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Dinkel J, Kneidinger N, Tarantino P. The radiologist's role in detecting systemic anticancer therapy-related interstitial lung disease: an educational review. Insights Imaging 2024; 15:191. [PMID: 39090512 PMCID: PMC11294314 DOI: 10.1186/s13244-024-01771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/07/2024] [Indexed: 08/04/2024] Open
Abstract
Systemic anticancer therapies (SACTs) are the leading cause of drug-induced interstitial lung disease (ILD). As more novel SACTs become approved, the incidence of this potentially life-threatening adverse event (AE) may increase. Early detection of SACT-related ILD allows for prompt implementation of drug-specific management recommendations, improving the likelihood of AE resolution and, in some instances, widening the patient's eligibility for future cancer treatment options. ILD requires a diagnosis of exclusion through collaboration with the patient's multidisciplinary team to rule out other possible etiologies of new or worsening respiratory signs and symptoms. At Grade 1, ILD is asymptomatic, and thus the radiologist is key to detecting the AE prior to the disease severity worsening. Planned computed tomography scans should be reviewed for the presence of ILD in addition to being assessed for tumor response to treatment, and when ILD is suspected, a high-resolution computed tomography (HRCT) scan should be requested immediately. An HRCT scan, with < 2-mm slice thickness, is the most appropriate method for detecting ILD. Multiple patterns of ILD exist, which can impact patient prognosis. The four main patterns include acute interstitial pneumonia / acute respiratory distress syndrome, organizing pneumonia, hypersensitivity pneumonitis, and non-specific interstitial pneumonia; their distinct radiological features, along with rarer patterns, are discussed here. Furthermore, HRCT is essential for following the course of ILD and might help to determine the intensity of AE management and the appropriateness of re-challenging with SACT, where indicated by drug-specific prescribing information. ILD events should be monitored closely until complete resolution. CRITICAL RELEVANCE STATEMENT: The incidence of potentially treatment-limiting and life-threatening systemic anticancer therapy-related interstitial lung disease (SACT-related ILD) events is likely increasing as more novel regimens become approved. This review provides best-practice recommendations for the early detection of SACT-related ILD by radiologists. KEY POINTS: Radiologists are crucial in detecting asymptomatic (Grade 1) ILD before severity/prognosis worsens. High-resolution computed tomography is the most appropriate method for detecting ILD. Drug-induced ILD is a diagnosis of exclusion, involving a multidisciplinary team. Familiarity with common HRCT patterns, described here, is key for prompt detection. Physicians should highlight systemic anticancer therapies (SACTs) with a known risk for interstitial lung diseases (ILD) on scan requisitions.
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Affiliation(s)
- Julien Dinkel
- Department of Radiology, University Hospital LMU Munich, Munich, Germany.
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Paolo Tarantino
- Breast Oncology Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
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Buschulte K, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederhold C, Skowasch D, Stolpe C, Joest M, Veitshans S, Höffgen M, Maqhuzu P, Schwarzkopf L, Hellmann A, Pfeifer M, Behr J, Karpavicius R, Günther A, Polke M, Höger P, Somogyi V, Lederer C, Markart P, Kreuter M. Disease trajectories in interstitial lung diseases - data from the EXCITING-ILD registry. Respir Res 2024; 25:113. [PMID: 38448953 PMCID: PMC10919020 DOI: 10.1186/s12931-024-02731-3] [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: 01/02/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with different disease trajectories. Progression (PF-ILD) occurs in up to 50% of patients and is associated with increased mortality. METHODS The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for disease trajectories in different ILD. The course of disease was classified as significant (absolute forced vital capacity FVC decline > 10%) or moderate progression (FVC decline 5-10%), stable disease (FVC decline or increase < 5%) or improvement (FVC increase ≥ 5%) during time in registry. A second definition for PF-ILD included absolute decline in FVC % predicted ≥ 10% within 24 months or ≥ 1 respiratory-related hospitalisation. Risk factors for progression were determined by Cox