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Cheung WK, Pakzad A, Mogulkoc N, Needleman S, Rangelov B, Gudmundsson E, Zhao A, Abbas M, McLaverty D, Asimakopoulos D, Chapman R, Savas R, Janes SM, Hu Y, Alexander DC, Hurst JR, Jacob J. Automated airway quantification associates with mortality in idiopathic pulmonary fibrosis. Eur Radiol 2023; 33:8228-8238. [PMID: 37505249 PMCID: PMC10598186 DOI: 10.1007/s00330-023-09914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The study examined whether quantified airway metrics associate with mortality in idiopathic pulmonary fibrosis (IPF). METHODS In an observational cohort study (n = 90) of IPF patients from Ege University Hospital, an airway analysis tool AirQuant calculated median airway intersegmental tapering and segmental tortuosity across the 2nd to 6th airway generations. Intersegmental tapering measures the difference in median diameter between adjacent airway segments. Tortuosity evaluates the ratio of measured segmental length against direct end-to-end segmental length. Univariable linear regression analyses examined relationships between AirQuant variables, clinical variables, and lung function tests. Univariable and multivariable Cox proportional hazards models estimated mortality risk with the latter adjusted for patient age, gender, smoking status, antifibrotic use, CT usual interstitial pneumonia (UIP) pattern, and either forced vital capacity (FVC) or diffusion capacity of carbon monoxide (DLco) if obtained within 3 months of the CT. RESULTS No significant collinearity existed between AirQuant variables and clinical or functional variables. On univariable Cox analyses, male gender, smoking history, no antifibrotic use, reduced DLco, reduced intersegmental tapering, and increased segmental tortuosity associated with increased risk of death. On multivariable Cox analyses (adjusted using FVC), intersegmental tapering (hazard ratio (HR) = 0.75, 95% CI = 0.66-0.85, p < 0.001) and segmental tortuosity (HR = 1.74, 95% CI = 1.22-2.47, p = 0.002) independently associated with mortality. Results were maintained with adjustment using DLco. CONCLUSIONS AirQuant generated measures of intersegmental tapering and segmental tortuosity independently associate with mortality in IPF patients. Abnormalities in proximal airway generations, which are not typically considered to be abnormal in IPF, have prognostic value. CLINICAL RELEVANCE STATEMENT Quantitative measurements of intersegmental tapering and segmental tortuosity, in proximal (second to sixth) generation airway segments, independently associate with mortality in IPF. Automated airway analysis can estimate disease severity, which in IPF is not restricted to the distal airway tree. KEY POINTS • AirQuant generates measures of intersegmental tapering and segmental tortuosity. • Automated airway quantification associates with mortality in IPF independent of established measures of disease severity. • Automated airway analysis could be used to refine patient selection for therapeutic trials in IPF.
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Affiliation(s)
- Wing Keung Cheung
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Computer Science, University College London, London, UK
| | - Ashkan Pakzad
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Nesrin Mogulkoc
- Department of Respiratory Medicine, Ege University Hospital, Izmir, Turkey
| | - Sarah Needleman
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Bojidar Rangelov
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Eyjolfur Gudmundsson
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Computer Science, University College London, London, UK
| | - An Zhao
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Computer Science, University College London, London, UK
| | - Mariam Abbas
- Department of Computer Science, University College London, London, UK
| | | | | | - Robert Chapman
- Interstitial Lung Disease Service, Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Recep Savas
- Department of Radiology, Ege University Hospital, Izmir, Turkey
| | - Sam M Janes
- Lungs for Living Research Centre, UCL, London, UK
- UCL Respiratory, University College London, London, UK
| | - Yipeng Hu
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Daniel C Alexander
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK
- Department of Computer Science, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing, University College London, 1st Floor, 90 High Holborn, London, WC1V6LJ, UK.
- Lungs for Living Research Centre, UCL, London, UK.
- UCL Respiratory, University College London, London, UK.
