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Saxena P, Singh I, Kumar A, Kartik S, Malik V, Tiwari S, Akhil KR, Pattanayak S, Velangi VG, Jain H. Impact of HRCT pattern on six-minute walk test in patients with interstitial lung disease-An observational study. Lung India 2023; 40:429-433. [PMID: 37787356 PMCID: PMC10553773 DOI: 10.4103/lungindia.lungindia_165_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 10/04/2023] Open
Abstract
Background Forced vital capacity (FVC) and six-minute walk distance (6MWD) are robust markers in interstitial lung diseases (ILD) to assess severity and prognosis. It is unknown whether high-resolution computed tomography pattern has any independent effect on the exercise capacity in ILD. We compared six-minute walk test (6MWT) parameters between usual interstitial pneumonia (UIP) and non-UIP ILD after adjusting for FVC. Methods Data from a tertiary care ILD clinic were retrospectively analysed. Based on HRCT, patients were classified as UIP and non-UIP. 6MWT parameters and FVC were recorded for enrolled patients. 6MWD, distance-saturation product (DSP) and exertional desaturation were compared between UIP and non-UIP, using analysis of covariance (ANCOVA), with per cent predicted FVC as covariate. Patients were grouped as mild (≥70%), moderate (51%-69%) and severe (≤50%) based on FVC severity. Results Out of 169 patients enrolled, only patients with all three data points: spirometry, 6MWT and HRCT were included in the analysis (n = 139). UIP group comprised 56 (40.3%), while non-UIP group had 83 (59.7%) patients. More females and lesser smokers were present in non-UIP group. Mean predicted FVC% was similar between the two HRCT groups (P = 0.611) and had a statistically significant, though very weak to weak correlation with 6MWT parameters {6MWD (r = 0.138); pred 6MWD% (r = 0.170); desaturation (r = -0.227); DSP index (r = 0.166)}. Analysis of covariance showed no statistically significant difference in the 6MWT parameters between UIP and non-UIP groups for similar FVC levels. Conclusion For a similar level of lung function, exercise capacity was similar for patients with UIP and non-UIP pattern ILD.
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Affiliation(s)
- Puneet Saxena
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Itishree Singh
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Abhishek Kumar
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India
| | - S Kartik
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India
| | - Virender Malik
- Department of Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India
| | - Saurabh Tiwari
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - KR Akhil
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Somali Pattanayak
- Department of Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India
| | - Vaibhavi G. Velangi
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India
| | - Harsh Jain
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India
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Sleep-related breathing disorders in idiopathic pulmonary fibrosis are frequent and may be associated with pulmonary vascular involvement. Sleep Breath 2022; 27:961-971. [DOI: 10.1007/s11325-022-02686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
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Value of Cardiopulmonary Exercise Testing in Prognostic Assessment of Patients with Interstitial Lung Diseases. J Clin Med 2022; 11:jcm11061609. [PMID: 35329935 PMCID: PMC8954900 DOI: 10.3390/jcm11061609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is associated with high rates of comorbidities and non-infectious lung disease mortality. Against this background, we aimed to evaluate the prognostic capacity of lung function and cardiopulmonary exercise testing (CPET) in patients with ILD. MATERIALS AND METHODS A total of 183 patients with diverse ILD entities were included in this monocentric analysis. Prediction models were determined using Cox regression models with age, sex, body mass index (BMI), and all parameters from pulmonary function testing and CPET. Kaplan-Meier curves were plotted for selected variables. RESULTS The median follow-up period was 3.0 ± 2.5 years. Arterial hypertension (57%) and pulmonary hypertension (38%) were the leading comorbidities. The Charlson comorbidity index score was 2 ± 2 points. The 3-year and 5-year survival rates were 68% and 50%, respectively. VO2peak (mL/kg/min or %pred.) was identified as a significant prognostic parameter in patients with ILD. The cut-off value for discriminating mortality was 61%. CONCLUSION The present analyses consistently revealed the high prognostic power of VO2peak %pred. and other parameters evaluating breathing efficacy (VÉ/VCO2 @AT und VÉ/VCO2 slope) in ILD patients. VO2peak %pred., in contrast to the established prognostic values FVC %pred., DLCO/KCO %pred., and GAP, showed an even higher prognostic ability in all statistical models.
