [PMID: 25633076 DOI: 10.1159/000370126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The interstitial lung diseases (ILDs) are characterised by dyspnoea on exertion, exercise-induced hypoxaemia, reduced skeletal muscle function and exercise intolerance. Evidence from nine randomised controlled trials shows that pulmonary rehabilitation improves exercise capacity, dyspnoea and quality of life in ILD, with moderately large effect sizes from 0.59 to 0.68. Participants with idiopathic pulmonary fibrosis, the most common and most progressive of the ILDs, achieve benefits in exercise capacity and quality of life that are of equal magnitude to those seen in other ILDs, with effect sizes from 0.59 to 0.75. Whole body exercise training is a core component of pulmonary rehabilitation for ILD. The standard exercise prescription used for other chronic lung diseases is effective in ILD, including 8 weeks of training with at least two supervised sessions per week and at least 30 min of aerobic training per session. However, the unique presentation and underlying pathophysiology of ILD may require modifications of the exercise prescription for individual patients. Those with connective tissue disease may present with joint pain and stiffness that require modification of the standard exercise prescription, including reduction in weight-bearing exercise. Some patients with severe disease may present with distressing dyspnoea that limits the intensity or progression of training. Because exercise-induced hypoxaemia is common in ILD and more severe than seen in other chronic lung diseases, pulmonary rehabilitation should be provided in a setting where supplemental oxygen therapy is available. Pulmonary rehabilitation programs offer the opportunity to address other critical aspects of ILD care, including management of comorbidities, symptoms and mood.
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
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Holland AE, Fiore JF, Bell EC, Goh N, Westall G, Symons K, Dowman L, Glaspole I. Dyspnoea and comorbidity contribute to anxiety and depression in interstitial lung disease. Respirology 2014; 19:1215-21. [PMID: 25112470 DOI: 10.1111/resp.12360] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/04/2014] [Accepted: 06/18/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the prevalence of anxiety in interstitial lung disease (ILD), and the contributors to depression are not clear. The aim of this study was to determine the prevalence and predictors of anxiety and depression in people with ILD. METHODS One hundred and twenty-four individuals with ILD (age 64 years (standard deviation 12), 48 idiopathic pulmonary fibrosis) participated. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale to determine likely cases and borderline cases. Associations with demographic data, respiratory function, 6-min walk and Modified Medical Research Council Dyspnoea Scale (MMRC) were examined. RESULTS The prevalence of anxiety was 31%, with clinically significant anxiety in 12%. Depression was present in 23% of individuals, with 7% having clinically significant depression. Independent predictors of anxiety were a higher MMRC score (P = 0.005, odds ratio (OR) for case 2.60, 95% confidence interval 1.37 to 4.92) and higher nadir SpO2 during walking (P = 0.003, OR for case 1.16, 1.04-1.30). Independent predictors of depression were a higher MMRC score (P = 0.006, case OR 3.84, 1.25-11.78, borderline case OR 2.44, 1.14-5.19) and a greater number of comorbidities (P = 0.003, case OR 2.02, 0.97-4.21, borderline case OR 2.26, 1.30-3.93). CONCLUSIONS Anxiety and depression are present in a significant minority of individuals with ILD. Dyspnoea and comorbidities are important contributors that may be amenable to intervention.
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia; Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
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57
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Ryu JH, Moua T, Daniels CE, Hartman TE, Yi ES, Utz JP, Limper AH. Idiopathic pulmonary fibrosis: evolving concepts. Mayo Clin Proc 2014; 89:1130-42. [PMID: 24867394 DOI: 10.1016/j.mayocp.2014.03.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) occurs predominantly in middle-aged and older adults and accounts for 20% to 30% of interstitial lung diseases. It is usually progressive, resulting in respiratory failure and death. Diagnostic criteria for IPF have evolved over the years, and IPF is currently defined as a disease characterized by the histopathologic pattern of usual interstitial pneumonia occurring in the absence of an identifiable cause of lung injury. Understanding of the pathogenesis of IPF has shifted away from chronic inflammation and toward dysregulated fibroproliferative repair in response to alveolar epithelial injury. Idiopathic pulmonary fibrosis is likely a heterogeneous disorder caused by various interactions between genetic components and environmental exposures. High-resolution computed tomography can be diagnostic in the presence of typical findings such as bilateral reticular opacities associated with traction bronchiectasis/bronchiolectasis in a predominantly basal and subpleural distribution, along with subpleural honeycombing. In other circumstances, a surgical lung biopsy may be needed. The clinical course of IPF can be unpredictable and may be punctuated by acute deteriorations (acute exacerbation). Although progress continues in unraveling the mechanisms of IPF, effective therapy has remained elusive. Thus, clinicians and patients need to reach informed decisions regarding management options including lung transplant. The findings in this review were based on a literature search of PubMed using the search terms idiopathic pulmonary fibrosis and usual interstitial pneumonia, limited to human studies in the English language published from January 1, 2000, through December 31, 2013, and supplemented by key references published before the year 2000.