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2
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Cerfeuillet V, Allimonnier L, Le Guellec S, Ménard L, Bokov P, Plantier L. Association of forced oscillation technique measurements with respiratory system compliance and resistance in a 2-compartment physical model. Respir Med Res 2023; 84:101027. [PMID: 37717385 DOI: 10.1016/j.resmer.2023.101027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) may be useful for diagnosis and follow-up of respiratory diseases. It is unclear how global or regional alterations in airway resistance (Raw) and lung compliance (CL) alter FOT measurements. METHODS A 2-compartment physical model of the respiratory system allowed to simulate variations in Raw, CL, and their heterogeneity during tidal breathing in an adult human. Five-Hz respiratory system resistance (Rrs5) and reactance (Xrs5), area of reactance (AX), resonance frequency (Fresp) and intrabreath variation in Rrs5 and Xrs5 were measured by FOT. Frequency dependance of resistance could not be studied in this model. Relationships between model characteristics (Raw, CL, and heterogeneity) and FOT measurements were explored by multiple regression. RESULTS Rrs5 and intrabreath variation in Rrs5 and Xrs5 strongly associated with model characteristics (R2=0.753, 0.5 and 0.658). Associations of Xrs5, AX, and Fresp with model characteristics were weak (R2=0.214, 0.349 and 0.076). Raw heterogeneity was the main determinant of Rrs5 (Coeff=0.594), AX (Coeff=0.566) and intrabreath variation in Rrs5 and Xrs5 (Coeff=0.586 and 0.732). Regional extremes in Raw strongly determined Rrs5 (Coeff=1.006). Xrs5 did not strongly associate with any model characteristic. CONCLUSION Raw heterogeneity and maximal regional Raw were the main determinants of FOT measurements, in particular Rrs5. Associations between CL and FOT measurements were weak.
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Affiliation(s)
- Valentin Cerfeuillet
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Laurine Allimonnier
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Sandrine Le Guellec
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Luke Ménard
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France
| | - Plamen Bokov
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, Paris, France; Université de Paris Cité, NSERM NeuroDiderot, F-75019, Paris, France
| | - Laurent Plantier
- Centre d'étude des pathologies respiratoires / Inserm UMR1100, Université de Tours, Tours, France; Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, Tours, France.
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3
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John J, Clark AR, Kumar H, Vandal AC, Burrowes KS, Wilsher ML, Milne DG, Bartholmai B, Levin DL, Karwoski R, Tawhai MH. Pulmonary vessel volume in idiopathic pulmonary fibrosis compared with healthy controls aged > 50 years. Sci Rep 2023; 13:4422. [PMID: 36932117 PMCID: PMC10023743 DOI: 10.1038/s41598-023-31470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterised by progressive fibrosing interstitial pneumonia with an associated irreversible decline in lung function and quality of life. IPF prevalence increases with age, appearing most frequently in patients aged > 50 years. Pulmonary vessel-like volume (PVV) has been found to be an independent predictor of mortality in IPF and other interstitial lung diseases, however its estimation can be impacted by artefacts associated with image segmentation methods and can be confounded by adjacent fibrosis. This study compares PVV in IPF patients (N = 21) with PVV from a healthy cohort aged > 50 years (N = 59). The analysis includes a connected graph-based approach that aims to minimise artefacts contributing to calculation of PVV. We show that despite a relatively low extent of fibrosis in the IPF cohort (20% of the lung volume), PVV is 2-3 times higher than in controls. This suggests that a standardised method to calculate PVV that accounts for tree connectivity could provide a promising tool to provide early diagnostic or prognostic information in IPF patients and other interstitial lung disease.
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Affiliation(s)
- Joyce John
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Haribalan Kumar
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Alain C Vandal
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Kelly S Burrowes
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | - David G Milne
- Radiology, Auckland City Hospital, Auckland, New Zealand
| | | | | | | | - Merryn H Tawhai
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
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4
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Chen CH, Wu CD, Lee YL, Lee KY, Lin WY, Yeh JI, Chen HC, Guo YLL. Air pollution enhance the progression of restrictive lung function impairment and diffusion capacity reduction: an elderly cohort study. Respir Res 2022; 23:186. [PMID: 35836168 PMCID: PMC9281077 DOI: 10.1186/s12931-022-02107-5] [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: 12/04/2021] [Accepted: 07/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some evidences have shown the association between air pollution exposure and the development of interstitial lung diseases. However, the effect of air pollution on the progression of restrictive ventilatory impairment and diffusion capacity reduction is unknown. This study aimed to evaluate the effects of long-term exposure to ambient air pollution on the change rates of total lung capacity, residual volume, and diffusion capacity among the elderly. METHODS From 2016 to 2018, single-breath helium dilution with the diffusion capacity of carbon monoxide was performed once per year on 543 elderly individuals. Monthly concentrations of ambient fine particulate matters (PM2.5) and nitric dioxide (NO2) at the individual residential address were estimated using a hybrid Kriging/Land-use regression model. Linear mixed models were used to evaluate the association between long-term (12 months) exposure to air pollution and lung function with adjustment for potential covariates, including basic characteristics, indoor air pollution (second-hand smoke, cooking fume, and incense burning), physician diagnosed diseases (asthma and chronic airway diseases), dusty job history, and short-term (lag one month) air pollution exposure. RESULTS An interquartile range (5.37 ppb) increase in long-term exposure to NO2 was associated with an additional rate of decline in total lung volume (- 1.8% per year, 95% CI: - 2.8 to - 0.9%), residual volume (- 3.3% per year, 95% CI: - 5.0 to - 1.6%), ratio of residual volume to total lung volume (- 1.6% per year, 95% CI: - 2.6 to - 0.5%), and diffusion capacity (- 1.1% per year, 95% CI: - 2.0 to - 0.2%). There is no effect on the transfer factor (ratio of diffusion capacity to alveolar volume). The effect of NO2 remained robust after adjustment for PM2.5 exposure. CONCLUSIONS Long-term exposure to ambient NO2 is associated with an accelerated decline in static lung volume and diffusion capacity in the elderly. NO2 related air pollution may be a risk factor for restrictive lung disorders.
