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Casal A, Suárez-Antelo J, Soto-Feijóo R, Ferreiro L, Rodríguez-Núñez N, Lama A, Riveiro V, Toubes ME, Lourido T, Ricoy J, Rábade C, Zamarrón C, Rodríguez C, Abelleira R, Álvarez-Dobaño JM, Golpe A, de Alegría AM, Antúnez JR, Gude F, Valdés L. Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors. Heart Lung 2022; 56:62-69. [PMID: 35780571 DOI: 10.1016/j.hrtlng.2022.06.020] [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: 03/27/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sarcoidosis is a multiorgan granulomatous disease with a variable course. OOBJECTIVES The purpose of this study is to identify the patients that are more likely to experience disease progression. METHODS A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). RESULTS The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. CONCLUSIONS At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.
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Affiliation(s)
- Ana Casal
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Juan Suárez-Antelo
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Roi Soto-Feijóo
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Lucía Ferreiro
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | - Nuria Rodríguez-Núñez
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Adriana Lama
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Vanessa Riveiro
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Mª Elena Toubes
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Tamara Lourido
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Jorge Ricoy
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlos Rábade
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlos Zamarrón
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Carlota Rodríguez
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Romina Abelleira
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - José Manuel Álvarez-Dobaño
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | - Antonio Golpe
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain.
| | | | - José Ramón Antúnez
- Anatomical Pathology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Francisco Gude
- Health Research Institute (IDIS), Santiago de Compostela, Spain; Clinical Epidemiology Unit, Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Luis Valdés
- Pneumology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain; Health Research Institute (IDIS), Santiago de Compostela, Spain; University of Santiago de Compostela.
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Ge J, Tang L, Mu P, Zhu F, Xie L, Tang Y. Association of ADAM17 Expression Levels in Patients with Interstitial Lung Disease. Immunol Invest 2019; 49:134-145. [PMID: 31469350 DOI: 10.1080/08820139.2019.1660367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A disintegrin and metalloproteinases (ADAMs) are believed to be involved in the pathogenesis of many fibrosis-related diseases. However, little is known regarding the significance of ADAM17 as a biomarker for interstitial lung disease (ILD). In this study, by using the RT-PCR, western blotting and ELISA, we detected the expression level of ADAM17 in peripheral blood mononuclear cells and serum from idiopathic pulmonary fibrosis (IPF) patients, connective tissue disease associated ILD (CTD-ILD) patients and healthy controls, and correlations between clinical and laboratory parameters were also analyzed. We found that IPF patients and CTD-ILD patients showed higher levels of ADAM17 than healthy controls. Moreover, ADAM17 in IPF patients with acute exacerbation (AE-IPF) was significantly higher than that in stable IPF (S-IPF) patients. Expression of ADAM17 was positively correlated with disease duration and CRP but negatively correlated with diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC). Among the CTD-ILD patients, SSc-ILD patients had the highest serum levels of ADAM17 compared with the RA-ILD, SS-ILD and IIM-ILD groups and ADAM17 expression levels were correlated with image grading. In conclusion, this study showed that ADAM17 is highly expressed in ILD patients and is associated with disease activity and severity. Additionally, ADAM17 expression is not only related to the primary CTDs, but also to image grading. ADAM17 may serve as a new biomarker for ILD.