proportional-hazard models and by logistic regression with forward selection. Kaplan-Meier curves were utilised to estimate survival time and time to progression. RESULTS Within the EXCITING-ILD registry 28.5% of the patients died (n = 171), mainly due to ILD (n = 71, 41.5%). Median survival time from date of diagnosis on was 15.5 years (range 0.1 to 34.4 years). From 601 included patients, progression was detected in 50.6% of the patients (n = 304) with shortest median time to progression in idiopathic NSIP (iNSIP; median 14.6 months) and idiopathic pulmonary fibrosis (IPF; median 18.9 months). Reasons for the determination as PF-ILD were mainly deterioration in lung function (PFT; 57.8%) and respiratory hospitalisations (40.6%). In multivariate analyses reduced baseline FVC together with age were significant predictors for progression (OR = 1.00, p < 0.001). Higher GAP indices were a significant risk factor for a shorter survival time (GAP stage III vs. I HR = 9.06, p < 0.001). A significant shorter survival time was found in IPF compared to sarcoidosis (HR = 0.04, p < 0.001), CTD-ILD (HR = 0.33, p < 0.001), and HP (HR = 0.30, p < 0.001). Patients with at least one reported ILD exacerbation as a reason for hospitalisation had a median survival time of 7.3 years (range 0.1 to 34.4 years) compared to 19.6 years (range 0.3 to 19.6 years) in patients without exacerbations (HR = 0.39, p < 0.001). CONCLUSION Disease progression is common in all ILD and associated with increased mortality. Most important risk factors for progression are impaired baseline forced vital capacity and higher age, as well as acute exacerbations and respiratory hospitalisations for mortality. Early detection of progression remains challenging, further clinical criteria in addition to PFT might be helpful.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Hans-Joachim Kabitz
- Medical Clinic II, Pneumology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Lars Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
| | | | | | | | - Dirk Skowasch
- Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | | | - Marcus Joest
- Outpatient center for pulmonology and allergology, Bonn, Germany
| | | | - Marc Höffgen
- Outpatient center for pulmonology, Rheine, Germany
| | - Phillen Maqhuzu
- Institute of Health Economics and Healthcare Management, Helmholtz Center Munich GmbH, German Research Center for Environmental Health, German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPCM), Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Healthcare Management, Helmholtz Center Munich GmbH, German Research Center for Environmental Health, German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPCM), Neuherberg, Germany
- IFT Institut für Therapieforschung, Center for Mental Health and Addiction Research, Munich, Germany
| | | | - Michael Pfeifer
- Medical Clinic II, University of Regensburg and Klinikum Donaustauf, Donaustauf, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, LMU University Hospital, LMU Munich, German Center for Lung Research (DZL), Munich, Germany
| | | | - Andreas Günther
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
- Pulmonary and Critical Care Medicine, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Höger
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Vivien Somogyi
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Christoph Lederer
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Markart
- Pulmonary and Critical Care Medicine, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
- Medical Clinic V (Pneumology), Cardiothoracic Center, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
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Buschulte K, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederhold C, Skowasch D, Stolpe C, Joest M, Veitshans S, Höffgen M, Maqhuzu P, Schwarzkopf L, Hellmann A, Pfeifer M, Behr J, Karpavicius R, Günther A, Polke M, Höger P, Somogyi V, Lederer C, Markart P, Kreuter M. Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry. Respir Res 2024; 25:5. [PMID: 38178212 PMCID: PMC10765927 DOI: 10.1186/s12931-023-02588-y] [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: 08/16/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD. METHODS The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations. Reasons for hospitalisation were classified as all cause, ILD-related and respiratory hospitalisations, and patients were analysed for frequency of hospitalisations, time to first non-elective hospitalisation, mortality and progression-free survival. Additionally, the risk for hospitalisation according to GAP index and ILD subtype was calculated by Cox proportional-hazard models as well as influencing factors on prediction of hospitalisation by logistic regression with forward selection. RESULTS In total, 601 patients were included. 