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Affiliation(s)
- Chi-Hsien Chen
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., North Dist., Hsinchu City, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and National Taiwan University Hospital, Rm 339, No. 7, Zhongshan S. Rd., 17 Syujhou Road, Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, No. 1, Daxue Rd., East Dist., Tainan City, Taiwan.,National Institute of Environmental Sciences, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Township, Miaoli County, Taiwan
| | - Ya Ling Lee
- Department of Dentistry, Taipei City Hospital, No. 33, Sec. 2, Zhonghua Rd., Zhongzheng Dist., Taipei City, Taiwan.,Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, Taiwan.,University of Taipei, No. 1, Aiguo W. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist., New Taipei City, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, Taiwan
| | - Wen-Yi Lin
- Department of Occupational Medicine, Health Management and Occupational Safety Hygiene Center, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
| | - Jih-I Yeh
- Department of Family Medicine, Hualien Tzu-Chi General Hospital, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County, Taiwan
| | - Hsing-Chun Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Dalin Tzu Chi Hospital, No. 2, Minsheng Rd., Dalin Township, Chiayi County, Taiwan
| | - Yue-Liang Leon Guo
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and National Taiwan University Hospital, Rm 339, No. 7, Zhongshan S. Rd., 17 Syujhou Road, Zhongzheng Dist., Taipei City, 100, Taiwan. .,National Institute of Environmental Sciences, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Township, Miaoli County, Taiwan. .,Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City, Taiwan.
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5
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Uthaya Kumar DB, Motakis E, Yurieva M, Kohar V, Martinek J, Wu TC, Khoury J, Grassmann J, Lu M, Palucka K, Kaminski N, Koff JL, Williams A. Bronchial epithelium epithelial-mesenchymal plasticity forms aberrant basaloid-like cells in vitro. Am J Physiol Lung Cell Mol Physiol 2022; 322:L822-L841. [PMID: 35438006 PMCID: PMC9142163 DOI: 10.1152/ajplung.00254.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022] Open
Abstract
Although epithelial-mesenchymal transition (EMT) is a common feature of fibrotic lung disease, its role in fibrogenesis is controversial. Recently, aberrant basaloid cells were identified in fibrotic lung tissue as a novel epithelial cell type displaying a partial EMT phenotype. The developmental origin of these cells remains unknown. To elucidate the role of EMT in the development of aberrant basaloid cells from the bronchial epithelium, we mapped EMT-induced transcriptional changes at the population and single-cell levels. Human bronchial epithelial cells grown as submerged or air-liquid interface (ALI) cultures with or without EMT induction were analyzed by bulk and single-cell RNA-Sequencing. Comparison of submerged and ALI cultures revealed differential expression of 8,247 protein coding (PC) and 1,621 long noncoding RNA (lncRNA) genes and revealed epithelial cell-type-specific lncRNAs. Similarly, EMT induction in ALI cultures resulted in robust transcriptional reprogramming of 6,020 PC and 907 lncRNA genes. Although there was no evidence for fibroblast/myofibroblast conversion following EMT induction, cells displayed a partial EMT gene signature and an aberrant basaloid-like cell phenotype. The substantial transcriptional differences between submerged and ALI cultures highlight that care must be taken when interpreting data from submerged cultures. This work supports that lung epithelial EMT does not generate fibroblasts/myofibroblasts and confirms ALI cultures provide a physiologically relevant system to study aberrant basaloid-like cells and mechanisms of EMT. We provide a catalog of PC and lncRNA genes and an interactive browser (https://bronc-epi-in-vitro.cells.ucsc.edu/) of single-cell RNA-Seq data for further exploration of potential roles in the lung epithelium in health and lung disease.