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Affiliation(s)
- Jianjian Ge
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Lijian Tang
- Department of Pulmonary Medicine, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Peipei Mu
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Fuli Zhu
- Department of Radiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Lian Xie
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Yurong Tang
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, Shandong, China
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Goljan Geremek A, Puscinska E, Czystowska M, Skoczylas A, Bednarek M, Nowinski A, Gorecka D, Demkow U, Sliwinski P. Methotrexate treatment efficacy in sarcoidosis might be related to TNF-α polymorphism: real life preliminary study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:261-273. [PMID: 32476962 DOI: 10.36141/svdld.v36i4.7708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/11/2019] [Indexed: 11/02/2022]
Abstract
Introduction Methotrexate therapy improves lung function in selected sarcoidosis patients. Variation in TNF gene was associated with response to treatment. Aim: To determine the predictive role of-308 G/A, -857C/T, -863 C/A and -1031 T/C TNF-α polymorphism in the efficacy of MTX for progressive pulmonary sarcoidosis. Material and Methods Twenty-eight sarcoidosis patients treated with MTX (6-24 months) were genotyped for TNF-α polymorphisms: -1031 T/C, -857C/T, -308 G/A and -863 C/A. Pulmonary function test (PFT) were performed every 6 months to determine treatment response, until the drug withdrawal. Results No correlation between the initial clinical presentation of sarcoidosis and TNF α polymorphisms was found, neither for every allele nor for combined genotypes distribution. According to PFT evaluation we have discovered 3 types of response to MTX: early (ER), late (LR) and No-response (NR). TNF-α-308 A allele carriers have got significantly higher chance to be LR, p=0.02, RRI:83%. TNF-α-308 GG genotype transferred the 3-fold higher probability of early vs late response to MTX, p=0.02. Combined genotyping allowed to distinguish LR from ER and NR groups. ER and NR patients are genetically similar (-857CC-308GG). LR are "genetically" different group of patients (-857C/T-308GG or -857CC-308A/G) with 5-fold greater probability to be LR than TNF-α-857CC-308GG patients, p=0,005 sensitivity 85%, specificity: 43%, PPV 58%, NPV 75%. TNF-α-308GG-857CC patients have significantly lower chance to be LR comparing to other response type p=0.03 OR=0,075 95% CI=0.07-0.08. Conclusion Two types of positive response to MTX therapy (early and late) in chronic respiratory sarcoidosis are associated with polymorphic changes in TNF gene.
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Affiliation(s)
- Anna Goljan Geremek
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Elzbieta Puscinska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Monika Czystowska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Agnieszka Skoczylas
- Geriatrics Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Michal Bednarek
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Adam Nowinski
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Dorota Gorecka
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
| | - Urszula Demkow
- Laboratory Diagnostics and Clinical Immunology, Medical University of Warsaw, Poland
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute, Warsaw Poland
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Interpretation of HRCT Scans in the Diagnosis of IPF: Improving Communication Between Pulmonologists and Radiologists. Lung 2018; 196:561-567. [PMID: 30097721 PMCID: PMC6153593 DOI: 10.1007/s00408-018-0143-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/26/2018] [Indexed: 12/01/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD). In this review, we describe the central role of high-resolution computed tomography (HRCT) in the diagnosis of IPF and discuss how communication between pulmonologists and radiologists might be improved to make the interpretation of HRCT scans more effective. Clinical information is important in the interpretation of HRCT scans, as the likelihood that specific radiologic features reflect IPF is not absolute, but dependent on the clinical context. In cases where the clinical context or HRCT pattern are inconclusive, multidisciplinary discussion (MDD) between a pulmonologist and radiologist (and, where relevant, a pathologist and rheumatologist) experienced in the differential diagnosis of ILD is necessary to establish a diagnosis. While it can be challenging to convene a face-to-face meeting, MDD can be conducted virtually or by telephone to enable each specialty group to contribute. To make the MDD most effective, it is important that relevant clinical information (for example, on the patient’s clinical history, exposures and the results of serological tests) is shared with all parties in advance. A common lexicon to describe HRCT features observed in ILD can also help improve the effectiveness of MDD. A working diagnosis may be made in patients who do not fulfill all the diagnostic criteria for any specific type of ILD, but this diagnosis should be reviewed at regular intervals, with repeat of clinical, radiological, and laboratory assessments as appropriate, as new information pertinent to the patient’s diagnosis may become available.
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Prasad JD, Mahar A, Bleasel J, Ellis SJ, Chambers DC, Lake F, Hopkins PMA, Corte TJ, Allan H, Glaspole IN. The interstitial lung disease multidisciplinary meeting: A position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia. Respirology 2017; 22:1459-1472. [PMID: 28891101 DOI: 10.1111/resp.13163] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/28/2023]
Abstract
Interstitial lung diseases (ILD) are a diverse group of pulmonary diseases for which accurate diagnosis is critical for optimal treatment outcomes. Diagnosis of ILD can be challenging and a multidisciplinary approach is recommended in international guidelines. The purpose of this position paper is to review the evidence for the use of the multidisciplinary meeting (MDM) in ILD and suggest an approach to its governance and constitution, in an attempt to provide a standard methodology that could be applied across Australia and New Zealand. This position paper is endorsed by the Thoracic Society of Australia and New Zealand (TSANZ) and the Lung Foundation Australia (LFA).