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Affiliation(s)
- Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Craig E Daniels
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - James P Utz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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58
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Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014; 35:369-89. [PMID: 24874132 DOI: 10.1016/j.ccm.2014.02.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary rehabilitation (PR) is an important therapeutic intervention that should no longer be considered suitable only for patients with chronic obstructive pulmonary disease (COPD). A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe and effective. A disease-relevant approach should be undertaken, based on individual patients' needs. Further research is needed to better understand the optimal program content, duration and outcomes measures, to enable diverse patients to achieve maximal benefits of PR.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep, Yale University School of Medicine, 333 Cedar Street, Building LCI-105, New Haven, CT 06520, USA.
| | - Carl Fairburn
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
| | - Rebecca H Crouch
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
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59
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Identification and treatment of comorbidities in idiopathic pulmonary fibrosis and other fibrotic lung diseases. Curr Opin Pulm Med 2014; 19:466-73. [PMID: 23912191 DOI: 10.1097/mcp.0b013e328363f460] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The interstitial lung diseases (ILDs) frequently result in considerable disability and reduced survival in affected patients. Unfortunately, they are often poorly responsive to available therapies. Comorbidities, both pulmonary and nonpulmonary, frequently accompany ILDs and contribute to adverse outcomes. RECENT FINDINGS Multiple comorbidities, including gastroesophageal reflux disease, venous thromboembolism, coronary artery disease, sleep-disordered breathing, depression, emphysema, pulmonary hypertension, and lung cancer contribute to the morbidity and mortality of fibrotic lung disease. SUMMARY The identification and treatment of comorbidities may improve morbidity and potentially impact mortality in patients with ILD. A high index of suspicion and an awareness of the spectrum of comorbidities are important in optimizing outcomes in this group of patients.
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60
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Abstract
PURPOSE OF REVIEW To summarize current knowledge of health-related quality of life (HRQL) assessment in idiopathic pulmonary fibrosis (IPF), with an emphasis on reviewing available data on HRQL instruments, operationalizing HRQL assessment in IPF research and interventions that show promise for improving HRQL in patients with IPF. RECENT FINDINGS Findings from several studies support the validity of the Medical Outcomes Study Short-Form 36-item Questionnaire and St George's Respiratory Questionnaire for assessing HRQL in IPF. IPF-specific HRQL instruments are in development, but additional research is needed before their broad implementation. Pulmonary rehabilitation and IPF disease management programs appear to be promising interventions for improving HRQL in IPF patients. SUMMARY IPF is a devastating disease. Because there is no cure, an improved understanding of how this disease affects patients' lives is needed. Rigorously developed and carefully administered instruments are needed to assess those effects and to measure the impact of interventions aimed at improving the lives of patients with IPF.