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Affiliation(s)
- Dinesh Babu Uthaya Kumar
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, Connecticut
| | - Efthymios Motakis
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Marina Yurieva
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | | | - Jan Martinek
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Te-Chia Wu
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Johad Khoury
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jessica Grassmann
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Mingyang Lu
- Department of Bioengineering, Northeastern University, Boston, Massachusetts
- Center for Theoretical Biological Physics, Northeastern University, Boston, Massachusetts
| | - Karolina Palucka
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, Connecticut
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan L Koff
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Adam Williams
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, Connecticut
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Chakraborty A, Mastalerz M, Ansari M, Schiller HB, Staab-Weijnitz CA. Emerging Roles of Airway Epithelial Cells in Idiopathic Pulmonary Fibrosis. Cells 2022; 11:cells11061050. [PMID: 35326501 PMCID: PMC8947093 DOI: 10.3390/cells11061050] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fatal disease with incompletely understood aetiology and limited treatment options. Traditionally, IPF was believed to be mainly caused by repetitive injuries to the alveolar epithelium. Several recent lines of evidence, however, suggest that IPF equally involves an aberrant airway epithelial response, which contributes significantly to disease development and progression. In this review, based on recent clinical, high-resolution imaging, genetic, and single-cell RNA sequencing data, we summarize alterations in airway structure, function, and cell type composition in IPF. We furthermore give a comprehensive overview on the genetic and mechanistic evidence pointing towards an essential role of airway epithelial cells in IPF pathogenesis and describe potentially implicated aberrant epithelial signalling pathways and regulation mechanisms in this context. The collected evidence argues for the investigation of possible therapeutic avenues targeting these processes, which thus represent important future directions of research.
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7
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Park H, Cho J, Lee J, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Han SK, Choi SM. Prevalence and impact of airway diseases on clinical outcomes in idiopathic pulmonary fibrosis. Korean J Intern Med 2022; 37:387-397. [PMID: 34865413 PMCID: PMC8925941 DOI: 10.3904/kjim.2021.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The prevalence and effects of airway diseases, including asthma, eosinophilic bronchitis (EB), chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) have not been thoroughly studied in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to evaluate the prevalence of airway diseases in patients with IPF and to identify the differences in symptoms based on the presence of airway diseases. METHODS This single-institution prospective cohort study was conducted from June 2017 to September 2018, at the Seoul National University Hospital. Spirometry with bronchodilator, methacholine bronchial provocation test, induced sputum with eosinophil stain, and exhaled nitric oxide were performed to confirm the presence of airway disease. The modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), St. George's Respiratory Questionnaire (SGRQ), EuroQol-5 dimension (EQ-5D) index, and cough-specific quality of life questionnaire (CQLQ) data were collected to assess symptom severity. RESULTS Total 147 patients with IPF were screened, and 70 patients were analyzed. The prevalence of airway diseases in the participants was as follows: 5.0% had COPD, 1.7% had asthma, 3.3% had ACO, and 1.7% had EB. The mMRC, CAT, SGRQ, EQ-5D, and CQLQ scores did not differ regardless of combined airway disease. After 3 months, the SGRQ (p = 0.028) and CQLQ (p = 0.030) scores were significantly higher in patients with airway disease than in those without. CONCLUSION The prevalence of airway diseases in patients with IPF is low, but when airway diseases are accompanied by IPF, symptom severity and quality of life may worsen rapidly.