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Affiliation(s)
- Jyotika D Prasad
- Department of Respiratory and Sleep Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Annabelle Mahar
- Pathology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jane Bleasel
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical Program, University of Sydney, Sydney, NSW, Australia
| | - Samantha J Ellis
- Radiology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Daniel C Chambers
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, Brisbane, QLD, Australia
| | - Fiona Lake
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Peter M A Hopkins
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, Brisbane, QLD, Australia
| | - Tamera J Corte
- Respiratory Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Ian N Glaspole
- Department of Respiratory and Sleep Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
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Calaras D, Munteanu O, Scaletchi V, Simionica I, Botnaru V. Ventilatory disturbances in patients with intrathoracic sarcoidosis - a study from a functional and histological perspective. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2017; 34:58-67. [PMID: 32476823 PMCID: PMC7170114 DOI: 10.36141/svdld.v34i1.5134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/17/2016] [Indexed: 01/06/2023]
Abstract
Background: Although sarcoidosis is commonly considered a restrictive disorder, more recent studies demonstrated opposite results. Objectives: To determine the prevalent functional pattern in patients with intrathoracic sarcoidosis and to assess the role of granulomatous inflammation in determining ventilatory disturbances. Methods: We included 144 consecutive newly diagnosed patients with sarcoidosis, who were evaluated by chest radiography, chest high resolution computer tomography, pulmonary function tests and dyspnea score. Additionally, endobronchial and transbronchial biopsies were performed to a subset of 78 patients. Results: We obtained a wide range of ventilatory abnormalities that characterize airways impairment: FEV1/FVC<70% - in 14 (9.7%) cases, low MMEF25-75 - in 69 (47.9%) patients, increased RV/TLC - in 65 (45.1%) subjects, while the subjects with restrictive defects was observed in a minority of cases - 7 (4.9%). Decreased DLCO was found in 100 (69.4%) individuals, in the majority of cases with mild changes. Patients in whom endobronchial biopsy showed granuloma had worse ventilatory results versus those in whom they have not been detected, with significant differences in FEV1 and MMEF25-75. We found significant correlations between radiological stage and pulmonary function tests. Dyspnea score (mMRC scale) in our cohort reflected lung volumes and DLCO modifications. Conclusion: The dominant functional abnormality in patients with intrathoracic sarcoidosis is obstruction, which affects the entire length of the bronchial tree causing a wide range of airways impairment and altered gas diffusion. These functional disturbances are prevalent from early stages of the disease and have a tendency to coexist with restriction as the disease advances. Granulomatous inflammation seems to have an important role in determining obstructive defect, even from "infra-radiological" stages. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 58-67).
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Affiliation(s)
- Diana Calaras
- “Nicolae Testemitanu” State Medical and Pharmaceutical University, Department of Pneumology and Allergy, Chisinau, Republic of Moldova
| | - Oxana Munteanu
- “Nicolae Testemitanu” State Medical and Pharmaceutical University, Department of Pneumology and Allergy, Chisinau, Republic of Moldova
| | - Valentina Scaletchi
- Phthisiopneumology Institute “Chiril Draganiuc”, Department of Functional and Endoscopic Evaluation, Chisinau, Republic of Moldova
| | - I. Simionica
- Phthisiopneumology Institute “Chiril Draganiuc”, Department of Functional and Endoscopic Evaluation, Chisinau, Republic of Moldova
| | - V. Botnaru
- “Nicolae Testemitanu” State Medical and Pharmaceutical University, Department of Pneumology and Allergy, Chisinau, Republic of Moldova
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Bonini M, Fiorenzano G. Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev 2017; 26:26/143/160099. [DOI: 10.1183/16000617.0099-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/01/2016] [Indexed: 01/08/2023] Open
Abstract
Interstitial lung diseases (ILDs) represent a heterogeneous group of pathologies characterised by alveolar and interstitial damage, pulmonary inflammation (usually associated with fibrosis), decreased lung function and impaired gas exchange, which can be attributed to either a known or an unknown aetiology. Dyspnoea is one of the most common and disabling symptoms in patients with ILD, significantly impacting quality of life. The mechanisms causing dyspnoea are complex and not yet fully understood. However, it is recognised that dyspnoea occurs when there is an imbalance between the central respiratory efferent drive and the response of the respiratory musculature. The respiratory derangement observed in ILD patients at rest is even more evident during exercise. Pathophysiological mechanisms responsible for exertional dyspnoea and reduced exercise tolerance include altered respiratory mechanics, impaired gas exchange, cardiovascular abnormalities and peripheral muscle dysfunction.This review describes the respiratory physiology of ILD, both at rest and during exercise, and aims to provide comprehensive and updated evidence on the clinical utility of the cardiopulmonary exercise test in the assessment and management of these pathological entities. In addition, the role of exercise training and pulmonary rehabilitation programmes in the ILD population is addressed.