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61
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Ryerson CJ, Cayou C, Topp F, Hilling L, Camp PG, Wilcox PG, Khalil N, Collard HR, Garvey C. Pulmonary rehabilitation improves long-term outcomes in interstitial lung disease: a prospective cohort study. Respir Med 2013; 108:203-10. [PMID: 24332409 DOI: 10.1016/j.rmed.2013.11.016] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pulmonary rehabilitation improves outcomes in patients with interstitial lung disease (ILD), however it is unclear whether these effects are long lasting and which patients benefit most. METHODS Patients with ILD were recruited into this prospective cohort study from three pulmonary rehabilitation programs. Patients completed functional assessments (6-minute walk distance (6MWD), and 4-meter walk time) and surveys (quality of life, dyspnea, depression, and physical activity) before rehabilitation, after rehabilitation, and at six months. Changes from baseline were compared using a paired t-test. Independent predictors of change in 6MWD and quality of life were determined using multivariate analysis. RESULTS Fifty-four patients were recruited (22 with idiopathic pulmonary fibrosis), 50 patients (93%) completed the rehabilitation program, and 39 returned for six-month follow-up. 6MWD improved 57.6 m immediately after rehabilitation (95% confidence interval (CI) 40.2-75.1 m, p < 0.0005), and remained 49.8 m above baseline at six months (95%CI 15.0-84.6 m, p = 0.005). The majority of patients achieved the minimum clinically important difference for quality of life (51%), dyspnea (65%), and depression score (52%) immediately after rehabilitation, and improvements were still significant at 6-month follow-up for quality of life, depression, and physical activity. A low baseline 6MWD was the only independent predictor of improvement in 6MWD during rehabilitation (r = -0.49, p < 0.0005). Change in 6MWD was an independent predictor of change in quality of life (r = -0.36, p = 0.01). CONCLUSIONS Pulmonary rehabilitation improved multiple short- and long-term outcomes in patients with ILD. While all patients appear to benefit, ILD patients with a low baseline 6MWD had greater benefit from rehabilitation. CLINICAL TRIALS REGISTRATION NUMBER NCT01055730 (clinicaltrials.gov).
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Affiliation(s)
- Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada; James Hogg Research Centre, St. Paul's Hospital, Canada.
| | - Cindy Cayou
- Lung Health Services, John Muir Health, Concord, CA, USA
| | - Fiona Topp
- Providence Health Care, Vancouver, Canada
| | - Lana Hilling
- Lung Health Services, John Muir Health, Concord, CA, USA
| | - Pat G Camp
- James Hogg Research Centre, St. Paul's Hospital, Canada; Providence Health Care, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Harold R Collard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chris Garvey
- Department of Pulmonary and Cardiac Rehabilitation, Seton Medical Center Pulmonary Rehabilitation, Daly City, CA, USA
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Kenn K, Gloeckl R, Behr J. Pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis--a review. ACTA ACUST UNITED AC 2013; 86:89-99. [PMID: 23942353 DOI: 10.1159/000354112] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Among the various types of interstitial lung diseases, idiopathic pulmonary fibrosis (IPF) is the most common disorder and has a poor prognosis and a limited response to pharmacological treatment. In patients with IPF, functional exercise tolerance and quality of life have been shown to be significantly decreased. Current IPF guidelines suggest only a weak recommendation for pulmonary rehabilitation (PR). However, PR is regarded as a reasonable choice for the majority of patients with IPF. This review will summarize all of the available studies that have investigated the effects of PR in patients with IPF so far. Although only a small number of studies have been published to date, most studies have found significant short-term improvements in functional exercise capacity, quality of life, and level of perceived dyspnea. Long-term improvements or maintenance strategies of PR in IPF patients have not been adequately investigated yet. Up to now there is still no sufficient evidence for the recommendation of PR in IPF. However, physical training seems to be the major component of all PR programs. The current review will discuss potential exercise training regimens for patients with IPF and suggest additional useful modalities of a specific multidisciplinary PR program for IPF patients. Based on the current literature and our own experience, this article will try to highlight the importance of PR as an additional, beneficial therapeutic option for patients with IPF.
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Affiliation(s)
- K Kenn
- Schoen Klinik Berchtesgadener Land, Department of Respiratory Medicine, Schoenau am Koenigssee, Germany.