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Affiliation(s)
- Heemoon Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Whan Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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8
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Yamamoto Y, Miki K, Tsujino K, Kuge T, Okabe F, Kawasaki T, Matsuki T, Kagawa H, Miki M, Kida H. Oscillometry and computed tomography findings in patients with idiopathic pulmonary fibrosis. ERJ Open Res 2020; 6:00391-2020. [PMID: 33344627 PMCID: PMC7737428 DOI: 10.1183/23120541.00391-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022] Open
Abstract
Although the utility of oscillometry for predicting disease severity in idiopathic pulmonary fibrosis (IPF) had been researched, little has been reported on the mechanism of why respiratory impedance reflects disease severity. In addition, traction bronchiectasis has been considered to reduce respiratory resistance and correlate negatively with airflow obstruction, but this hypothesis has not been validated. The present study aimed to investigate the correlations between oscillometric parameters and fibrosis-related lung abnormalities in IPF and to assess the utility of oscillometry as a surrogate marker for traction bronchiectasis and airflow obstruction. Eighty Japanese patients with IPF underwent high-resolution computed tomography (HRCT), spirometry, and oscillometry and were retrospectively investigated. Fibrosis-related HRCT findings were scored regarding airspace consolidation, honeycombing, architectural distortion, traction bronchiectasis, and fibrosis. Correlations between the HRCT scores, spirometric parameters, and oscillometric parameters were analysed. Respiratory reactance correlated positively with all fibrosis-related HRCT scores. Vital capacity and forced vital capacity (FVC) correlated negatively with oscillometric parameters and HRCT scores, reflecting the severity of restrictive ventilatory deficiency. Respiratory resistance was not related to any of the HRCT scores or forced expiratory volume in 1 s/FVC. However, forced expiratory volume in 1 s/FVC correlated positively with HRCT scores, which showed that airflow obstruction became milder as the disease progressed. In conclusion, respiratory reactance reflects fibrosis and restrictive ventilatory deficiency in IPF. Moreover, respiratory resistance is independent of traction bronchiectasis and airflow obstruction in patients with IPF, which implies that respiratory resistance might reflect different properties of the airways. Respiratory reactance measured by oscillometry correlates with fibrosis-related computed tomography findings in idiopathic pulmonary fibrosis (IPF). Respiratory resistance is independent of traction bronchiectasis and airflow obstruction in IPF.https://bit.ly/36zoGtf
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Affiliation(s)
- Yuji Yamamoto
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Keisuke Miki
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kazuyuki Tsujino
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Tomoki Kuge
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Fukuko Okabe
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takahiro Kawasaki
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takanori Matsuki
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroyuki Kagawa
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Mari Miki
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroshi Kida
- Dept of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
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Derseh HB, Dewage SNV, Perera UE, Koumoundouros E, Pagel CN, Organ L, Snibson KJ. Small airway remodeling in a sheep model of bleomycin-induced pulmonary fibrosis. Exp Lung Res 2020; 46:409-419. [PMID: 34346276 DOI: 10.1080/01902148.2020.1834015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although IPF is described traditionally as a disease affecting lung parenchyma, there is renewed interest in the alterations in the structure and function of the small airways in both IPF patients, and animal models of pulmonary fibrosis. Small airway remodeling may contribute to the pathophysiology of pulmonary fibrosis. Given the dearth of knowledge of small airway changes in pulmonary fibrosis, this study aims to assess the structural remodeling, as well as functional changes associated with bleomycin-injured small airways in a sheep model of pulmonary fibrosis. MATERIALS AND METHODS Two separate lung segments in ten sheep received two challenges of either 3 IU bleomycin, or saline (control), two weeks apart. The animals were euthanized seven weeks after the final bleomycin injury. Airflow resistance in the infused segments was measured with a wedged-bronchoscope procedure. This parameter was measured at baseline before bleomycin/saline-infusion, and at 2-, 4-, and 7-weeks after the final bleomycin-infusion. Inflammation and fibrosis in the airways were assessed by semi-quantitative morphological parameters. The density of blood vessels in the small airway walls was assessed in lung tissue sections immuno-stained with antibodies against collagen type IV. RESULTS There were a number of changes in the distal airways of bleomycin-infused lung segments. Bleomycin exposure significantly elevated airway resistance in these lung segments when compared to saline-infused control lung segments. In the peribronchial and peribronchiolar regions of the small airways, there were significantly increased levels of inflammation, fibrosis, airway wall area, and collagen deposition in bleomycin-infused airways when compared to saline-infused airways. Bronchial blood vessel density was not significantly different between bleomycin-and saline-infused lung segments. CONCLUSIONS In summary, our results indicate that the distal airways are involved in the pathology induced by bleomycin in this sheep model. This suggests that the sheep model may be useful for studying small airway remodeling in pulmonary fibrosis.