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Sergiacomi G, Pugliese L, Ricci F, Floris R, Fusco A. High-resolution computed tomography and magnetic resonance imaging protocols in the diagnosis of fibrotic interstitial lung disease: overview for "non-radiologists". SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:300-306. [PMID: 32476862 DOI: 10.36141/svdld.v34i4.5792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 08/10/2017] [Indexed: 11/02/2022]
Abstract
Fibrotic interstitial lung diseases (ILDs) include a number of pulmonary disorders characterized by infiltration of inflammatory cells in lung parenchyma and fibrosis resulting in decreased lung compliance. Idiopathic pulmonary fibrosis (IPF) represents the most common ILD. ILDs can be divided in two anatomo-pathological and radiographic patterns: usual interstitial pneumonitis (UIP) and non-specific interstitial pneumonitis (NSIP). The different radiological features of UIP and NSIP are discussed. The American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association guidelines for the diagnosis and management of IPF have identified several characteristic high-resolution computed tomography (HRCT) features of UIP. However, even if these guidelines recommend to avoid surgical lung biopsy in case of confident UIP diagnosis on HRCT, they present some limitations, the most important of which is represented by interobserver agreement. Magnetic resonance imaging (MRI) can be considered as a radiation-free alternative to HRCT for several lung diseases. However, the clinical value of MRI for IPF diagnosis remains to be proven. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 300-306).
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Affiliation(s)
- Gianluigi Sergiacomi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy
| | - Luca Pugliese
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy
| | - Armando Fusco
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy
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Prasad J, Holland AE, Glaspole I, Westall G. Idiopathic pulmonary fibrosis: an Australian perspective. Intern Med J 2016; 46:663-8. [DOI: 10.1111/imj.13078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/13/2015] [Accepted: 12/13/2015] [Indexed: 01/20/2023]
Affiliation(s)
- J. Prasad
- Allergy Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
- Clinical School of Medicine; Monash University; Melbourne Victoria Australia
| | - A. E. Holland
- Allergy Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
- Department of Physiotherapy; La Trobe University; Melbourne Victoria Australia
| | - I. Glaspole
- Allergy Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - G. Westall
- Allergy Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
- Clinical School of Medicine; Monash University; Melbourne Victoria Australia
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Bozzetti F, Paladini I, Rabaiotti E, Franceschini A, Alfieri V, Chetta A, Crisafulli E, Silva M, Pastorino U, Sverzellati N. Are interstitial lung abnormalities associated with COPD? A nested case-control study. Int J Chron Obstruct Pulmon Dis 2016; 11:1087-96. [PMID: 27307724 PMCID: PMC4887075 DOI: 10.2147/copd.s103256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose In this study, we tested the association between COPD and interstitial lung abnormality (ILA), notably in relation to the presence of computed tomography (CT) signs of lung fibrosis. Patients and methods COPD cases were selected from participants undergoing lung cancer screening (Multicentric Italian Lung Detection trial) for airflow obstruction (n=311/2,303, 13.5%) and 146 consecutive patients with clinical COPD. In all, 457 COPD cases were selected and classified according to the stages of Global Initiative for Chronic Obstructive Lung Disease. A nested matching (case:control = 1:2) according to age, sex, and smoking history was operated between each COPD case and two control subjects from Multicentric Italian Lung Detection trial without airflow obstruction. Low-dose CT scans of COPD cases and controls were reviewed for the presence of ILA, which were classified into definite or indeterminate according to the presence of signs of lung fibrosis. Results The frequency of definite ILA was similar between COPD cases and controls (P=0.2), independent of the presence of signs of lung fibrosis (P=0.07). Combined definite and indeterminate ILA was homogeneously distributed across Global Initiative for Chronic Obstructive Lung Disease stages (P=0.6). Definite ILA was directly associated with current smoker status (odds ratio [OR] 4.05, 95% confidence interval [CI]: 2.2–7.4) and increasing pack-years (OR 1.01, 95% CI: 1–1.02). Subjects with any fibrotic ILA were more likely to be older (OR 1.17, 95% CI: 1.10–1.25) and male (OR 8.58, 95% CI: 1.58–68.9). Conclusion There was no association between COPD and definite ILA. However, low-dose CT signs of lung fibrosis were also observed in COPD, and their clinical relevance is yet to be determined.