1210 hospitalisations were recorded during the 6 months prior to registry inclusion until the last study visit. 800 (66.1%) were ILD-related, 59.3% of admissions were registered in the first year after inclusion. Mortality was associated with all cause, ILD-related and respiratory-related hospitalisation. Risk factors for hospitalisation were advanced disease (GAP Index stages II and III) and CTD (connective tissue disease)-ILDs. All cause hospitalisations were associated with pulmonary hypertension (OR 2.53, p = 0.005). ILD-related hospitalisations were associated with unclassifiable ILD and concomitant emphysema (OR = 2.133, p = 0.001) as well as with other granulomatous ILDs and a positive smoking status (OR = 3.082, p = 0.005). CONCLUSION Our results represent a crucial contribution in understanding predisposing factors for hospitalisation in ILD and its major impact on mortality. Further studies to characterize the most vulnerable patient group as well as approaches to prevent hospitalisations are warranted.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Hans-Joachim Kabitz
- Medical Clinic II, Pneumology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Lars Hagmeyer
- Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Solingen, Germany
| | | | | | | | - Dirk Skowasch
- Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | | | - Marcus Joest
- Outpatient Center for Pulmonology and Allergology, Bonn, Germany
| | | | - Marc Höffgen
- Outpatient Center for Pulmonology, Rheine, Germany
| | - Phillen Maqhuzu
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPCM), Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPCM), Neuherberg, Germany
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | | | - Michael Pfeifer
- Medical Clinic II, University of Regensburg and Klinikum Donaustauf, Donaustauf, Germany
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Centre, German Center for Lung Research (DZL), Munich, Germany
| | | | - Andreas Günther
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Höger
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Vivien Somogyi
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Christoph Lederer
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Markart
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
- Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg, Fulda, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
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Ye Y, Sing CW, Hubbard R, Lam DCL, Li HL, Li GHY, Ho SC, Cheung CL. Prevalence, incidence, and survival analysis of interstitial lung diseases in Hong Kong: a 16-year population-based cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100871. [PMID: 38357389 PMCID: PMC10865042 DOI: 10.1016/j.lanwpc.2023.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 02/16/2024]
Abstract
Background Published data on the epidemiology of interstitial lung disease (ILD) in Asia is scarce. Understanding the epidemiology is important for authorities in the health management planning. This study aimed to estimate the prevalence, incidence, and survival of ILD in Hong Kong from 2005 to 2020 and evaluate the change of trend over time. Methods In this retrospective cohort study, we identified ILD patients between 2005 and 2020 using a territory-wide electronic health record database. Prevalence, incidence rates, and age- and sex-standardised incidence rates with United Nations population in 2020 as a reference were estimated. Trends in prevalence and incidence were analysed using joinpoint regression and the average annual percent change (AAPC) was estimated. Median survival, and risk factors of mortality were evaluated using Cox proportional hazard regression. Findings We identified 5924 patients and included 5884 of them for analysis. The prevalence of ILD increased from 24.7 to 33.6 per 100,000 population from 2005 to 2020 with an AAPC of 1.94 (95% confidence interval, CI: 1.69-2.34). The standardized incidence rate decreased from 5.36 to 2.57 per 100,000 person from 2005 to 2020 (AAPC -3.56, 95% CI, -4.95 to -1.78). The median survival of ILD was 2.50 (95% CI, 2.32-2.69) years. Male, older age, higher Charlson comorbidity index, and IIP subtype were associated with increased mortality with statistical significance. Interpretation This study provided the first epidemiological evaluation of ILD in Hong Kong. Further studies on ILD in multiple Asian cities and countries are warranted. Funding None.
