1
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Koschel D, Behr J, Berger M, Bonella F, Hamer O, Joest M, Jonigk D, Kreuter M, Leuschner G, Nowak D, Raulf M, Rehbock B, Schreiber J, Sitter H, Theegarten D, Costabel U. [Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology]. Pneumologie 2024. [PMID: 39227017 DOI: 10.1055/a-2369-8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.
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Affiliation(s)
- Dirk Koschel
- Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland
- Bereich Pneumologie, Medizinische Klinik 1, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
- Ostdeutsches Lungenzentrum (ODLZ), Coswig/Dresden, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Melanie Berger
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Abteilung für Radiologie, Lungenfachklinik Donaustauf, Donaustauf, Deutschland
| | - Marcus Joest
- Praxis für Pneumologie und Allergologie, Bonn, Deutschland
| | - Danny Jonigk
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
- Institut für Pathologie, RWTH Aachen, Universität Aachen, Aachen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, ZfT, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, München, Deutschland
| | - Monika Raulf
- Abteilung Kompetenz-Zentrum Allergologie/Immunologie, Institut für Prävention und Arbeitsmedizin der DGUV, Institut der Ruhr-Universität Bochum (IPA), Bochum, Deutschland
| | - Beate Rehbock
- Privatpraxis für Diagnostische Radiologie und Begutachtung, Berlin, Deutschland
| | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dirk Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
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2
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Hauber R, Kreuter M, Dinkel J, Schön F, Hellmann A, Behr J. [The virtual ILD board: a pilot project]. Pneumologie 2023; 77:632-638. [PMID: 37696286 DOI: 10.1055/a-2113-0556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Interstitial lung diseases are associated with high morbitity and mortality. Rapid diagnosis in a qualified center is necessary in order to provide the best possible treatment. However, geographic distance and organizational issues lead to unacceptable delays. To support pulmonologists in private practice, we have trialed a digital system that minimizes such delays. The "virtual ILD board" leads to a considerably faster diagnosis and is a helpful tool for pulmonologists in practice. Standardization increases patient safety by ensuring interdisciplinary assessment and thus makes a relevant contribution to the management and guideline-based care of interstitial lung diseases.
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Affiliation(s)
- Roman Hauber
- Medizinische Fakultät, Julius-Maximilians-Universität, Würzburg, Deutschland
| | - Michael Kreuter
- Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Universitäres Lungenzentrum, Mainz, Deutschland
| | - Julien Dinkel
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität, München, Deutschland
| | - Franziska Schön
- Praxis für Pneumologie, Onkologie und Schlafmedizin am Diako, Ausgburg, Deutschland
| | - Andreas Hellmann
- PneumoMed Genossenschaft für Leistungen im Bereich der Lungen- und Bronchialheilkunde e.G., Heidenheim, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, Ludwig-Maximilians-Universität, München, Deutschland
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3
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Lederer C, Buschulte K, Hellmich B, Heußel CP, Kriegsmann M, Polke M, Kreuter M. [Interstitial lung diseases : Classification, differential diagnosis and treatment approaches in a heterogeneous group of chronic lung disorders]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:247-259. [PMID: 36786822 PMCID: PMC9926427 DOI: 10.1007/s00108-023-01476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/15/2023]
Abstract
Interstitial lung diseases (ILD) comprise a heterogeneous group of chronic lung disorders of different etiologies that can not only affect the interstitium but also the alveolar space and the bronchial system. According to the "Global Burden of Disease Study" there has been an increase in incidence over the last decades and it is expected that the number of ILD-associated deaths will double over the next 20 years. ILD are grouped into those of unknown cause, e.g. idiopathic pulmonary fibrosis (IPF), and ILD of known cause, which include drug-induced and connective tissue disease-associated ILD as well as granulomatous ILD such as sarcoidosis and hypersensitivity pneumonitis. In addition, some ILD present a progressive fibrosing phenotype, which influences therapeutic decisions. Predominantly inflammatory entities are treated with immunosuppressives, whereas predominantly fibrosing ILD are treated with antifibrotic drugs; in some cases, a combination of both is necessary. The spectrum of differential diagnoses in ILD is broad, but definite diagnosis is essential for treatment selection; therefore, the multidisciplinary ILD board plays a pivotal role.