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Affiliation(s)
- Francesca Bozzetti
- Section of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Ilaria Paladini
- Section of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Enrico Rabaiotti
- Department of Radiology, Academic Hospital of Parma, Parma, Italy
| | | | - Veronica Alfieri
- Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Ernesto Crisafulli
- Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Mario Silva
- Department of Radiology, Academic Hospital of Parma, Parma, Italy
| | - Ugo Pastorino
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
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Lopes AJ, Ferreira ADS, Lima TRL, Menezes SLS, Guimarães FS. An explanatory model of functional exercise capacity in patients with systemic sclerosis: considerations for rehabilitation programs. J Phys Ther Sci 2016; 28:569-75. [PMID: 27065545 PMCID: PMC4793012 DOI: 10.1589/jpts.28.569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to evaluate the impact of lung function and peripheral muscle function on the six-minute walking distance (6MWD) in systemic sclerosis (SS) patients and, thereby, to develop an explanatory model of functional exercise capacity for these individuals. [Methods] In a cross-sectional study, 31 SS patients underwent pulmonary function testing (including spirometry, diffusing capacity for carbon monoxide [DLCO], and respiratory muscle strength), isometric dynamometry with surface electromyography, and the 6MWD. [Results] There was a significant correlation between the 6MWD (% predicted, 6MWD%) and the following parameters: height (r = 0.427) and DLCO (r = 0.404). In contrast, no other independent variable showed a significant correlation with the 6MWD% (r ≤ 0.257). The final prediction model for 6MWD% (adjusted R(2) = 0.456, SE of bias=12%) was 6MWD% Gibbons = -131.3 + 1.16 × heightcm + 0.33 × DLCO% predicted. [Conclusion] In SS patients, body height and pulmonary diffusion are the main determinants of the 6MWD. Our results justify further investigation of the performance of SS patients during exercise, which may increase the understanding of the pathophysiological mechanisms involved in the disease. The impact of these findings in SS patients may be useful for evaluating the effects of rehabilitation programs.
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Affiliation(s)
- Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Program, Augusto
Motta University Center, Brazil
| | - Arthur de Sá Ferreira
- Rehabilitation Sciences Post-Graduation Program, Augusto
Motta University Center, Brazil
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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: 85] [Impact Index Per Article: 9.4] [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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14
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Lima TRL, Guimarães FS, Silva LA, Silva DPG, Menezes SLS, Lopes AJ. Relationship between functional capacity, joint mobility and pulmonary function in patients with systemic sclerosis. J Bodyw Mov Ther 2015; 19:17-24. [DOI: 10.1016/j.jbmt.2014.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/16/2013] [Accepted: 12/31/2013] [Indexed: 12/01/2022]
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15
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Martínez González C, González Barcala FJ, Belda Ramírez J, González Ros I, Alfageme Michavila I, Orejas Martínez C, González Rodríguez-Moro JM, Rodríguez Portal JA, Fernández Álvarez R. Recommendations for fitness for work medical evaluations in chronic respiratory patients. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2013; 49:480-90. [PMID: 24120308 DOI: 10.1016/j.arbres.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/02/2013] [Accepted: 06/18/2013] [Indexed: 12/25/2022]
Abstract
Chronic respiratory diseases often cause impairment in the functions and/or structure of the respiratory system, and impose limitations on different activities in the lives of persons who suffer them. In younger patients with an active working life, these limitations can cause problems in carrying out their normal work. Article 41 of the Spanish Constitution states that «the public authorities shall maintain a public Social Security system for all citizens guaranteeing adequate social assistance and benefits in situations of hardship». Within this framework is the assessment of fitness for work, as a dual-nature process (medico-legal) that aims to determine whether it is appropriate or not to recognise a person's right to receive benefits which replace the income that they no longer receive as they cannot carry out their work, due to loss of health. The role of the pulmonologist is essential in evaluating the diagnosis, treatment, prognosis and functional capacity of respiratory patients. These recommendations seek to bring the complex setting of fitness for work evaluation to pulmonologists and thoracic surgeons, providing action guidelines that allow them to advise their own patients about their incorporation into working life.
