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Kobayashi T, Kunihiro Y, Uehara T, Tanabe M, Ito K. Volume changes of diseased and normal areas in progressive fibrosing interstitial lung disease on inspiratory and expiratory computed tomography. Jpn J Radiol 2024; 42:832-840. [PMID: 38581478 PMCID: PMC11286720 DOI: 10.1007/s11604-024-01560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The diagnosis of progressive fibrosing interstitial lung disease (PF-ILD) using computed tomography (CT) is an important medical practice in respiratory care, and most imaging findings for this disease have been obtained with inspiratory CT. It is possible that some characteristic changes in respiration may be seen in normal and diseased lung in PF-ILD, which may lead to a new understanding of the pathogenesis of interstitial pneumonia, but it has never been examined. In this study, we collected and selected inspiratory and expiratory CT scans performed in pure PF-ILD cases, and evaluated the volumes of diseased and normal lung separately by manual detection and 3-dimensional volumetry to characterize the dynamic features of PF-ILD. MATERIALS AND METHODS Cases were collected retrospectively from a total of 753 inspiratory and expiratory CT scans performed at our hospital over a 3-year period. Sixteen cases of pure PF-ILD, excluding almost all other diseases, were included. We measured their diseased, normal, and the whole lung volumes manually and evaluated the correlation of their values and their relationship with respiratory function tests (FVC, FVC%-predicted, and DLCO%-predicted). RESULTS The relative expansion rate of the diseased lung is no less than that of the normal lung. The "Expansion volume of total lung" divided by the "Expansion volume of normal lung" was found to be significantly associated with DLCO%-predicted abnormalities (p = 0.0073). CONCLUSION The diseased lung in PF-ILD retained expansion capacity comparable to the normal lung, suggesting a negative impact on respiratory function.
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Affiliation(s)
- Taiga Kobayashi
- Department of Radiology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yoshie Kunihiro
- Department of Radiology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takuya Uehara
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
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2
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Zhao A, Gudmundsson E, Mogulkoc N, van Moorsel C, Corte TJ, Vasudev P, Romei C, Chapman R, Wallis TJ, Denneny E, Goos T, Savas R, Ahmed A, Brereton CJ, van Es HW, Jo H, De Liperi A, Duncan M, Pontoppidan K, De Sadeleer LJ, van Beek F, Barnett J, Cross G, Procter A, Veltkamp M, Hopkins P, Moodley Y, Taliani A, Taylor M, Verleden S, Tavanti L, Vermant M, Nair A, Stewart I, Janes SM, Young AL, Barber D, Alexander DC, Porter JC, Wells AU, Jones MG, Wuyts WA, Jacob J. Mortality surrogates in combined pulmonary fibrosis and emphysema. Eur Respir J 2024; 63:2300127. [PMID: 37973176 PMCID: PMC7616106 DOI: 10.1183/13993003.00127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) with coexistent emphysema, termed combined pulmonary fibrosis and emphysema (CPFE) may associate with reduced forced vital capacity (FVC) declines compared to non-CPFE IPF patients. We examined associations between mortality and functional measures of disease progression in two IPF cohorts. METHODS Visual emphysema presence (>0% emphysema) scored on computed tomography identified CPFE patients (CPFE/non-CPFE: derivation cohort n=317/n=183, replication cohort n=358/n=152), who were subgrouped using 10% or 15% visual emphysema thresholds, and an unsupervised machine-learning model considering emphysema and interstitial lung disease extents. Baseline characteristics, 1-year relative FVC and diffusing capacity of the lung for carbon monoxide (D LCO) decline (linear mixed-effects models), and their associations with mortality (multivariable Cox regression models) were compared across non-CPFE and CPFE subgroups. RESULTS In both IPF cohorts, CPFE patients with ≥10% emphysema had a greater smoking history and lower baseline D LCO compared to CPFE patients with <10% emphysema. Using multivariable Cox regression analyses in patients with ≥10% emphysema, 1-year D LCO decline showed stronger mortality associations than 1-year FVC decline. Results were maintained in patients suitable for therapeutic IPF trials and in subjects subgrouped by ≥15% emphysema and using unsupervised machine learning. Importantly, the unsupervised machine-learning approach identified CPFE patients in whom FVC decline did not associate strongly with mortality. In non-CPFE IPF patients, 1-year FVC declines ≥5% and ≥10% showed strong mortality associations. CONCLUSION When assessing disease progression in IPF, D LCO decline should be considered in patients with ≥10% emphysema and a ≥5% 1-year relative FVC decline threshold considered in non-CPFE IPF patients.