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Affiliation(s)
- Christoph Lederer
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Katharina Buschulte
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, medius Klinik Kirchheim und Vaskulitiszentrum Süd, Kirchheim, Deutschland
| | - Claus Peter Heußel
- Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Sektion Thoraxpathologie, Abteilung für Allgemeine Pathologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | | | - Markus Polke
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.
- Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland.
- Lungenzentrum Mainz, 55131, Mainz, Deutschland.
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Nowak D, Ochmann U, Mueller-Lisse UG. Berufskrankheiten der Atemwege und der Lunge. PNEUMO NEWS 2022; 14:28-41. [PMID: 36281236 PMCID: PMC9581555 DOI: 10.1007/s15033-022-3415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dennis Nowak
- Inst. u. Poliklinik f. Arbeits-u. Umweltmedizin LMU München, Ziemssenstr. 1, 80336 München, Deutschland
| | - Uta Ochmann
- Klinikum Innenstadt der LMU, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ziemssenstr. 1, 80336 München, Deutschland
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5
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Reichenberger F, Dechant C, Ley S, Gschwendtner A, Benedikter J, Späthling-Mestekemper S, Kneidinger N, Powitz F, Krüger K, Wahle M, Schwaiblmair M. [Diagnostics of Interstitial Lung Diseases - Practical Instructions with a Focus on Rheumatologic Systemic Diseases]. Dtsch Med Wochenschr 2022; 147:1371-1383. [PMID: 36279863 DOI: 10.1055/a-1877-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interstitial lung diseases (ILD) are etiologically heterogeneous with unknown and known causes like rheumatologic systemic diseases differing in their therapeutic and prognostic consequences. In consensus between pulmonologists, rheumatologists, radiologists, and pathologists, we developed practical instructions for ILD diagnosis in rheumatologic systemic diseases, in particular because ILD can present in early stages of rheumatic systemic diseases. ILD diagnosis is based on clinical assessment results including a detailed medical history, physical examination, focused laboratory tests, radiology with a high-resolution computed tomography, lung function, and histopathology also to differentiate it from cardiac and infection associated lung diseases. The ILD diagnosis is made in a multidisciplinary discussion leading to therapeutic and prognostic consequences. The occurrence of acute exacerbations is especially critical. They are often the causes for ILD progression and are associated with considerable mortality.
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Prior TS, Hyldgaard C, Torrisi SE, Kronborg-White S, Ganter C, Bendstrup E, Kreuter M. Comorbidities in unclassifiable interstitial lung disease. Respir Res 2022; 23:59. [PMID: 35296320 PMCID: PMC8925215 DOI: 10.1186/s12931-022-01981-3] [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: 09/24/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidities are common in interstitial lung diseases (ILD) and have an important association with survival, but the frequency and prognostic impact of comorbidities in unclassifiable interstitial lung disease (uILD) remains elusive. We aimed to describe the prevalence of comorbidities and assess the impact on survival in patients with uILD. Furthermore, we aimed to identify and characterize potential phenotypes based on clusters of comorbidities and examine their association with disease progression and survival. METHODS Incident patients diagnosed with uILD were identified at two ILD referral centers in Denmark and Germany from 2003 to 2018. The diagnosis uILD was based on multidisciplinary team meetings. Clinical characteristics and comorbidities were extracted from ILD registries and patient case files. Survival analyses were performed using Cox regression analyses, disease progression was analyzed by linear mixed effects models, and clusters of comorbidities were analyzed using self-organizing maps. RESULTS A total of 249 patients with uILD were identified. The cohort was dominated by males (60%), former (49%) or current (15%) smokers, median age was 70 years, mean FVC was 75.9% predicted, and mean DLCO was 49.9% predicted. One-year survival was 89% and three-year survival was 73%. Eighty-five percent of the patients had ≥ 1 comorbidities, 33% had ≥ 3 comorbidities and 9% had ≥ 5 comorbidities. The only comorbidity associated with excess mortality was dyslipidemia. No association between survival and number of comorbidities or the Charlson comorbidity index was observed. Three clusters with different comorbidities profiles and clinical characteristics were identified. A significant annual decline in FVC and DLCO % predicted was observed in cluster 1 and 2, but not in cluster 3. No difference in mortality was observed between the clusters. CONCLUSIONS The comorbidity burden in uILD is lower than reported in other types of ILD and the impact of comorbidities on mortality needs further clarification. Three clusters with distinct comorbidity profiles were identified and could represent specific phenotypes. No difference in mortality was observed between clusters, but slower disease progression was observed in cluster 3. Better understanding of disease behavior and mortality will require further studies of subgroups of uILD with longer observation time.