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Affiliation(s)
- Habtamu B Derseh
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Sasika N Vithana Dewage
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Udari E Perera
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | | | - Charles N Pagel
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Louise Organ
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Ken J Snibson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
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10
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Le Guellec S, Allimonnier L, Heuzé-Vourc’h N, Cabrera M, Ossant F, Pourchez J, Vecellio L, Plantier L. Low-Frequency Intrapulmonary Percussive Ventilation Increases Aerosol Penetration in a 2-Compartment Physical Model of Fibrotic Lung Disease. Front Bioeng Biotechnol 2020; 8:1022. [PMID: 32984287 PMCID: PMC7483496 DOI: 10.3389/fbioe.2020.01022] [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: 06/12/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
In patients with fibrotic pulmonary disease such as idiopathic pulmonary fibrosis (IPF), inhaled aerosols deposit mostly in the less affected region of the lungs, resulting in suboptimal pharmacokinetics of airway-delivered treatments. Refinement of aerosol delivery technique requires new models to simulate the major alterations of lung physiology associated with IPF, i.e., heterogeneously reduced lung compliance and increased airway caliber. A novel physical model of the respiratory system was constructed to simulate aerosol drug delivery in spontaneously breathing (negative pressure ventilation) IPF patients. The model comprises upper (Alberta ideal throat) and lower airway (plastic tubing) models and branches into two compartments (Michigan lung models) which differ in compliance and caliber of conducting airway. The model was able to reproduce the heterogeneous, compliance-dependent reduction in ventilation and aerosol penetration (using NaF as a model aerosol) seen in fibrotic lung regions in IPF. Of note, intrapulmonary percussive ventilation induced a 2-3-fold increase in aerosol penetration in the low-compliance/high airway caliber compartment of the model, demonstrating the responsiveness of the model to therapeutic intervention.
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Affiliation(s)
- Sandrine Le Guellec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- DTF Aerodrug, Tours, France
- Université de Tours, Tours, France
| | - Laurine Allimonnier
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Nathalie Heuzé-Vourc’h
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Maria Cabrera
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | | | - Jérémie Pourchez
- Mines Saint-Etienne, Univ. Lyon, Univ. Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Laurent Vecellio
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Laurent Plantier
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
- CHRU de Tours, Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Tours, France
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11
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Costa CM, Neder JA, Verrastro CG, Paula-Ribeiro M, Ramos R, Ferreira EM, Nery LE, O'Donnell DE, Pereira CAC, Ota-Arakaki J. Uncovering the mechanisms of exertional dyspnoea in combined pulmonary fibrosis and emphysema. Eur Respir J 2019; 55:13993003.01319-2019. [PMID: 31649067 DOI: 10.1183/13993003.01319-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/12/2019] [Indexed: 01/19/2023]
Abstract
The prevailing view is that exertional dyspnoea in patients with combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) can be largely explained by severe hypoxaemia. However, there is little evidence to support these assumptions.We prospectively contrasted the sensory and physiological responses to exercise in 42 CPFE and 16 IPF patients matched by the severity of exertional hypoxaemia. Emphysema and pulmonary fibrosis were quantified using computed tomography. Inspiratory constraints were assessed in a constant work rate test: capillary blood gases were obtained in a subset of patients.CPFE patients had lower exercise capacity despite less extensive fibrosis compared to IPF (p=0.004 and 0.02, respectively). Exertional dyspnoea was the key limiting symptom in 24 CPFE patients who showed significantly lower transfer factor, arterial carbon dioxide tension and ventilatory efficiency (higher minute ventilation (V'E)/carbon dioxide output (V'CO2 ) ratio) compared to those with less dyspnoea. However, there were no between-group differences in the likelihood of pulmonary hypertension by echocardiography (p=0.44). High dead space/tidal volume ratio, low capillary carbon dioxide tension emphysema severity (including admixed emphysema) and traction bronchiectasis were related to a high V'E/V'CO2 ratio in the more dyspnoeic group. V'E/V'CO2 nadir >50 (OR 9.43, 95% CI 5.28-13.6; p=0.0001) and total emphysema extent >15% (2.25, 1.28-3.54; p=0.01) predicted a high dyspnoea burden associated with severely reduced exercise capacity in CPFEContrary to current understanding, hypoxaemia per se is not the main determinant of exertional dyspnoea in CPFE. Poor ventilatory efficiency due to increased "wasted" ventilation in emphysematous areas and hyperventilation holds a key mechanistic role that deserves therapeutic attention.