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Affiliation(s)
- An Zhao
- Satsuma Lab, Centre for Medical Image Computing, UCL, London,
UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Eyjolfur Gudmundsson
- Satsuma Lab, Centre for Medical Image Computing, UCL, London,
UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Nesrin Mogulkoc
- Department of Respiratory Medicine, Ege University Hospital,
Izmir, Turkey
| | - Coline van Moorsel
- Interstitial Lung Diseases Center of Excellence, Department of
Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Tamera J. Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital
and University of Sydney, Sydney, Australia
| | - Pardeep Vasudev
- Satsuma Lab, Centre for Medical Image Computing, UCL, London,
UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Chiara Romei
- Department of Radiology, Pisa University Hospital, Pisa,
Italy
| | - Robert Chapman
- Interstitial Lung Disease Service, Department of Respiratory
Medicine, University College London Hospitals NHS Foundation Trust, London,
UK
| | - Tim J.M. Wallis
- NIHR Southampton Biomedical Research Centre and Clinical and
Experimental Sciences, University of Southampton, Southampton, UK
| | - Emma Denneny
- Interstitial Lung Disease Service, Department of Respiratory
Medicine, University College London Hospitals NHS Foundation Trust, London,
UK
| | - Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU
Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals
Leuven, Leuven, Belgium
| | - Recep Savas
- Department of Radiology, Ege University Hospital, Izmir,
Turkey
| | - Asia Ahmed
- Department of Radiology, University College London Hospitals
NHS Foundation Trust, London, UK
| | - Christopher J. Brereton
- NIHR Southampton Biomedical Research Centre and Clinical and
Experimental Sciences, University of Southampton, Southampton, UK
| | - Hendrik W. van Es
- Interstitial Lung Diseases Center of Excellence, Department of
Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Helen Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital
and University of Sydney, Sydney, Australia
| | | | - Mark Duncan
- Department of Radiology, University College London Hospitals
NHS Foundation Trust, London, UK
| | - Katarina Pontoppidan
- NIHR Southampton Biomedical Research Centre and Clinical and
Experimental Sciences, University of Southampton, Southampton, UK
| | - Laurens J. De Sadeleer
- Department of Respiratory Diseases, University Hospitals
Leuven, Leuven, Belgium
- Institute of Lung Health and Immunity (LHI) / Comprehensive
Pneumology Center (CPC), Helmholtz Zentrum München, Munich, Germany
| | - Frouke van Beek
- Interstitial Lung Diseases Center of Excellence, Department of
Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Joseph Barnett
- Department of Radiology, Royal Free London NHS Foundation
Trust, London, UK
| | - Gary Cross
- Department of Radiology, Royal United Hospitals Bath NHS
Foundation Trust, Bath, UK
| | - Alex Procter
- Department of Radiology, University College London Hospitals
NHS Foundation Trust, London, UK
| | - Marcel Veltkamp
- Interstitial Lung Diseases Center of Excellence, Department of
Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands
- Division of Heart and Lungs, University Medical Center,
Utrecht, Netherlands
| | - Peter Hopkins
- Queensland Centre for Pulmonary Transplantation and Vascular
Disease, The Prince Charles Hospital, QLD, Australia
| | - Yuben Moodley
- School of Medicine & Pharmacology, University Western
Australia, WA, Australia
- Fiona Stanley Hospital, Perth, Australia
| | | | - Magali Taylor
- Department of Radiology, University College London Hospitals
NHS Foundation Trust, London, UK
| | - Stijn Verleden
- Antwerp Surgical Training, Anatomy and Research Centre
(ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp,
Edegem, Belgium
| | - Laura Tavanti
- Cardiovascular and Thoracic Department, Pisa University
Hospital, Pisa, Italy
| | - Marie Vermant
- BREATHE, Department of Chronic Diseases and Metabolism, KU
Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals
Leuven, Leuven, Belgium
| | - Arjun Nair
- Department of Radiology, University College London Hospitals
NHS Foundation Trust, London, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London,
London, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL, London, UK
| | - Alexandra L. Young
- Centre for Medical Image Computing, UCL, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology
and Neuroscience, King’s College London, London, UK
| | - David Barber
- Centre for Artificial Intelligence, UCL, London, UK
| | | | - Joanna C. Porter
- Interstitial Lung Disease Service, Department of Respiratory
Medicine, University College London Hospitals NHS Foundation Trust, London,
UK
| | - Athol U. Wells
- Department of Respiratory Medicine, Royal Brompton Hospital,
London, UK
- Imperial College London, London, UK
| | - Mark G. Jones
- NIHR Southampton Biomedical Research Centre and Clinical and
Experimental Sciences, University of Southampton, Southampton, UK
| | - Wim A. Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU
Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals
Leuven, Leuven, Belgium
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing, UCL, London,
UK
- Centre for Medical Image Computing, UCL, London, UK
- Lungs for Living Research Centre, UCL, London, UK
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Wells AU, Jacob J, Sverzellati N, Cross G, Barnett J, De Lauretis A, Antoniou K, Weycker D, Atwood M, Kirchgaessler KU, Cottin V. A formula for predicting emphysema extent in combined idiopathic pulmonary fibrosis and emphysema. Respir Res 2024; 25:33. [PMID: 38238788 PMCID: PMC10795205 DOI: 10.1186/s12931-023-02589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND No single pulmonary function test captures the functional effect of emphysema in idiopathic pulmonary fibrosis (IPF). Without experienced radiologists, other methods are needed to determine emphysema extent. Here, we report the development and validation of a formula to predict emphysema extent in patients with IPF and emphysema. METHODS The development cohort included 76 patients with combined IPF and emphysema at the Royal Brompton Hospital, London, United Kingdom. The formula was derived using stepwise regression to generate the weighted combination of pulmonary function data that fitted best with emphysema extent on high-resolution computed tomography. Test cohorts included patients from two clinical trials (n = 455 [n = 174 with emphysema]; NCT00047645, NCT00075998) and a real-world cohort from the Royal Brompton Hospital (n = 191 [n = 110 with emphysema]). The formula is only applicable for patients with IPF and concomitant emphysema and accordingly was not used to detect the presence or absence of emphysema. RESULTS The formula was: predicted emphysema extent = 12.67 + (0.92 x percent predicted forced vital capacity) - (0.65 x percent predicted forced expiratory volume in 1 second) - (0.52 x percent predicted carbon monoxide diffusing capacity). A significant relationship between the formula and observed emphysema extent was found in both cohorts (R2 = 0.25, P < 0.0001; R2 = 0.47, P < 0.0001, respectively). In both, the formula better predicted observed emphysema extent versus individual pulmonary function tests. A 15% emphysema extent threshold, calculated using the formula, identified a significant difference in absolute changes from baseline in forced vital capacity at Week 48 in patients with baseline-predicted emphysema extent < 15% versus ≥ 15% (P = 0.0105). CONCLUSION The formula, designed for use in patients with IPF and emphysema, demonstrated enhanced ability to predict emphysema extent versus individual pulmonary function tests. TRIAL REGISTRATION NCT00047645; NCT00075998.