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Affiliation(s)
- Thomas Skovhus Prior
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Charlotte Hyldgaard
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Sebastiano Emanuele Torrisi
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
| | - Sissel Kronborg-White
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ganter
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
| | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Centre for Lung Research, Heidelberg, Germany
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7
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[68/f-Cough and exertional dyspnea : Preparation for the medical specialist examination: part 100]. Internist (Berl) 2021; 62:635-638. [PMID: 34613427 DOI: 10.1007/s00108-021-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
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8
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Kirsten D, de Vries U, Costabel U, Koschel D, Bonella F, Günther A, Behr J, Claussen M, Schwarz S, Prasse A, Kreuter M. [Linguistic Validation of the "German Lung Fibrosis Health Related Quality of Life Questionnaire"]. Pneumologie 2021; 75:753-760. [PMID: 34428830 DOI: 10.1055/a-1334-2745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Health status and quality of life are impaired in patients with idiopathic pulmonary fibrosis (IPF) and idiopathic non-specific interstitial fibrosis (iNSIP). In Germany exists only the K-BILD questionnaire for patients with ILD 1 in a professional translation by Kreuter et al. 2 This questionnaire focuses on the main problems in patients with progressive lung fibrosis in a limited manner. Therefore a new quality of life questionnaire for patients with idiopathic pulmonary fibrosis was developed and linguistically validated. METHODS The linguistic validation of our questionnaire was carried out in a multistage process in collaboration with the developer of the questionnaire and bilingual, professional translators. Review by the developers and back translations as well as clinical assessment by IPF- and iNSIP-patients ensured that the translated questionnaire reflected the intention of the original English version of our questionnaire.Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). RESULTS The new questionnaire concerning the health status was composed in English and German language. The questions cover five scales (sensitivity, selectivity and symptoms like breathlessness and cough and a visual analog scale on general health status) with 23 items. CONCLUSIONS The results show that the FFB maps the special needs of the patients with IPF and iNSIP well and can support clinical and scientific questions and can be helpful in monitoring the clinical course.
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Affiliation(s)
| | - U de Vries
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - U Costabel
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | | | - F Bonella
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | - A Günther
- Medizinische Klinik Universität Gießen
| | - J Behr
- Medzinische Klinik und Poliklinik V, LMU Klinikum, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | | | - S Schwarz
- Asklepios Klinikum Harburg, Lungenabteilung
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Deutsches Zentrum für Lungenforschung, Heidelberg
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Bastian H, Krause A. Lunge – Interstitielle Lungenerkrankungen in der
Rheumatologie. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1543-0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungInterstitielle Lungenerkrankungen (ILD) gehören zu den
häufigsten Organmanifestationen bei entzündlich-rheumatischen
Systemerkrankungen. Sie können sich bei einer Vielzahl rheumatischer
Erkrankungen manifestieren, insbesondere bei rheumatoider Arthritis,
systemischer Sklerose und idiopathischen inflammatorischen Myopathien. ILD sind
mit einer erhöhten Morbidität und Mortalität assoziiert.