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Affiliation(s)
- Yisha Ye
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chor-Wing Sing
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong, China
| | - Richard Hubbard
- School of Medicine, University of Nottingham, United Kingdom
| | - David Chi Leung Lam
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hang-Long Li
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gloria Hoi-Yee Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shun-Cheong Ho
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ching Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong, China
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Henning JW, Brezden-Masley C, Gelmon K, Chia S, Shapera S, McInnis M, Rayson D, Asselah J. Managing the Risk of Lung Toxicity with Trastuzumab Deruxtecan (T-DXd): A Canadian Perspective. Curr Oncol 2023; 30:8019-8038. [PMID: 37754497 PMCID: PMC10529919 DOI: 10.3390/curroncol30090582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/28/2023] Open
Abstract
Ongoing advances in precision cancer therapy have increased the number of molecularly targeted and immuno-oncology agents for a variety of cancers, many of which have been associated with a risk of pulmonary complications, among the most concerning being drug-induced interstitial lung disease/pneumonitis (DI-ILD). As the number of patients undergoing treatment with novel anticancer agents continues to grow, DI-ILD is expected to become an increasingly significant clinical challenge. Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate targeting human epidermal growth factor receptor 2 that is gaining widespread use in the metastatic breast cancer setting and is undergoing exploration for other oncologic indications. ILD/pneumonitis is an adverse event of special interest associated with T-DXd, which has potentially fatal consequences if left untreated and allowed to progress. When identified in the asymptomatic stage (grade 1), T-DXd-related ILD can be monitored and treated effectively with the possibility of treatment continuation. Delayed diagnosis and/or treatment, however, results in progression to grade 2 or higher toxicity and necessitates immediate and permanent discontinuation of this active agent. Strategies are, therefore, needed to optimize careful monitoring during treatment to ensure patient safety and optimize outcomes. Several guidance documents have been developed regarding strategies for the early identification and management of T-DXd-related ILD, although none have been within the context of the Canadian health care environment. A Canadian multidisciplinary steering committee was, therefore, convened to evaluate existing recommendations and adapt them for application in Canada. A multidisciplinary approach involving collaboration among medical oncologists, radiologists, respirologists, and allied health care professionals is needed to ensure the proactive identification and management of T-DXd-related ILD and DI-ILD associated with other agents with a similar toxicity profile.
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Affiliation(s)
| | | | - Karen Gelmon
- BC Cancer Agency, 600 10th Avenue West, Vancouver, BC V5Z 4E6, Canada; (K.G.); (S.C.)
| | - Stephen Chia
- BC Cancer Agency, 600 10th Avenue West, Vancouver, BC V5Z 4E6, Canada; (K.G.); (S.C.)
| | - Shane Shapera
- University Health Network, University of Toronto, Toronto General Hospital, 9N-971, 585 University Avenue, Toronto, ON M5G 2N2, Canada;
| | - Micheal McInnis
- Department of Medical Imaging, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada;
| | - Daniel Rayson
- Department of Medical Oncology, Dalhousie University, QEII-Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada;
| | - Jamil Asselah
- Cedars Cancer Centre, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada;
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Zeng Q, Jiang D. Global trends of interstitial lung diseases from 1990 to 2019: an age-period-cohort study based on the Global Burden of Disease study 2019, and projections until 2030. Front Med (Lausanne) 2023; 10:1141372. [PMID: 37554509 PMCID: PMC10404716 DOI: 10.3389/fmed.2023.1141372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are indispensable components of chronic respiratory diseases and global health challenges. We aimed to explore the global long-term changes in the prevalence, mortality, and disability-adjusted life years (DALYs) of ILDs; investigate the independent effect of age, period, and cohort; and project the disease burden over the next decade. METHODS Data were retrieved from the Global Burden of Disease (GBD) database 2019. The joinpoint regression model was used to calculate the average annual percent change (AAPC). An age-period-cohort (APC) analysis was employed to measure the independent effect of age, period, and cohort. The Bayesian age-period-cohort (BAPC) model was used to project the global epidemiological trends until 2030. RESULTS From 1990 to 2019, the age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) of interstitial lung disease and pulmonary sarcoidosis (ILD) slightly increased from 52.66 per 100,000 [95% uncertainty interval (UI) 44.49 to 61.07] to 57.62 per 100,000 (95% UI 49.42 to 65.67), from 1.76 per 100,000 (95% UI 1.41 to 2.22) to 2.17 per 100,000 (95% UI 1.5 to 2.62), and from 41.57 per 100,000 (95% UI 33.93 to 51.92) to 46.45 per 100,000 (95% UI 35.12 to 54.98), whereas the ASPR, ASMR, and ASDR of pneumoconiosis decreased. High social-demographic index (SDI) regions possessed the highest ASPR, whereas low-middle SDI regions had the highest ASMR and ASDR, followed by low-SDI regions in ILD. Middle-SDI regions reported the highest ASPR, ASMR, and ASDR in pneumoconiosis. The age effect showed that the rate ratio (RR) was high in older adults. Period effect indicated that the RR of prevalence increased over time, whereas the RR of mortality and DALYs decreased in men but increased in women. The cohort effect exhibited that the more recent birth cohort had a higher RR than the previous cohort in prevalence. We projected that ASPR, ASMR, and ASDR would stabilize with little variation over the next decade. CONCLUSION The global burden of ILDs remains relatively severe, especially among older adults, in low- and middle-SDI regions. Effective measurements are expected to improve this situation.