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Affiliation(s)
- Athol U Wells
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University Hospital Parma, Parma, Italy
| | | | | | - Angelo De Lauretis
- Department of Respiratory Medicine, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Katerina Antoniou
- Interstitial Lung Disease Unit, Department of Thoracic Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Mark Atwood
- Policy Analysis Inc. (PAI), Brookline, MA, USA
| | | | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Chen X, Ji Q, Yao Q, Zhou Y. Factors associated with rapid progression in fibrotic interstitial lung disease. Heliyon 2023; 9:e22565. [PMID: 38046148 PMCID: PMC10686856 DOI: 10.1016/j.heliyon.2023.e22565] [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: 07/26/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Background Early identification of fibrotic interstitial lung disease (F-ILD) patients with high risk of progression will help initiate early therapeutic intervention and potential improvement of outcomes. This study was designed to assess the predictors of progression in patients with F-ILD. Methods Patients with F-ILD in Shanghai Pulmonary Hospital between January 1, 2019 and July 31, 2021 were retrospectively analyzed. The patients enrolled were divided into progressive group and non-progressive group according to the specified criteria. Baseline characteristics were collected and a multivariate regression was conducted to identify independent predictors of progression. Results Of the 177 F-ILD cases, 87 were enrolled in the progressive group and 90 were in the non-progressive group. The cohort included 11 types of F-ILD, primarily were connective tissue disease-associated interstitial lung disease (CTD-ILD) (43, 24.3 %), idiopathic pulmonary fibrosis (IPF) (39, 22.0 %), interstitial pneumonia with autoimmune features (IPAF) (32, 18.1 %), and unclassifiable (23, 13.0 %). The highest proportion of progression was seen in nonspecific interstitial pneumonia (NSIP) subgroup (66.7 %), followed by IPF (59.0 %) and HP (57.1 %). After adjusting for gender and age, a course of disease longer than 9.5 months (OR: 2.633; 95 % CI: 1.190-5.826, P = 0.017), lymphocyte in peripheral blood more than 2.24 (109/L) (OR: 2.670; 95 % CI: 1.095-6.510, P = 0.031), and emphysema in high-resolution computed tomography (HRCT) (OR: 2.387; 95 % CI: 1.017-5.640, P = 0.046) were independent predictors of progression in F-ILD patients. Conclusions This study suggested that in patients with F-ILD, long course of disease, elevated blood lymphocyte and emphysema on HRCT were independent predictors of progression, which may suggest utility in early therapeutic intervention.
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Affiliation(s)
- Xianqiu Chen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiuliang Ji
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Yao
- Department of Respiratory Medicine and Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Respiratory Medicine and Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Mandal M, Popek R, Przybysz A, Roy A, Das S, Sarkar A. Breathing Fresh Air in the City: Implementing Avenue Trees as a Sustainable Solution to Reduce Particulate Pollution in Urban Agglomerations. PLANTS (BASEL, SWITZERLAND) 2023; 12:1545. [PMID: 37050171 PMCID: PMC10097214 DOI: 10.3390/plants12071545] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
The issue of air pollution from particulate matter (PM) is getting worse as more and more people move into urban areas around the globe. Due to the complexity and diversity of pollution sources, it has long been hard to rely on source control techniques to manage this issue. Due to the fact that urban trees may provide a variety of ecosystem services, there is an urgent need to investigate alternative strategies for dramatically improving air quality. PM has always been a significant concern due to its adverse effects on humans and the entire ecosystem. The severity of this issue has risen in the current global environmental context. Numerous studies on respiratory and other human disorders have revealed a statistical relationship between human exposure to outdoor levels of particles or dust and harmful health effects. These risks are undeniably close to industrial areas where these airborne, inhalable particles are produced. The combined and individual effects of the particle and gaseous contaminants on plants' general physiology can be detrimental. According to research, plant leaves, the primary receptors of PM pollution, can function as biological filters to remove significant amounts of particles from the atmosphere of urban areas. This study showed that vegetation could provide a promising green infrastructure (GI) for better air quality through the canopy and leaf-level processes, going beyond its traditional role as a passive target and sink for air pollutants. Opportunities exist for urban GI as a natural remedy for urban pollution caused by PMs.
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Affiliation(s)
- Mamun Mandal
- Laboratory of Applied Stress Biology, Department of Botany, University of Gour Banga, Malda 732103, West Bengal, India
| | - Robert Popek
- Section of Basic Research in Horticulture, Department of Plant Protection, Institute of Horticultural Sciences, Warsaw University of Life Sciences-SGGW (WULS-SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland
| | - Arkadiusz Przybysz
- Section of Basic Research in Horticulture, Department of Plant Protection, Institute of Horticultural Sciences, Warsaw University of Life Sciences-SGGW (WULS-SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland
| | - Anamika Roy
- Laboratory of Applied Stress Biology, Department of Botany, University of Gour Banga, Malda 732103, West Bengal, India
| | - Sujit Das
- Laboratory of Applied Stress Biology, Department of Botany, University of Gour Banga, Malda 732103, West Bengal, India
| | - Abhijit Sarkar
- Laboratory of Applied Stress Biology, Department of Botany, University of Gour Banga, Malda 732103, West Bengal, India
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Bonnemaison B, Castagna O, de Maistre S, Blatteau JÉ. Chest CT scan for the screening of air anomalies at risk of pulmonary barotrauma for the initial medical assessment of fitness to dive in a military population. Front Physiol 2022; 13:1005698. [PMID: 36277200 PMCID: PMC9585318 DOI: 10.3389/fphys.2022.1005698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: The presence of intra-pulmonary air lesions such as cysts, blebs and emphysema bullae, predisposes to pulmonary barotrauma during pressure variations, especially during underwater diving activities. These rare accidents can have dramatic consequences. Chest radiography has long been the baseline examination for the detection of respiratory pathologies in occupational medicine. It has been replaced since 2018 by the thoracic CT scan for military diving fitness in France. The objective of this work was to evaluate the prevalence of the pulmonary abnormalities of the thoracic CT scan, and to relate them to the characteristics of this population and the results of the spirometry. Methods: 330 records of military diving candidates who underwent an initial assessment between October 2018 and March 2021 were analyzed, in a single-center retrospective analysis. The following data were collected: sex, age, BMI, history of respiratory pathologies and smoking, treatments, allergies, diving practice, results of spirometry, reports of thoracic CT scans, as well as fitness decision. Results: The study included 307 candidates, mostly male, with a median age of 25 years. 19% of the subjects had abnormal spirometry. We identified 25% of divers with CT scan abnormalities. 76% of the abnormal scans were benign nodules, 26% of which measured 6 mm or more. Abnormalities with an aerial component accounted for 13% of the abnormal scans with six emphysema bullae, three bronchial dilatations and one cystic lesion. No association was found between the presence of nodules and the general characteristics of the population, whereas in six subjects emphysema bullae were found statistically associated with active smoking or abnormal spirometry results. Conclusion: The systematic performance of thoracic CT scan in a young population free of pulmonary pathology revealed a majority of benign nodules. Abnormalities with an aerial component are much less frequent, but their presence generally leads to a decision of unfitness. These results argue in favor of a systematic screening of aeric pleuro-pulmonary lesions during the initial assessment for professional divers.