Eine sorgfältige Diagnostik unter Einbeziehung von Klinik, apparativer
und Labordiagnostik ist zur Klassifikation und Risikostratifizierung der
zugrundeliegenden Erkrankung und vorliegenden Lungenbeteiligung unabdingbar.
Auch wenn weiterhin nicht alle ätiologischen und pathogenetischen
Details bekannt sind, haben die letzten Jahre einige Fortschritte in
Verständnis und Management der (CTD-) ILD ergeben.
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Affiliation(s)
- Hans Bastian
- Abteilung Innere Medizin, Rheumatologie, Klinische Immunologie und
Osteologie, Immanuel Krankenhaus Berlin, Deutschland
| | - Andreas Krause
- Abteilung Innere Medizin, Rheumatologie, Klinische Immunologie und
Osteologie, Immanuel Krankenhaus Berlin, Deutschland
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10
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Kirsten D, de Vries U, Costabel U, Koschel D, Bonella F, Günther A, Behr J, Claussen M, Schwarz S, Prasse A, Kreuter M. A New Tool to Assess Quality of Life in Patients with Idiopathic Pulmonary Fibrosis or Non-specific Interstitial Pneumonia. Pneumologie 2021; 76:25-34. [PMID: 34521147 PMCID: PMC8789482 DOI: 10.1055/a-1579-7618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background
Quality of life (QoL) is significantly impaired in patients with pulmonary fibrosis, however reliable tools to assess QoL issues specific for this group of patients are still missing. We thus aimed to develop a new questionnaire called “Quality of life in patients with idiopathic pulmonary fibrosis” (QPF) to measure QoL in patients with fibrotic idiopathic interstitial pneumonias (IIP).
Methods
An item pool was created on the basis of a German expert group with support of patients suffering from pulmonary fibrosis. In a 1st step, this version of the questionnaire was completed by 52 patients with idiopathic pulmonary fibrosis (IPF) or non-specific interstitial pneumonia (NSIP). Following this, an item- and an exploratory factor analysis was carried out and a 2nd version created. In a multicenter validation study in a one-group pre-post design, the questionnaire was filled in by 200 patients with IIP (IPF = 190, iNSIP = 10) at 2 time points with an interval of 6 months. Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ).
Results
The mean age of the patients was 71.0 years (50–90 years), 82.5 % were male. Item analysis revealed that most of Cronbach alpha and selectivity values of QPF-scales could be considered as sufficient (e. g. QPF-scale “condition” [alpha = 0.827], “impairment” [alpha = 0.882]). At scale level, there were significant differences in terms of a deterioration or improvement in the QPF-condition and QPF-breathlessness scales and also in the SGRQ-activity scale. Analysis of construct validation of QPF and SGRQ showed moderate correlations between both questionnaires. A deterioration in health status from the patient’s and doctorʼs perspective was seen in the scales “impairment”, “shortness of breath” and “health status” of the QPF. The QPF was able to detect a change in the patientʼs mood (“condition” scale) in the course of treatment.
Conclusion
This newly developed questionnaire maps the special needs of the patients well. The QPF is suitable for screening of quality of life as well as for supplementing the medical history and for monitoring the course of disease in fibrotic IIPs.
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Affiliation(s)
| | - Ulrike de Vries
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Ulrich Costabel
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | | | | | | | - Jürgen Behr
- Department of Internal Medicine V, LMU Klinikum, University of Munich and German Center for Lung Research
| | | | | | - Antje Prasse
- Medizinische Hochschule Hannover, Klinik für Pneumologie; Pneumologie und Beatmungsmedizin
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung ResearchHeidelberg, Germany
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11
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Wälscher J. [66/m-Dry cough and exertional dyspnea : Preparation for the medical specialist examination: part 68]. Internist (Berl) 2021; 62:455-461. [PMID: 34487200 DOI: 10.1007/s00108-021-01115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- J Wälscher
- Ruhrlandklinik, Klinik für Pneumologie, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen, Deutschland.