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Affiliation(s)
- Camila M Costa
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | | | - Marcelle Paula-Ribeiro
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Roberta Ramos
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eloara M Ferreira
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Luiz E Nery
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Carlos A C Pereira
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jaquelina Ota-Arakaki
- Pulmonary Vascular Disease and Interstitial Lung Disease Services, Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
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12
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Sécher T, Guilleminault L, Reckamp K, Amanam I, Plantier L, Heuzé-Vourc'h N. Therapeutic antibodies: A new era in the treatment of respiratory diseases? Pharmacol Ther 2018; 189:149-172. [PMID: 29730443 DOI: 10.1016/j.pharmthera.2018.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Respiratory diseases affect millions of people worldwide, and account for significant levels of disability and mortality. The treatment of lung cancer and asthma with therapeutic antibodies (Abs) is a breakthrough that opens up new paradigms for the management of respiratory diseases. Antibodies are becoming increasingly important in respiratory medicine; dozens of Abs have received marketing approval, and many more are currently in clinical development. Most of these Abs target asthma, lung cancer and respiratory infections, while very few target chronic obstructive pulmonary disease - one of the most common non-communicable causes of death - and idiopathic pulmonary fibrosis. Here, we review Abs approved for or in clinical development for the treatment of respiratory diseases. We notably highlight their molecular mechanisms, strengths, and likely future trends.
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Affiliation(s)
- T Sécher
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université François Rabelais de Tours, F-37032 Tours, France
| | - L Guilleminault
- Pôle des Voies respiratoires, Hôpital Larrey, CHU de Toulouse, F-31059 Toulouse, France; STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, F-31013 Toulouse, France
| | - K Reckamp
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - I Amanam
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - L Plantier
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université François Rabelais de Tours, F-37032 Tours, France; CHRU de Tours, Service de Pneumologie, F-37000 Tours, France
| | - N Heuzé-Vourc'h
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université François Rabelais de Tours, F-37032 Tours, France.
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13
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Nyilas S, Schreder T, Singer F, Poellinger A, Geiser TK, Latzin P, Funke M. Multiple breath washout: A new and promising lung function test for patients with idiopathic pulmonary fibrosis. Respirology 2018; 23:764-770. [DOI: 10.1111/resp.13294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/03/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sylvia Nyilas
- Division of Respiratory Medicine, Department of Pediatrics; University Children's Hospital of Bern, University of Bern; Bern Switzerland
| | - Theresa Schreder
- Department of Pulmonary Medicine; Bern University Hospital, University of Bern; Bern Switzerland
| | - Florian Singer
- Division of Respiratory Medicine, Department of Pediatrics; University Children's Hospital of Bern, University of Bern; Bern Switzerland
| | - Alexander Poellinger
- Department of Interventional and Pediatric Radiology; Bern University Hospital; Bern Switzerland
| | - Thomas Kurt Geiser
- Department of Pulmonary Medicine; Bern University Hospital, University of Bern; Bern Switzerland
| | - Philipp Latzin
- Division of Respiratory Medicine, Department of Pediatrics; University Children's Hospital of Bern, University of Bern; Bern Switzerland
| | - Manuela Funke
- Department of Pulmonary Medicine; Bern University Hospital, University of Bern; Bern Switzerland
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Plantier L, Cazes A, Dinh-Xuan AT, Bancal C, Marchand-Adam S, Crestani B. Physiology of the lung in idiopathic pulmonary fibrosis. Eur Respir Rev 2018; 27:27/147/170062. [PMID: 29367408 PMCID: PMC9489199 DOI: 10.1183/16000617.0062-2017] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022] Open
Abstract
The clinical expression of idiopathic pulmonary fibrosis (IPF) is directly related to multiple alterations in lung function. These alterations derive from a complex disease process affecting all compartments of the lower respiratory system, from the conducting airways to the lung vasculature. In this article we review the profound alterations in lung mechanics (reduced lung compliance and lung volumes), pulmonary gas exchange (reduced diffusing capacity, increased dead space ventilation, chronic arterial hypoxaemia) and airway physiology (increased cough reflex and increased airway volume), as well as pulmonary haemodynamics related to IPF. The relative contribution of these alterations to exertional limitation and dyspnoea in IPF is discussed. Physiological impairment in IPF is complex and involves all compartments of the respiratory systemhttp://ow.ly/gyao30hdHUb
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