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Affiliation(s)
- Brieuc Bonnemaison
- Service de Médecine Hyperbare et d’Expertise Plongée (SMHEP), Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - Olivier Castagna
- Equipe de Recherche Subaquatique et Hyperbare, Institut de Recherche biomédicale des armées, Toulon, France
- Laboratoire Motricité Humaine Expertise Sport Santé, UPR 6312, Nice, France
| | - Sébastien de Maistre
- Cellule plongée humaine et Intervention sous la Mer (CEPHISMER), Force d’action navale, Toulon, France
| | - Jean-Éric Blatteau
- Service de Médecine Hyperbare et d’Expertise Plongée (SMHEP), Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
- *Correspondence: Jean-Éric Blatteau,
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7
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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8
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Li C, Wang Y, Liu Q, Zhang H, Xu F, Gao Z, Wang X, Tao G, Chen Y, Rong W, Yu H, Li F. Clinical, radiologic and physiologic features of idiopathic pulmonary fibrosis (IPF) with and without emphysema. Expert Rev Respir Med 2022; 16:813-821. [PMID: 35731004 DOI: 10.1080/17476348.2022.2093717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) can combine with emphysema, a condition termed as IPF with emphysema (IPFE). We compared the clinical, radiologic and physiologic features of IPF and IPFE. RESEARCH DESIGN AND METHODS Newly diagnosed IPF (n=57) and IPFE (n=44) were recruited between January 2018 and September 2020. Symptoms, high resolution computed tomography (HRCT), pulmonary function test (PFT) data, composite physiologic index (CPI), gender-age-physiology (GAP) scores, and follow-up data were obtained. RESULTS The IPFE group had greater proportion of male smoking subjects, and of lung cancer cases. The IPFE group had higher VC, FVC FEV1, and lower FEV1/FVC and DLCO and lower percent fibrosis on HRCT. Both groups had similar symptoms and mortality. Mortality rate was associated with inability to perform PFT, CPI, GAP scores, percent fibrosis, VC, FVC, FEV1 and DLCO, serum SCC-Ag and CA125, and anti-fibrotic therapy (≥12months) in IPF, while it was associated with inability to perform PFT, CPI, percent fibrosis, DLCO, serum CEA, CYFRA21-1 and CA125, and anti-fibrotic therapy (≥12months) in IPFE. CONCLUSION IPF and IPFE patients are different in smoking history, physiologic indices, HRCT patterns and prognostic factors, however, they have similar mortality. Anti-fibrotic therapy could improve the survival rate in both IPF and IPFE.
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Affiliation(s)
- Chenfei Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China.,Department of Respiratory Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, 750011, P.R.China
| | - Qi Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Fei Xu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China.,Department of Internal Medicine, Shanghai Electric Power Hospital, 937 West Yan'an Road, Shanghai, 200050, P.R.China
| | - Zhenyun Gao
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China.,Department of Respiratory Medicine, Nanjing Lishui people's Hospital, Lishui, Nanjing, Jiangsu, 211200, P.R.China
| | - Xiaohui Wang
- Department of Pharmacy, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Guangyu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Yuqing Chen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Wenwen Rong
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China
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Pedraza-Serrano F, Jiménez-García R, López-de-Andrés A, Hernández-Barrera V, Sánchez-Muñoz G, Puente-Maestu L, de-Miguel-Díez J. Characteristics and outcomes of patients hospitalized with interstitial lung diseases in Spain, 2014 to 2015. Medicine (Baltimore) 2019; 98:e15779. [PMID: 31124970 PMCID: PMC6571208 DOI: 10.1097/md.0000000000015779] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To assess characteristics and outcomes of patients hospitalized with interstitial lung diseases (ILD) and to analyze patient's comorbidities, procedures, and in-hospital outcomes.We identified patients hospitalized with idiopathic pulmonary fibrosis and others ILD such as hypersensitivity pneumonitis, cryptogenic organizing pneumonia, lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, and sarcoidosis in Spain during 2014 and 2015.We identified 14,565 discharges among patients admitted for ILD in Spain during the study period: idiopathic pulmonary fibrosis (IPF) in 42.32% (n = 6164), sarcoidosis in 37.65% (n = 5484), hypersensitivity pneumonitis in 10.55% (n = 1538), cryptogenic organizing pneumonia in 7.06% (n = 1028), pulmonary Langerhans cell histiocytosis in 1.48% (n = 215), and lymphangioleiomyomatosis in 0.94% (n = 136). The most common associated comorbidities according to those included in the Charlson Comorbidity Index (CCI) were COPD, diabetes, and congestive heart disease. The presence of pulmonary hypertension increased the probability of dying in patients with idiopathic pulmonary fibrosis (OR 1.36; 95%CI 1.06-1.73). Patients with cryptogenic organizing pneumonia had the longest length of hospital stay and the highest percentage of hospital readmissions (23.64%). The highest IHM corresponded to the idiopathic pulmonary fibrosis (14.94%). Computed tomography of the chest was the procedure more used during admissions for ILD.IPF was responsible for larger percentage of hospital admission among ILD in our study. In addition, the IHM were higher in IPF patients in comparison with those with other ILD. The most common associated comorbidity in ILD according to those included in the CCI was COPD. Computed tomography of the chest was the procedure more frequently used.
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Affiliation(s)
- Fernando Pedraza-Serrano
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gema Sánchez-Muñoz
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Javier de-Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
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10
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Nakagawa H, Ogawa E, Fukunaga K, Kinose D, Yamaguchi M, Nagao T, Tanaka-Mizuno S, Nakano Y. Quantitative CT analysis of honeycombing area predicts mortality in idiopathic pulmonary fibrosis with definite usual interstitial pneumonia pattern: A retrospective cohort study. PLoS One 2019; 14:e0214278. [PMID: 30897161 PMCID: PMC6428407 DOI: 10.1371/journal.pone.0214278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/11/2019] [Indexed: 12/31/2022] Open
Abstract
Background Honeycombing on high-resolution computed tomography (HRCT) images is a key finding in idiopathic pulmonary fibrosis (IPF). In IPF, honeycombing area determined by quantitative CT analysis is correlated with pulmonary function test findings. We hypothesized that quantitative CT-derived honeycombing area (HA) might predict mortality in patients with IPF. Materials and methods Chest HRCT images of 52 IPF patients with definite usual interstitial pneumonia (UIP) pattern were retrospectively evaluated. Mortality data up to July 31, 2016, were recorded. Using a computer-aided system, HA and percentage of HA (%HA) were measured quantitatively. Predictors of 3-year mortality were evaluated using logistic regression models. Results The median %HA, %predicted forced vital capacity (FVC) and composite physiologic index (CPI) were 3.8%, 83.6%, and 33.6, respectively. According to GAP (gender, age, and physiology) stage, 20, 14, and 5 patients were classified under stages I-II-III, respectively. Percentage of HA was significantly correlated with %FVC, CPI, and GAP stage (all, p < 0.001). In univariate analysis, %HA, %FVC, and CPI were statistically significant predictors of mortality. In multivariate analysis using the stepwise regression method, only %HA (odds ratio [OR], 1.27; p = 0.011) was a significant independent predictors of mortality. Patients with %HA ≥ 4.8% had significantly lower survival rates than those with lesser %HA (median survival time, 1.3 vs 5.0 years; log-rank test; p < 0.001). Conclusion Quantitative CT-derived HA might be an important and independent predictor of mortality in IPF patients with definite UIP pattern.