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12
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Nowak D, Ochmann U, Mueller-Lisse UG. [Occupational diseases of the airways and the lungs]. Internist (Berl) 2021; 62:906-920. [PMID: 34387701 PMCID: PMC8361830 DOI: 10.1007/s00108-021-01109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/10/2022]
Abstract
The attributable proportion of occupation-related influences on airway and lung diseases is 10-30%. In patients with obstructive airway diseases it is extremely important to sufficiently document findings during the period of activities burdening the airway as compared to periods off work. Chronic obstructive pulmonary disease (COPD) can have a work-related (partial) cause even in smokers. Regarding occupational infectious diseases, the main cause up to 2019 was tuberculosis but the corona pandemic has led to coronavirus disease 2019 (COVID-19) being the most frequent occupational disease. For the occupational medical assessment of interstitial and malignant pulmonary diseases, checklists can be helpful to support the medical history.
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Affiliation(s)
- Dennis Nowak
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, LMU Klinikum, Ziemssenstr. 1, 80336, München, Deutschland.
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland.
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, LMU Klinikum, Ziemssenstr. 1, 80336, München, Deutschland
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
| | - Ullrich G Mueller-Lisse
- Klinik und Poliklinik für Radiologie, LMU Klinikum, München, Deutschland
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
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13
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Bastian H, Krause A. [Lung involvement in rheumatic diseases]. Dtsch Med Wochenschr 2021; 146:752-756. [PMID: 34062592 DOI: 10.1055/a-1334-7479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lung involvement is one of the most frequent organ manifestation in rheumatic diseases (CTD-ILD). Especially patients with rheumatoid arthritis, systemic sclerosis, and idiopathic inflammatory myopathies are affected. Interstitial lung diseases (ILD) are still associated with significant morbidity and mortality. The last years have brought advances in management and treatment of ILDs. Methotrexate is probably not a significant cause of lung disease in rheumatoid arthritis but might even delay the presentation of interstitial lung disease (ILD). Tocilizumab could be a treatment option in SSc-ILD, despite the limitations of the current studies. For Systemic Sclerosis-ILD (SSc-ILD) and progressive fibrosing ILD, antifibrotic therapy with nintedanib is now approved.
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Affiliation(s)
- Hans Bastian
- Abteilung Innere Medizin, Rheumatologie, Klinische Immunologie und Osteologie, Immanuel-Krankenhaus Berlin, Standort Berlin-Wannsee
| | - Andreas Krause
- Abteilung Innere Medizin, Rheumatologie, Klinische Immunologie und Osteologie, Immanuel-Krankenhaus Berlin, Standort Berlin-Wannsee
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Kreuter M, Müller-Ladner U, Costabel U, Jonigk D, Peter Heussel C. The Diagnosis and Treatment of Pulmonary Fibrosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0018. [PMID: 33531115 PMCID: PMC8212400 DOI: 10.3238/arztebl.m2021.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/14/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The different types of pulmonary fibrosis are a subgroup of the interstitial lung diseases (ILDs). They are associated with a chronic and often progressive course. METHODS This review is based on pertinent publications retrieved by a selective search in the EMBASE and PubMed databases, with an emphasis on articles published from 2000 to 2020. RESULTS The most common type of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF). Among other relevant types, the most important ones are fibrosing hypersensitivity pneumonitis (fHP) and ILDs associated with systemic diseases, all of which are rare and generally carry a poor prognosis. The essential prerequisite to accurate diagnosis is aninterdisciplinary approach, taking account of the clinical, histological, and radiological aspects. The main complications of pulmonary fibrosis are acute exacerbations and pulmonary hypertension; comorbidities are also of prognostic relevance. Treatment of pulmonary fibrosis depends on the subtype and clinical behavior. For IPF, antifibrotic therapy is indicated; fHP, on the other hand, is mainly treated by antigen avoidance and immune modulation. The predominant mode of treatment for systemic disease-associated pulmonary fibrosis is immune suppression. Antifibrotic agents can also be useful in the treatment of other types of progressivepulmonary fibrosis besides IPF. CONCLUSION The differential diagnosis of pulmonary fibrosis, though complex, is clinically essential, as different types of pulmonary fibrosis are treated differently.