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Affiliation(s)
- Cristina Martínez González
- Área del Pulmón, Instituto Nacional de Silicosis-Hospital Universitario Central de Asturias, Facultad de Medicina, Universidad de Oviedo, Oviedo, España.
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16
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Baldi BG, Pereira CADC, Rubin AS, Santana ANDC, Costa AN, Carvalho CRR, Algranti E, Capitani EMD, Bethlem EP, Coletta ENAM, Arakaki JSO, Martinez JAB, Carvalho JFD, Steidle LJM, Rocha MJJ, Lima MS, Soares MR, Caramori ML, Aidé MA, Ferreira RG, Kairalla RA, Oliveira RKFD, Jezler S, Rodrigues SCS, Pimenta SP. Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases. J Bras Pneumol 2012; 38:282-91. [PMID: 22782597 DOI: 10.1590/s1806-37132012000300002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/11/2012] [Indexed: 01/30/2023] Open
Abstract
Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.
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Affiliation(s)
- Bruno Guedes Baldi
- Instituto do Coração Divisão de Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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17
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Abstract
In the last decade, significant progress has been made toward a better understanding of interstitial lung disease (ILD). A valuable tool for the clinician is high-resolution computed tomography, which aids in narrowing the differential diagnosis in patients with ILD and obviates the need for surgical lung biopsy when a usual interstitial pneumonia pattern is present. Clinicians evaluating and caring for patients with ILD need to recognize associated comorbidities. Substantial evidence shows that implementation of a multidisciplinary approach provides a high standard of care for patients, leading to improvements in the accuracy of clinical diagnosis that can significantly affect patient outcome.
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Affiliation(s)
- Esam H Alhamad
- Division of Pulmonary Medicine, College of Medicine, King Saud University, Riyadh 11461, KS, USA.
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18
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Abstract
Sarcoidosis is a multisystem, granulomatous disease. In this article, the various clinical manifestations, approach to, and management of, pulmonary and extrapulmonary sarcoidosis are reviewed.
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Affiliation(s)
- Nabeel Hamzeh
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO 80206, USA.
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19
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Lopes AJ, de Menezes SLS, Dias CM, de Oliveira JF, Mainenti MRM, Guimarães FS. Comparison between cardiopulmonary exercise testing parameters and computed tomography findings in patients with thoracic sarcoidosis. Lung 2011; 189:425-31. [PMID: 21858420 DOI: 10.1007/s00408-011-9316-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a safe and clinically useful method to assess functional capacity and to follow disease progression and the response to treatment in several clinical conditions. AIM We set out to determine the relationship between outcome measures of CPET and high-resolution computed tomography (HRCT) findings in thoracic sarcoidosis. METHODS A cross-sectional study was carried out in which 42 nonsmoking outpatients (22 females; median age = 46.5 years) were evaluated. All the patients underwent pulmonary function tests (PFTs) and CPET. By using CPET, the most probable causes of exercise limitation were separated into respiratory mechanics (n = 25) and cardiovascular (n = 17). By using HRCT, the following patterns were recorded: predominant nodules (n = 18), predominant ground-glass opacity (n = 10), and predominant traction bronchiectasis and honeycombing (n = 14). RESULTS Although significant differences have been shown for both PFT parameters and CPET results, only the latter were able to distinguish between patients with ground-glass opacity and patients with traction bronchiectasis and honeycombing on HRCT. A statistically significant difference was found for peak VO(2), breathing reserve, and P(A-a)O(2) when patients with predominant traction bronchiectasis and honeycombing were compared to patients with other HRCT patterns (p < 0.0001). There was no statistical difference among the patterns with abnormal CPET and the patterns of abnormalities on HRCT (p > 0.05). CONCLUSION The functional capacity assessed by CPET was strongly influenced by HRCT patterns in sarcoidosis. Patients with traction bronchiectasis and honeycombing have lower exercise capacity measured by CPET.