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Affiliation(s)
- Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Emiko Ogawa
- Health Administration Center, Shiga University of Medical Science, Shiga, Japan
| | - Kentaro Fukunaga
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Daisuke Kinose
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Masafumi Yamaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Taishi Nagao
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | | | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
- * E-mail:
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11
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Mendes MA, Guimarães M, Neves S, Campainha S. Combined Pulmonary Fibrosis and Emphysema Versus Idiopathic Pulmonary Fibrosis Versus Emphysema: A Clinical Perspective. Arch Bronconeumol 2018; 55:269-270. [PMID: 30190225 DOI: 10.1016/j.arbres.2018.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/05/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Maria Aurora Mendes
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
| | - Miguel Guimarães
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Sofia Neves
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Sérgio Campainha
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
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12
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Karampitsakos T, Tzouvelekis A, Chrysikos S, Bouros D, Tsangaris I, Fares WH. Pulmonary hypertension in patients with interstitial lung disease. Pulm Pharmacol Ther 2018; 50:38-46. [PMID: 29605286 DOI: 10.1016/j.pupt.2018.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 01/20/2023]
Abstract
Interstitial lung diseases (ILDs) comprise a broad and heterogeneous group of more than two hundred diseases with common functional characteristics. Their diagnosis and management require a multidisciplinary approach. This multidisciplinary approach involves the assessment of comorbid conditions including pulmonary hypertension (PH) that exerts a dramatic impact on survival. The current World Health Organization (WHO) classification of PH encompasses many of the interstitial lung diseases into WHO Group 3, while sarcoidosis, Pulmonary Langerhans Cell Histiocytosis and lymphangioleiomyomatosis are placed into WHO Group 5 as diseases with unclear or multifactorial mechanisms. Connective tissue diseases could span any of the 5 WHO groups based on the primary phenotype into which they manifest. Interestingly, several challenging phenotypes present with features that overlap between two or more WHO PH groups. Currently, PH-specific treatment is recommended only for patients classified into WHO Group 1 PH. The lack of specific treatment for other groups, including PH in the setting of ILD, reflects the poor outcomes of these patients. Thus, identification of the optimal strategy for ILD patients with PH remains an amenable need. This review article provides a brief overview of biomarkers indicative of vascular remodeling in interstitial lung disease, summarizes the current state of knowledge regarding patients with PH and ILD and highlights future perspectives that remain to be addressed.
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Affiliation(s)
| | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece; Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Serafeim Chrysikos
- 5(th) Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Tsangaris
- Second Critical Care Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Wassim H Fares
- Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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13
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Prevalence and Effects of Emphysema in Never-Smokers with Rheumatoid Arthritis Interstitial Lung Disease. EBioMedicine 2018; 28:303-310. [PMID: 29422289 PMCID: PMC5835571 DOI: 10.1016/j.ebiom.2018.01.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 01/16/2023] Open
Abstract
AIMS Autoimmune conditions such as rheumatoid arthritis-related interstitial lung disease (RA-ILD) have been linked to the existence of emphysema in never-smokers. We aimed to quantify emphysema prevalence in RA-ILD never-smokers and investigate whether combined pulmonary fibrosis and emphysema (CPFE) results in a worsened prognosis independent of baseline disease extent. METHODS RA-ILD patients presenting to the Royal Brompton Hospital (n=90) and Asan Medical Center (n=155) had CT's evaluated for a definite usual interstitial pneumonia (UIP) pattern, and visual extents of emphysema and ILD. RESULTS Emphysema, identified in 31/116 (27%) RA-ILD never-smokers, was associated with obstructive functional indices and conformed to a CPFE phenotype: disproportionate reduction in gas transfer (DLco), relative preservation of lung volumes. Using multivariate logistic regression, adjusted for patient age, gender and ILD extent, emphysema presence independently associated with a CT-UIP pattern in never-smokers (0.009) and smokers (0.02). On multivariate Cox analysis, following adjustment for patient age, gender, DLco, and a CT-UIP pattern, emphysema presence (representing the CPFE phenotype) independently associated with mortality in never-smokers (p=0.04) and smokers (p<0.05). CONCLUSION 27% of RA-ILD never-smokers demonstrate emphysema on CT. Emphysema presence in never-smokers independently associates with a definite CT-UIP pattern and a worsened outcome following adjustment for baseline disease severity.