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at Heidelberg University Hospital
- German Center for Lung Research (DZL)
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim
| | - Ulrich Costabel
- Department of Pneumology, Ruhrlandklinik, University Medical Center Essen
| | - Danny Jonigk
- German Center for Lung Research (DZL)
- Institute of Pathology, Hannover Medical School
| | - Claus Peter Heussel
- German Center for Lung Research (DZL)
- Department of Diagnostic and Interventional Radiology, Thoraxklinik at Heidelberg University Hospital
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15
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Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geissler K, Gläser S, Handzhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. S2K Guideline for Diagnosis of Idiopathic Pulmonary Fibrosis. Respiration 2021; 100:238-271. [PMID: 33486500 DOI: 10.1159/000512315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since the publication of the international IPF guideline in the year 2011 and the update 2018 several studies and technical advances have occurred, which made a new assessment of the diagnostic process mandatory. The goal of this guideline is to foster early, confident, and effective diagnosis of IPF. The guideline focusses on the typical clinical context of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardized questionnaires, serologic testing, and cellular analysis of bronchoalveolar lavage. High-resolution computed tomography remains crucial in the diagnostic workup. If it is necessary to obtain specimens for histology, transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom a bronchoscopic diagnosis did not provide the information needed. After all, IPF is a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
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Affiliation(s)
- Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany,
| | - Andreas Günther
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, Agaplesion Pneumological Clinic Waldhof-Elgershausen, University of Giessen Marburg Lung Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU, and Asklepios Specialty Hospitals Munich Gauting, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Ludger Fink
- Institute of Pathology and Cytology, Supraregional Joint Practice for Pathology (Überregionale Gemeinschaftspraxis für Pathologie, ÜGP), Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Wetzlar, Germany
| | - Thomas Geiser
- Clinic of Pneumology of the University Hospital of Bern, Bern, Switzerland
| | - Klaus Geissler
- Pulmonary Fibrosis (IPF) Patient Advocacy Group, Essen, Germany
| | - Sven Gläser
- Vivantes Neukölln and Spandau Hospitals Berlin, Department of Internal Medicine - Pneumology and Infectiology as well as Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Sabin Handzhiev
- Clinical Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Danny Jonigk
- Institute of Pathology, Hanover Medical School, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Dirk Koschel
- Department of Internal Medicine/Pneumology, Coswig Specialist Hospital, Center for Pneumology, Allergology, Respiratory Medicine, Thoracic Surgery and Medical Clinic 1, Pneumology Department, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Medicine, Thorax Clinic, University Hospital Heidelberg, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Heidelberg, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Philipp Markart
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, University of Giessen Marburg Lung Center, as well as the Fulda Campus of the Medical University of Marburg, Med. Clinic V, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Antje Prasse
- Department of Pneumology, Hanover Medical School and Clinical Research Center Fraunhofer Institute ITEM, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Nicolas Schönfeld
- Pneumology Clinic, Part of the Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Jonas Christian Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Helmut Sitter
- Institute for Surgical Research, Philipps-University Marburg, Marburg, Germany
| | - Joachim Müller-Quernheim
- Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
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16
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[Occupational medical pneumology - what's new?]. Dtsch Med Wochenschr 2020; 145:1174-1178. [PMID: 32791555 DOI: 10.1055/a-1090-5723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In case of obstructive, interstitial and malignant respiratory and lung diseases, occupational causes must always be searched for. The sensitivity and specificity of specific IgE determinations in the diagnosis of occupational asthma are only slightly above 70 %, even for high-molecular allergens. If the patient's medical history is positive, further diagnostics must be carried out, if necessary up to specific exposure testing in specialised institutions. New data show that the serial FeNO determination after working days compared to days off contains additional information that can lead to a positive diagnostic classification. In case of interstitial lung diseases, (avoidable) occupational triggers must be searched for - a new questionnaire provides practical assistance. Patients with lung carcinoma should also be investigated for occupational causes. Here too, questionnaires and tables are available in simple language. In future lung cancer caused by long-term exposure to passive smoke will be considered an occupational disease.