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Gille T, Laveneziana P. Cardiopulmonary exercise testing in interstitial lung diseases and the value of ventilatory efficiency. Eur Respir Rev 2021; 30:30/162/200355. [PMID: 34853093 DOI: 10.1183/16000617.0355-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/26/2021] [Indexed: 12/27/2022] Open
Abstract
Interstitial lung diseases (ILDs) are diverse parenchymal pulmonary disorders, primarily characterised by alveolar and interstitial inflammation and/or fibrosis, and sharing pathophysiological similarities. Thus, patients generally harbour common respiratory symptoms, lung function abnormalities and modified exercise adaptation. The most usual and disabling complaint is exertional dyspnoea, frequently responsible for premature exercise interruption. Cardiopulmonary exercise testing (CPET) is increasingly used for the clinical assessment of patients with ILD. This is because exercise performance or dyspnoea on exertion cannot reliably be predicted by resting pulmonary function tests. CPET, therefore, provides an accurate evaluation of functional capacity on an individual basis. CPET can unmask anomalies in the integrated functions of the respiratory, cardiovascular, metabolic, peripheral muscle and neurosensory systems in ILDs. CPET uniquely provides an evaluation of all above aspects and can help clinicians shape ILD patient management. Preliminary evidence suggests that CPET may also generate valuable prognostic information in ILDs and can be used to shed light on the presence of associated pulmonary hypertension. This review aims to provide comprehensive and updated evidence concerning the clinical utility of CPET in ILD patients, with particular focus on the physiological and clinical value of ventilatory efficiency (V˙E/V˙CO2 ).
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Affiliation(s)
- Thomas Gille
- Université Sorbonne Paris Nord (USPN), INSERM, UMR 1272 Hypoxia & the Lung, UFR SMBH Léonard de Vinci, Bobigny, France .,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Paris-Seine-Saint-Denis (GHUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles du Département Médico-Universitaire NARVAL, Bobigny, France
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
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Tomlinson O, Duckworth A, Markham L, Wollerton R, Knight B, Spiers A, Gibbons M, Williams C, Scotton C. Feasibility of cardiopulmonary exercise testing in interstitial lung disease: the PETFIB study. BMJ Open Respir Res 2021; 8:8/1/e000793. [PMID: 33926958 PMCID: PMC8094359 DOI: 10.1136/bmjresp-2020-000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiopulmonary exercise testing (CPET) provides a series of biomarkers, such as peak oxygen uptake, which could assess the development of disease status in interstitial lung disease (ILD). However, despite use in research and clinical settings, the feasibility of CPET in this patient group has yet to be established. Methods Twenty-six patients with ILD (19 male) were recruited to this study. Following screening for contraindications to maximal exercise, participants underwent an incremental CPET to volitional exhaustion. Feasibility of CPET was assessed by the implementation, practicality, acceptability and demand, thus providing clinical-driven and patient-driven information on this testing procedure. Results Of the 26 recruited participants, 24 successfully completed at least one CPET, with 67/78 prospective tests being completed. Contraindications included hypertension, low resting oxygen saturation and recent pulmonary embolism. Of the CPETs undertaken, 63% successfully reached volitional exhaustion, with 31% being terminated early by clinicians due to excessive desaturation. Quantitative and qualitative feedback from participants revealed a positive experience of CPET and desire for it to be included as a future monitoring tool. Conclusion CPET is feasible in patients with ILD. Identification of common clinical contraindications, and understanding of patient perspectives will allow for effective design of future studies utilising CPET as a monitoring procedure.
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Affiliation(s)
- Owen Tomlinson
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Anna Duckworth
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Rebecca Wollerton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Bridget Knight
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Alexander Spiers
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Michael Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Craig Williams
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Scotton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK .,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
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Discriminating Between Non-Specific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis at Early Stages: When CPET is Enough? Lung 2020; 198:243-244. [DOI: 10.1007/s00408-019-00316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
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