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Affiliation(s)
- Agnaldo José Lopes
- Laboratory of Respiratory Physiology, University of the State of Rio de Janeiro, and Rehabilitation Science Graduate Program, Augusto Motta University, Rua Araguaia, 1266, bloco 1/405, Freguesia, Jacarepaguá, 22745-271, Rio de Janeiro, Brazil.
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Román A, Ussetti P, Solé A, Zurbano F, Borro JM, Vaquero JM, de Pablo A, Morales P, Blanco M, Bravo C, Cifrian J, de la Torre M, Gámez P, Laporta R, Monforte V, Mons R, Salvatierra A, Santos F, Solé J, Varela A. Guidelines for the selection of lung transplantation candidates. Arch Bronconeumol 2011; 47:303-9. [PMID: 21536362 DOI: 10.1016/j.arbres.2011.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/26/2011] [Indexed: 01/24/2023]
Abstract
The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.
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Affiliation(s)
- Antonio Román
- Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, España.
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21
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Dellaripa PF, O. Rosas I. The lung in rheumatic disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Sarcoidosis is an inflammatory granulomatous disease that is characterized by diverse organ system manifestations, a variable clinical course, and a predilection for affecting relatively young adults worldwide. Abnormalities on chest radiographs are detected in 85% to 95% of patients who have sarcoidosis. Approximately 20% to 50% of patients who have sarcoidosis present with respiratory symptoms, including dyspnea, cough, chest pain, and tightness of the chest. The clinical course and manifestations of pulmonary sarcoidosis are protean: spontaneous remission occurs in approximately two thirds of patients; up to 30% of patients have chronic course of the lung disease, resulting in progressive, (sometimes life-threatening) loss of lung function. Morbidity that correlates to sarcoidosis occurs in 1% to 4% of patients.
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Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, Egan T, Keshavjee S, Knoop C, Kotloff R, Martinez FJ, Nathan S, Palmer S, Patterson A, Singer L, Snell G, Studer S, Vachiery JL, Glanville AR. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006; 25:745-55. [PMID: 16818116 DOI: 10.1016/j.healun.2006.03.011] [Citation(s) in RCA: 702] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 01/12/2006] [Accepted: 03/13/2006] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jonathan B Orens
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA
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24
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Akkoca O, Celik G, Ulger F, Arbak P, Saryal S, Karabiyikoğlu G, Alper D. Exercise capacity in sarcoidosis. Study of 29 patients. Med Clin (Barc) 2005; 124:686-9. [PMID: 15899162 DOI: 10.1157/13075090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Groups 1, 2 and 3 included 11, 13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed for each patient. RESULTS Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis.
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Affiliation(s)
- Oznuc Akkoca
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Cebeci Hospital, Ankara, Turkey.
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Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of parenchymal pulmonary disorders with varying histologic appearances. Pulmonary function tests have gained a prominent role in the diagnosis and management of patients with these disorders. Although their role in the differential diagnosis of the various ILDs is limited, physiologic measurements are pivotal studies providing clues regarding disease severity, prognosis,and response to therapy.
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Affiliation(s)
- Vibha N Lama
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360, USA
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Khalil N, O'Connor R. Idiopathic pulmonary fibrosis: current understanding of the pathogenesis and the status of treatment. CMAJ 2004; 171:153-60. [PMID: 15262886 PMCID: PMC450366 DOI: 10.1503/cmaj.1030055] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal pulmonary fibrotic lung disease. The diagnostic histological changes are called usual interstitial pneumonia and are characterized by histological temporal heterogeneity, whereby normal lung tissue is interspersed with interstitial fibrosis, honeycomb cysts and fibroblast foci. Pulmonary functions show restricted volumes and capacities, preserved flows and evidence of decreased gas exchange. High-resolution computed axial tomography demonstrates evidence of fibrosis and lung remodelling such as honeycomb cysts and traction bronchiectasis. There is no known effective treatment for IPF, but lung transplantation improves survival.
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Affiliation(s)
- Nasreen Khalil
- Respiratory Division, Vancouver Coastal Health Research Institute, Vancouver, BC.
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