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Polke M, Kirsten D, Teucher B, Kahn N, Geissler K, Costabel U, Herth FJF, Kreuter M. A Comparison of Existing Questionnaires for Identifying the Causes of Interstitial and Rare Lung Diseases. Respiration 2020; 99:119-124. [PMID: 32000164 DOI: 10.1159/000504677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A thorough diagnostic process is essential with regard to prognosis and treatment of the more than 200 different types of interstitial lung diseases (ILD). Key to this complex process is a comprehensive medical history. For this, a template is recommended and questionnaires are increasingly used. Yet, the optimal questionnaire has not been established. OBJECTIVES We aimed to compare well-established questionnaires that are used in the diagnostic process of interstitial and rare lung diseases. METHODS Via a structured internet search and ILD expert interviews, we identified 6 different questionnaires for the diagnosis of ILDs: the questionnaires developed by the German Respiratory Society (DGP), American College of Chest Physicians (ACCP), National Jewish Health (NJH), Österreichische Röntgengesellschaft/Gesellschaft für Medizinische Radiologie und Nuklearmedizin (OERG), University of California, Los Angeles Health (UCLA), and University of California, San Francisco Medical Center (UCSF). We compared the forms, lengths, and contents of the 6 questionnaires regarding symptoms, comorbidities, drug history, previous ILD therapies, family history, smoking habits, occupational history, exposures, travel history, and former diagnostic procedures. RESULTS The questionnaires differed in length and content. The UCLA questionnaire focuses on connective tissue diseases extensively, while the NJH questionnaire captures previous diagnostics in detail. The OERG questionnaire is condensed, while the other 5 questionnaires are very detailed. The UCSF questionnaire contains a personal assessment part for the patient. For the majority of the questions, the patient can choose options from a preselected list of possible answers. The DGP questionnaire offers the patient the opportunity to add additional information in the form of free text to some of the key questions. CONCLUSIONS Questionnaires are an important tool in the diagnostic process of ILDs. Further validation and adjustment to clinical guidelines will help to improve existing questionnaires. Future work must aim to develop an internationally accepted template.