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14
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Plantier L, Cazes A, Dinh-Xuan AT, Bancal C, Marchand-Adam S, Crestani B. Physiology of the lung in idiopathic pulmonary fibrosis. Eur Respir Rev 2018; 27:27/147/170062. [PMID: 29367408 PMCID: PMC9489199 DOI: 10.1183/16000617.0062-2017] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022] Open
Abstract
The clinical expression of idiopathic pulmonary fibrosis (IPF) is directly related to multiple alterations in lung function. These alterations derive from a complex disease process affecting all compartments of the lower respiratory system, from the conducting airways to the lung vasculature. In this article we review the profound alterations in lung mechanics (reduced lung compliance and lung volumes), pulmonary gas exchange (reduced diffusing capacity, increased dead space ventilation, chronic arterial hypoxaemia) and airway physiology (increased cough reflex and increased airway volume), as well as pulmonary haemodynamics related to IPF. The relative contribution of these alterations to exertional limitation and dyspnoea in IPF is discussed. Physiological impairment in IPF is complex and involves all compartments of the respiratory systemhttp://ow.ly/gyao30hdHUb
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15
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Cottin V, Hansell DM, Sverzellati N, Weycker D, Antoniou KM, Atwood M, Oster G, Kirchgaessler KU, Collard HR, Wells AU. Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2017; 196:1162-1171. [PMID: 28657784 DOI: 10.1164/rccm.201612-2492oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
RATIONALE Patients with idiopathic pulmonary fibrosis and emphysema may have artificially preserved lung volumes. OBJECTIVES In this post hoc analysis, we investigated the relationship between baseline emphysema and fibrosis extents, as well as pulmonary function changes, over 48 weeks. METHODS Data were pooled from two phase III, randomized, double-blind, placebo-controlled trials of IFN-γ-1b in idiopathic pulmonary fibrosis (GIPF-001 [NCT00047645] and GIPF-007 [NCT00075998]). Patients with Week 48 data, baseline high-resolution computed tomographic images, and FEV1/FVC ratios less than 0.8 or greater than 0.9 (<0.7 or >0.9 in GIPF-007), as well as randomly selected patients with ratios of 0.8-0.9 and 0.7-0.8, were included. Changes from baseline in pulmonary function at Week 48 were analyzed by emphysema extent. The relationship between emphysema and fibrosis extents and change in pulmonary function was assessed using multivariate linear regression. MEASUREMENTS AND MAIN RESULTS Emphysema was identified in 38% of patients. A negative correlation was observed between fibrosis and emphysema extents (r = -0.232; P < 0.001). In quartile analysis, patients with the greatest emphysema extent (28 to 65%) showed the smallest FVC decline, with a difference of 3.32% at Week 48 versus patients with no emphysema (P = 0.047). In multivariate analyses, emphysema extent greater than or equal to 15% was associated with significantly reduced FVC decline over 48 weeks versus no emphysema or emphysema less than 15%. No such association was observed for diffusing capacity of the lung for carbon monoxide or composite physiologic index. CONCLUSIONS FVC measurements may not be appropriate for monitoring disease progression in patients with idiopathic pulmonary fibrosis and emphysema extent greater than or equal to 15%.
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Affiliation(s)
- Vincent Cottin
- 1 Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Lyon, France.,2 Université Claude Bernard, Lyon, France
| | - David M Hansell
- 3 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
| | - Nicola Sverzellati
- 4 Department of Surgical Sciences, Ospedale Maggiore di Parma, Parma, Italy
| | | | | | - Mark Atwood
- 5 Policy Analysis Inc., Brookline, Massachusetts
| | - Gerry Oster
- 5 Policy Analysis Inc., Brookline, Massachusetts
| | | | - Harold R Collard
- 8 Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Athol U Wells
- 3 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
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16
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Behr J. Disease Progression in Idiopathic Pulmonary Fibrosis. FVC Is Not Enough. Am J Respir Crit Care Med 2017; 196:1094-1095. [DOI: 10.1164/rccm.201706-1246ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jürgen Behr
- Klinikum der LMU, MünchenAsklepios Fachkliniken München-Gauting, Member of the German Center for Lung ResearchMunich, Germany
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17
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Jacob J, Bartholmai BJ, Rajagopalan S, Kokosi M, Maher TM, Nair A, Karwoski R, Renzoni E, Walsh SLF, Hansell DM, Wells AU. Functional and prognostic effects when emphysema complicates idiopathic pulmonary fibrosis. Eur Respir J 2017; 50:50/1/1700379. [PMID: 28679612 DOI: 10.1183/13993003.00379-2017] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/26/2017] [Indexed: 11/05/2022]
Abstract
This study aimed to investigate whether the combination of fibrosis and emphysema has a greater effect than the sum of its parts on functional indices and outcome in idiopathic pulmonary fibrosis (IPF), using visual and computer-based (CALIPER) computed tomography (CT) analysis.Consecutive patients (n=272) with a multidisciplinary IPF diagnosis had the extent of interstitial lung disease (ILD) scored visually and by CALIPER. Visually scored emphysema was subcategorised as isolated or mixed with fibrotic lung. The CT scores were evaluated against functional indices forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO), transfer coefficient of the lung for carbon monoxide (KCO), composite physiologic index (CPI)) and mortality.The presence and extent of emphysema had no impact on survival. Results were maintained following correction for age, gender, smoking status and baseline severity using DLCO, and combined visual emphysema and ILD extent. Visual emphysema quantitation indicated that relative preservation of lung volumes (FVC) resulted from tractionally dilated airways within fibrotic lung, ventilating areas of admixed emphysema (p<0.0001), with no independent effect on FVC from isolated emphysema. Conversely, only isolated emphysema (p<0.0001) reduced gas transfer (DLCO).There is no prognostic impact of emphysema in IPF, beyond that explained by the additive extents of both fibrosis and emphysema. With respect to the location of pulmonary fibrosis, emphysema distribution determines the functional effects of emphysema.
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Affiliation(s)
- Joseph Jacob
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Srinivasan Rajagopalan
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Arjun Nair
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ronald Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Simon L F Walsh
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David M Hansell
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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18
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Jacob J, Bartholmai BJ, Rajagopalan S, Kokosi M, Nair A, Karwoski R, Walsh SL, Wells AU, Hansell DM. Mortality prediction in idiopathic pulmonary fibrosis: evaluation of computer-based CT analysis with conventional severity measures. Eur Respir J 2016; 49:13993003.01011-2016. [DOI: 10.1183/13993003.01011-2016] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/07/2016] [Indexed: 01/04/2023]
Abstract
Computer-based computed tomography (CT) analysis can provide objective quantitation of disease in idiopathic pulmonary fibrosis (IPF). A computer algorithm, CALIPER, was compared with conventional CT and pulmonary function measures of disease severity for mortality prediction.CT and pulmonary function variables (forced expiratory volume in 1 s, forced vital capacity, diffusion capacity of the lung for carbon monoxide, transfer coefficient of the lung for carbon monoxide and composite physiologic index (CPI)) of 283 consecutive patients with a multidisciplinary diagnosis of IPF were evaluated against mortality. Visual and CALIPER CT features included total extent of interstitial lung disease, honeycombing, reticular pattern, ground glass opacities and emphysema. In addition, CALIPER scored pulmonary vessel volume (PVV) while traction bronchiectasis and consolidation were only scored visually. A combination of mortality predictors was compared with the Gender, Age, Physiology model.On univariate analyses, all visual and CALIPER-derived interstitial features and functional indices were predictive of mortality to a 0.01 level of significance. On multivariate analysis, visual CT parameters were discarded. Independent predictors of mortality were CPI (hazard ratio (95% CI) 1.05 (1.02–1.07), p<0.001) and two CALIPER parameters: PVV (1.23 (1.08–1.40), p=0.001) and honeycombing (1.18 (1.06–1.32), p=0.002). A three-group staging system derived from this model was powerfully predictive of mortality (2.23 (1.85–2.69), p<0.0001).CALIPER-derived parameters, in particular PVV, are more accurate prognostically than traditional visual CT scores. Quantitative tools such as CALIPER have the potential to improve staging systems in IPF.