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63
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Abstract
PURPOSE OF REVIEW This review seeks to inform readers of evolving concepts of ageing-associated risks for developing interstitial lung disease (ILD) and current approaches to the diagnosis and management of ILD in elderly patients. RECENT FINDINGS Various aspects of cellular and immune senescence have been identified that may explain the increased susceptibility of the elderly to developing fibrotic lung disease. New guidelines have been recently published concerning the diagnosis and management of idiopathic pulmonary fibrosis (IPF), which is highly prevalent in elderly patients. Nontransplant therapies that can have a significant impact on disease progression for patients with IPF have yet to be identified. Additionally, evidence is accumulating that abnormal gastroesophageal reflux and microaspiration may play a role in IPF pathogenesis. SUMMARY High-resolution computed tomographic scanning of the thorax can play a key role in making a specific ILD diagnosis and be used to make a confident diagnosis of various forms of ILD, especially IPF, when combined with a consistent clinical presentation. Management of ILD in the elderly should be not only disease specific but potentially therapeutic, and supportive interventions should be tailored to each individual patient and not entail significant risk of adverse complications, especially for the frail elderly patient.
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Affiliation(s)
- Keith C Meyer
- Section of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792-9988, USA.
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Bajwah S, Ross JR, Peacock JL, Higginson IJ, Wells AU, Patel AS, Koffman J, Riley J. Interventions to improve symptoms and quality of life of patients with fibrotic interstitial lung disease: a systematic review of the literature. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202040] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lewis D, Scullion J. Palliative and end-of-life care for patients with idiopathic pulmonary fibrosis: challenges and dilemmas. Int J Palliat Nurs 2012; 18:331-7. [PMID: 22885965 DOI: 10.12968/ijpn.2012.18.7.331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, life-threatening interstitial lung disease of unknown aetiology and with limited proven treatment options. As it is predominantly a disease of older age, a growing elderly population will increase its incidence. IPF has a poor prognosis, with a median survival of 3-5 years after diagnosis and a 5-year survival rate of 10-15%. Patients may suffer gradual decline but acute and unpredictable episodes of respiratory failure may result in death. Further research is needed to ascertain the worth of potential prognostic indicators such as age, respiratory hospitalisations, percentage of predicted forced vital capacity (FVC), and 24-week change in FVC. Integration of palliative care principles into IPF treatment is essential, including advance care planning, relief of physical and psychological burden, and patient and carer education. It is unknown whether pulmonary rehabilitation is of benefit but it may improve fatigue and functional capacity.
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Cardiopulmonary exercise testing in lung transplantation: a review. Pulm Med 2012; 2012:237852. [PMID: 22666582 PMCID: PMC3361366 DOI: 10.1155/2012/237852] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/11/2012] [Accepted: 02/28/2012] [Indexed: 11/23/2022] Open
Abstract
There has been an increase in lung transplantation in the USA. Lung allocation is guided by the lung allocation score (LAS), which takes into account one measure of exercise capacity, the 6-minute walk test (6MWT). There is a paucity of data regarding the role and value of cardiopulmonary stress test (CPET) in the evaluation of lung transplant recipients while on the transplant waiting list and after lung transplantation. While clearly there is a need for further prospective investigation, the available literature strongly suggests a potential role for CPET in the setting of lung transplant.
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Abstract
The burden of chronic obstructive pulmonary disease (COPD) has increased recently in developing countries. On the other hand, structured or non-structured rehabilitation services for COPD patients are not routinely available in these countries. We, therefore, planned this review to re-emphasize the emerging benefits of pulmonary rehabilitation in COPD population. Aim of this review is to stimulate pulmonary physicians in India and other resource-poor areas of the world so that they start using pulmonary rehabilitation or its components more often. The search included standard english literature PubMed citation of relevant original articles, review articles and practice guidelines. The articles and reviews were searched including standard MeSH terms - Rehabilitation (TIAB) and pulmonary disease, chronic obstructive/therapy (MAJOR) and guidelines (TIAB). Available 58 articles in English including 23 reviews from July 2001 to October 2010 were screened for evidence-based benefits regarding respiratory rehabilitation as a whole or its different components. The cross references and current citations relating to primary articles were also included for description. No attempt was done to make a systematic analysis because our purpose was not to derive evidence-based recommendations from database and because sufficient evidence is already available for benefits of selected components of pulmonary rehabilitation in COPD patients. Pulmonary rehabilitation has emerged as an important modality as an adjunct to other therapies in patients of COPD. Limited and more cost-effective protocols are to be developed and executed by healthcare providers, especially in developing countries like India.
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Affiliation(s)
- Bharat Bhushan Sharma
- Division of Allergy and Pulmonary Medicine, Department of Medicine, SMS Medical College, Jaipur, India
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