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Behr J, Bonella F, Günther A, Koschel D, Prasse A, Pittrow D, Klotsche J, Kreuter M. Investigating significant health trends in progressive fibrosing interstitial lung disease (INSIGHTS-ILD): rationale, aims and design of a nationwide prospective registry. BMC Pulm Med 2023; 23:64. [PMID: 36774483 PMCID: PMC9922453 DOI: 10.1186/s12890-023-02333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/18/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The progressive course of pulmonary fibrosis (PPF) is observed with variable prevalence in different entities of fibrosing interstitial lung disease (fILD). PPF is characterised by worsening respiratory symptoms, declining lung function and increasing extent of fibrosis on high-resolution computer tomography. In Germany, data are limited on the characteristics and management of such patients. METHODS/DESIGN INSIGHTS-ILD is a prospective observational longitudinal registry designed to describe characteristics, management and course of newly diagnosed (incident) and prevalent patients with fILD on the long term. The registry uses a non-probability sampling approach to collect data on characteristics, therapeutic interventions, health-related quality of life and health economic parameters. It is planned to include 900 patients in ambulatory care in about 30 expert sites over three years. The study has been initiated in December 2021, and currently (January 2023) follows 360 patients. DISCUSSION The registry is expected to provide much-needed data on the characteristics, management, and trajectories of patients fILD in Germany. The start of the study comes at a time when new treatment options are available for PPF. We hypothesize that PPF represents a broad clinical phenotype that is differentially influenced by inflammatory and fibrotic pathomechanisms that need to be treated with anti-inflammatory and/or anti-fibrotic treatment strategies. This registry will allow comparisons with other countries. Gap analyses based on current guidelines for management of these patients will be possible. Trial registration DRKS00027389 (registered on 7.12.2021), BfArM NIS 7562.
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Affiliation(s)
- Juergen Behr
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.
| | - Francesco Bonella
- grid.5718.b0000 0001 2187 5445Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, Duisburg-Essen University, Essen, Germany
| | - Andreas Günther
- grid.440517.3Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Dirk Koschel
- grid.412282.f0000 0001 1091 2917Medical Department I, Division of Pneumology, University Hospital Carl Gustav Carus, and Department of Pulmonology, Fachkrankenhaus Coswig GmbH, Lung Center, Coswig, Germany
| | - Antje Prasse
- grid.10423.340000 0000 9529 9877Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - David Pittrow
- grid.4488.00000 0001 2111 7257Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany
| | - Jens Klotsche
- grid.418217.90000 0000 9323 8675German Rheuma Research Center (DRFZ), Epidemiology, Berlin, Germany
| | - Michael Kreuter
- grid.452624.3Center for Interstitial and Rare Lung Diseases, and Interdisciplinary Center for Sarcoidosis, Pneumology, Thoraxklinik, University Hospital Heidelberg, German Center for Lung Research, Heidelberg, Germany ,Department of Pneumology, RKH Clinics Ludwigsburg, Ludwigsburg, Germany
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Zo S, Chung MP, Yoo HY, Lee KS, Han J, Chung MJ, Yoo H. Clinical characteristics and outcomes of hypersensitivity pneumonitis in South Korea. Ther Adv Respir Dis 2023; 17:17534666231212304. [PMID: 37970818 PMCID: PMC10655655 DOI: 10.1177/17534666231212304] [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: 05/10/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) that results from an immune-mediated reaction involving various antigens in susceptible individuals. However, the clinical characteristics and outcomes of HP in South Korea are not well understood. OBJECTIVES This study was conducted to identify the clinical characteristics and outcomes of HP in South Korea. DESIGN This is a retrospective observational study investigating patients with pathologically confirmed HP at our center, along with a comprehensive review of published HP cases in the Republic of Korea. METHODS This retrospective study analyzed 43 patients with pathologically proven HP at a