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Kohashi Y, Arai T, Sugimoto C, Tachibana K, Akira M, Kitaichi M, Hayashi S, Inoue Y. Clinical Impact of Emphysema Evaluated by High-Resolution Computed Tomography on Idiopathic Pulmonary Fibrosis Diagnosed by Surgical Lung Biopsy. Respiration 2016; 92:220-228. [PMID: 27576553 DOI: 10.1159/000448118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prognosis of combined cases of pulmonary fibrosis and emphysema is unresolved partially because radiological differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia is difficult in coexisting emphysema cases. OBJECTIVE The purpose of this study was to clarify the clinical impact of emphysema on the survival of patients with idiopathic pulmonary fibrosis (IPF). METHODS One hundred and seven patients with interstitial lung diseases were diagnosed by surgical lung biopsies between 2006 and 2012, and 47 patients were diagnosed with IPF through multidisciplinary discussion. Emphysema on high-resolution computed tomography scans was evaluated semiquantitatively by visual scoring. RESULTS Eight out of the 47 IPF patients showed a higher emphysema score (>3) and were diagnosed to have IPF-emphysema. The median survival time of patients with IPF-emphysema (1,734 days) from the initial diagnosis was significantly shorter than that of patients with IPF alone (2,229 days) by Kaplan-Meier analysis (p = 0.007, log-rank test). Univariate Cox proportional hazard regression analyses revealed that a higher total emphysema score (>3.0) was a significantly poor prognostic factor in addition to Krebs von den Lungen-6, surfactant protein-D, arterial oxygen tension, percent forced vital capacity, and percent diffusing capacity of carbon monoxide (%DLCO). Multivariate Cox proportional hazard regression analyses with the stepwise method showed that higher total emphysema score (>3) and %DLCO were significantly poor prognostic factors. CONCLUSIONS The prognosis of IPF-emphysema was significantly worse than that of IPF alone.
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Affiliation(s)
- Yasuo Kohashi
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan
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Papaioannou AI, Kostikas K, Manali ED, Papadaki G, Roussou A, Kolilekas L, Borie R, Bouros D, Papiris SA. Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract. Respir Med 2016; 117:14-26. [PMID: 27492509 DOI: 10.1016/j.rmed.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/20/2016] [Accepted: 05/05/2016] [Indexed: 12/12/2022]
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. Patients with this condition experience severe dyspnea and impaired gas exchange with preserved lung volumes. The diagnosis of the CPFE syndrome is based on HRCT imaging, showing the coexistence of emphysema and pulmonary fibrosis both in varying extent and locations within the lung parenchyma. Individual genetic background seem to predispose to the development of the disease. The risk of the development of pulmonary hypertension in patients with CPFE is high and related to poor prognosis. CPFE patients also present a high risk of lung cancer. Mortality is significant in patients with CPFE and median survival is reported between 2.1 and 8.5 years. Currently, no specific recommendations are available regarding the management of patients with CPFE. In this review we provide information on the existing knowledge on CPFE regarding the pathophysiology, clinical manifestations, imaging, complications, possible therapeutic interventions and prognosis of the disease.
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Affiliation(s)
- Andriana I Papaioannou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Konstantinos Kostikas
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Effrosyni D Manali
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Georgia Papadaki
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Aneza Roussou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Likurgos Kolilekas
- 7th Department of Pneumonology, "Sotiria" Chest Diseases Hospital, Athens, Greece.
| | - Raphaël Borie
- APHP, Hôpital Bichat, DHU FIRE Service de Pneumologie A, Centre de compétence des maladies pulmonaires rares, INSERM, Unité 1152, Université Paris Diderot, Paris, France.
| | - Demosthenis Bouros
- 1st Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Medical School, National and Kapodistrian University of Athens, Greece.
| | - Spyridon A Papiris
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
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Ciccarese F, Attinà D, Zompatori M. Combined pulmonary fibrosis and emphysema (CPFE): what radiologist should know. Radiol Med 2016; 121:564-72. [PMID: 26892068 DOI: 10.1007/s11547-016-0627-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Abstract
Combined pulmonary fibrosis and emphysema is a relatively newly defined entity, which has been deeply studied in the recent years. Despite the wide numbers of papers on this topic, there are still several open questions about pathogenesis, epidemiology, natural history and prognosis. The diagnosis could be assessed only after HRCT scan as functional tests often result in an underestimation of this syndrome. What radiologists need to know about this syndrome consists in the heterogeneity of appearances: emphysema is mainly paraseptal and fibrotic pattern could be variable, including the variant of airspace enlargement with fibrosis which needs to be differentiated from honeycombing. A special attention must be paid on complications which could worsen the prognosis, such as pulmonary hypertension and lung cancer. Further studies are needed to address if the type of fibrotic pattern as well as fibrosis CT index could be considered as prognostic factors. Thus, the role of radiologists in the management of these patients is crucial as it involves diagnosis, detection of complications and could possible concerns the identification of patients at higher risk.