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Affiliation(s)
- Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Detlef Kirsten
- Pneumology, LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Birgit Teucher
- Translational Lung Research Center (TLRC), Department of Translational Pulmonology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Klaus Geissler
- Patient Support Group Lungenfibrose e.V., Essen, Germany.,EU-IPFF, Gentbrugge, Belgium
| | - Ulrich Costabel
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Felix J F Herth
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany, .,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany,
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18
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Wälscher J, Gross B, Morisset J, Johannson KA, Vasakova M, Bruhwyler J, Kreuter M. Comorbidities and survival in patients with chronic hypersensitivity pneumonitis. Respir Res 2020; 21:12. [PMID: 31918716 PMCID: PMC6953142 DOI: 10.1186/s12931-020-1283-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/05/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Chronic Hypersensitivity Pneumonitis (cHP) is a fibrotic interstitial lung disease (ILD) resulting from repeated exposure to an offending antigen. Prognostication in cHP remains challenging, and the relationship between comorbidities and survival has yet to be characterized. The aim of this study was to describe the relationship between comorbid conditions and survival in patients with cHP. Methods The prospective database from a tertiary referral centre for ILD was reviewed for patient-reported comorbidities, their frequency, and relationship with survival in cHP patients. Comorbidities were assessed by direct questioning of the patient at the baseline visit and by a standardized questionnaire for the diagnosis of interstitial lung diseases. During the follow-up examinations, patients were asked about newly diagnosed comorbidities. Results Two hundred eleven patients with cHP were identified (mean age 63 years, 53% male, mean FVC 73%), with mean follow-up of 32 months. The mean number of comorbidities was 3 (10% had 0, 59% 1–3 and 31% ≥4 comorbidities). Most frequent comorbidities groups were cardiovascular (65%) and respiratory (26%), most common comorbidities were hypertension (56%), gastro-esophageal reflux disease (GERD) (24%), diabetes (20%) and coronary heart disease (18%). In general, deceased patients had more comorbidities than survivors (p = 0.005), yet there was no association between the absolute number of comorbidities and survival. Pulmonary hypertension (30.8% versus 5.7%, p = 0.001;), diastolic dysfunction (26.9% versus 6.4%, p = 0.004) and cerebrovascular disease were more frequent in non-survivors (23.1% versus 7.6%, p = 0.026). Lung cancer was not observed, and neither GERD nor antacid drugs were associated with outcome (p = 0.357 and p = 0.961, respectively). Conclusions Comorbidities are common in cHP are associated with survival. Further work should determine whether interventions for these specific comorbidities can positively affect survival.
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Affiliation(s)
- Julia Wälscher
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126, Heidelberg, Germany
| | - Benjamin Gross
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126, Heidelberg, Germany
| | - Julie Morisset
- Centre Hospitalier de l'Universite de Montreal, Quebec, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Medicine, Calgary, Canada
| | - Martina Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine of Charles University, Thomayer Hospital, Prague, Czech Republic
| | | | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126, Heidelberg, Germany. .,German Center for Lung Research, Heidelberg, Germany.
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19
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Jakubczyc A, Neurohr C. [Rheumathism and pneumology]. DER ORTHOPADE 2019; 48:942-948. [PMID: 31538207 DOI: 10.1007/s00132-019-03806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to the broad range of diagnostic and therapeutic aspects with an increased risk of mortality, lung manifestations of rheumatic diseases are an exciting and important field in the clinical routine of pulmonologists and rheumatologists. OBJECTIVE Discussion of different presentations in the lung, diagnostics and management of lung manifestation associated with rheumatic diseases. MATERIAL AND METHODS Analysis and presentation of current literature on the subject. RESULTS The manuscript presents forms of lung involvement associated with rheumatic diseases, in particular the connective tissue disease-associated interstitial lung disease. Considering the negative impact on survival, rapid and adequate diagnosis is of great importance. In the case of a known underlying rheumatic disease, histological confirmation of interstitial changes is not always necessary. In addition to the patient's history, pulmonary function testing and diagnostic imaging with high-resolution CT-scan (HR-CT) are cornerstones of the diagnostic process. The final diagnosis and therapeutic approach should be determined by a multidisciplinary discussion process. The basis of the treatment is immunosuppressants, however the use antifibrotic drugs is currently under investigation in clinical trials. In the case of advanced lung disease, lung transplantation should be evaluated promptly. CONCLUSION In the case of pulmonary involvement with rheumatic disease, the teamwork of pulmonologists, rheumatologists and radiologists is of particular importance.
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Affiliation(s)
- A Jakubczyc
- Abteilung für Pneumologie und Beatmungsmedizin, Klinik Schillerhöhe, Robert-Bosch-Krankenhaus, Solitudestr. 18, 70839, Gerlingen, Deutschland.
| | - C Neurohr
- Abteilung für Pneumologie und Beatmungsmedizin, Klinik Schillerhöhe, Robert-Bosch-Krankenhaus, Solitudestr. 18, 70839, Gerlingen, Deutschland
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