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Affiliation(s)
- Federica Ciccarese
- Radiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Malpighi University Hospital, Via Massarenti 9, 40100, Bologna, Italy.
| | - Domenico Attinà
- Radiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Malpighi University Hospital, Via Massarenti 9, 40100, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Malpighi University Hospital, Via Massarenti 9, 40100, Bologna, Italy
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Falcon-Rodriguez CI, Osornio-Vargas AR, Sada-Ovalle I, Segura-Medina P. Aeroparticles, Composition, and Lung Diseases. Front Immunol 2016; 7:3. [PMID: 26834745 PMCID: PMC4719080 DOI: 10.3389/fimmu.2016.00003] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/05/2016] [Indexed: 12/15/2022] Open
Abstract
Urban air pollution is a serious worldwide problem due to its impact on human health. In the past 60 years, growing evidence established a correlation between exposure to air pollutants and the developing of severe respiratory diseases. Recently particulate matter (PM) is drawing more public attention to various aspects including historical backgrounds, physicochemical characteristics, and its pathological role. Therefore, this review is focused on these aspects. The most famous air pollution disaster happened in London on December 1952; it has been calculated that more than 4,000 deaths occurred during this event. Air pollution is a complex mix of gases and particles. Gaseous pollutants disseminate deeply into the alveoli, allowing its diffusion through the blood–air barrier to several organs. Meanwhile, PM is a mix of solid or liquid particles suspended in the air. PM is deposited at different levels of the respiratory tract, depending on its size: coarse particles (PM10) in upper airways and fine particles (PM2.5) can be accumulated in the lung parenchyma, inducing several respiratory diseases. Additionally to size, the composition of PM has been associated with different toxicological outcomes on clinical and epidemiological, as well as in vivo and in vitro animal and human studies. PM can be constituted by organic, inorganic, and biological compounds. All these compounds are capable of modifying several biological activities, including alterations in cytokine production, coagulation factors balance, pulmonary function, respiratory symptoms, and cardiac function. It can also generate different modifications during its passage through the airways, like inflammatory cells recruitment, with the release of cytokines and reactive oxygen species (ROS). These inflammatory mediators can activate different pathways, such as MAP kinases, NF-κB, and Stat-1, or induce DNA adducts. All these alterations can mediate obstructive or restrictive respiratory diseases like asthma, COPD, pulmonary fibrosis, and even cancer. In 2013, outdoor air pollution was classified as Group 1 by IARC based on all research studies data about air pollution effects. Therefore, it is important to understand how PM composition can generate several pulmonary pathologies.
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Affiliation(s)
- Carlos I Falcon-Rodriguez
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City, Mexico; Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Isabel Sada-Ovalle
- Laboratorio de Inmunologia Integrativa, Instituto Nacional de Enfermedades Respiratorias , Mexico City , Mexico
| | - Patricia Segura-Medina
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias , Mexico City , Mexico
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Nakagawa H, Nagatani Y, Takahashi M, Ogawa E, Tho NV, Ryujin Y, Nagao T, Nakano Y. Quantitative CT analysis of honeycombing area in idiopathic pulmonary fibrosis: Correlations with pulmonary function tests. Eur J Radiol 2015; 85:125-130. [PMID: 26724656 DOI: 10.1016/j.ejrad.2015.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/24/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The 2011 official statement of idiopathic pulmonary fibrosis (IPF) mentions that the extent of honeycombing and the worsening of fibrosis on high-resolution computed tomography (HRCT) in IPF are associated with the increased risk of mortality. However, there are few reports about the quantitative computed tomography (CT) analysis of honeycombing area. In this study, we first proposed a computer-aided method for quantitative CT analysis of honeycombing area in patients with IPF. We then evaluated the correlations between honeycombing area measured by the proposed method with that estimated by radiologists or with parameters of PFTs. MATERIALS AND METHODS Chest HRCTs and pulmonary function tests (PFTs) of 36 IPF patients, who were diagnosed using HRCT alone, were retrospectively evaluated. Two thoracic radiologists independently estimated the honeycombing area as Identified Area (IA) and the percentage of honeycombing area to total lung area as Percent Area (PA) on 3 axial CT slices for each patient. We also developed a computer-aided method to measure the honeycombing area on CT images of those patients. The total honeycombing area as CT honeycombing area (HA) and the percentage of honeycombing area to total lung area as CT %honeycombing area (%HA) were derived from the computer-aided method for each patient. RESULTS HA derived from three CT slices was significantly correlated with IA (ρ=0.65 for Radiologist 1 and ρ=0.68 for Radiologist 2). %HA derived from three CT slices was also significantly correlated with PA (ρ=0.68 for Radiologist 1 and ρ=0.70 for Radiologist 2). HA and %HA derived from all CT slices were significantly correlated with FVC (%pred.), DLCO (%pred.), and the composite physiologic index (CPI) (HA: ρ=-0.43, ρ=-0.56, ρ=0.63 and %HA: ρ=-0.60, ρ=-0.49, ρ=0.69, respectively). CONCLUSIONS The honeycombing area measured by the proposed computer-aided method was correlated with that estimated by expert radiologists and with parameters of PFTs. This quantitative CT analysis of honeycombing area may be useful and reliable in patients with IPF.
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Affiliation(s)
- Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Masashi Takahashi
- Department of Radiology, Yujin-Yamazaki Hospital, Takegahana-cho 88, Hikone, Shiga 522-0044, Japan
| | - Emiko Ogawa
- Health Administration Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Nguyen Van Tho
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yasushi Ryujin
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Taishi Nagao
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
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Raghu G, Amatto VC, Behr J, Stowasser S. Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review. Eur Respir J 2015; 46:1113-30. [DOI: 10.1183/13993003.02316-2014] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is associated with a fatal prognosis and manifests in patients over 60 years old who may have comorbidities. The prevalence and impact of comorbidities on the clinical course of IPF is unclear.This systematic literature review examined the prevalence of comorbidities and mortality associated with comorbidities in IPF patients. Relevant observational studies published in English from January 1990 to January 2015 identifiedviaMEDLINE and EMBASE were included; bibliographies of articles were also searched.Among the 126 studies included, prevalence of pulmonary hypertension (PH) was 3–86%, 6–91% for obstructive sleep apnoea, 3–48% for lung cancer and 6–67% for chronic obstructive pulmonary disease (COPD). Nonrespiratory comorbidities included ischaemic heart disease (IHD) (3–68%) and gastro-oesophageal reflux (GER) (0–94%). Mortality was highest among patients with IPF and lung cancer. Most studies assessed relatively small samples of patients with IPF.PH, COPD, lung cancer, GER and IHD are significant comorbidities; differences in IPF severity, case definitions and patient characteristics limited the comparability of findings. The identification and prompt treatment of comorbidities may have a clinically significant impact on overall outcome that is meaningful for patients with IPF.
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