single tertiary hospital in Korea between 1996 and 2020. In addition, case reports of HP published in Korea were collected. The clinical characteristics, etiologies, treatment, and outcomes of patients from our center, as well as case reports, were reviewed. Patients from our hospital were divided into fibrotic and nonfibrotic subtypes according to the ATS/JRS/ALAT guidelines. RESULTS Among 43 patients with biopsy-proven HP, 12 (27.9%) and 31 (72.1%) patients were classified into the fibrotic and nonfibrotic subtypes, respectively. The fibrotic HP group was older (64.6 ± 8.5 versus 55.2 ± 8.3, p = 0.002) with less frequent complaints of fever (0% versus 45.2%, p = 0.013) compared to the nonfibrotic HP group. The most common inciting antigen was household mold (21, 48.8%), followed by inorganic substances (6, 14.0%). Inciting antigens were not identified in eight (18.6%) patients. Treatment of corticosteroids was initiated in 34 (79.1%) patients. An analysis of 46 patients from Korea by literature review demonstrated that reported cases were relatively younger and drugs were the most common etiology compared to our cohort. CONCLUSION The analysis of reported cases, as well as our cohort, showed that exposure history and clinical manifestations are heterogeneous for patients with HP in South Korea.
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Affiliation(s)
- Sungmin Zo
- Division of Pulmonary, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hak Young Yoo
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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9
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Mendonça Almeida L, Fernandes AL, Gouveia Cardoso C, Lima B, Neves I, Novais-Bastos H, Caetano Mota P, Melo N, Souto Moura C, Guimarães S, Carvalho A, Cunha R, Pereira JM, Morais A. Mortality risk prediction with ILD-GAP index in a fibrotic hypersensitivity pneumonitis cohort. Ther Adv Respir Dis 2022; 16:17534666221135316. [PMID: 36476249 PMCID: PMC9742694 DOI: 10.1177/17534666221135316] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fibrotic hypersensitivity pneumonitis (fHP) is associated with significant morbidity and mortality. Interstitial lung disease-gender-age-physiology (ILD-GAP) performance in fHP outside the initial cohort was never performed. AIM To assess the ILD-GAP index's ability to predict mortality in a Portuguese cohort of patients with fHP and analyse whether other clinical variables add value. METHODS Retrospective analysis of fHP cohort in two Portuguese ILD centres. The baseline ILD-GAP index was calculated. Survival was analysed in months; mortality was the primary outcome. Univariate and multivariate analyses to identify mortality risk factors were performed. RESULTS A total of 141 patients were included. Fifty-three patients (37.6%) died during the follow-up. The usual interstitial pneumonia (UIP) pattern was found in 49.6%, and their survival was inferior to non-UIP [32 months (interquartile range, IQR = 19, 60) versus 52 months (IQR = 28, 98), p = 0.048]. Patients with an ILD-GAP index higher than three double their risk of mortality [hazard ratio (HR) = 6.48, 95% confidence interval (CI) = (3.03-13.96)] when compared with the patients with an index between 2 and 3 [HR = 3.04, 95% CI = (1.62-5.71)] adjusting for acute exacerbation history. Even though UIP patients had worse survival, it did not reach statistical significance when UIP pattern was added to this model. Acute exacerbation history was an independent risk factor for mortality; however, ILD-GAP still predicted mortality after adjusting for this factor. PaO2 and 6-minute walk test desaturation were not significant risk factors. CONCLUSION ILD-GAP index is a good predictor for mortality in fHP, even after adjusting for other mortality risk factors.
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Affiliation(s)
| | | | | | - Bruno Lima
- Oficina de Bioestatística, Porto, Portugal
| | - Inês Neves
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Hélder Novais-Bastos
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,i3S – Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine, University of Porto, Porto, Portugal,Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal,Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - André Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Rui Cunha
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - José Miguel Pereira
- Faculty of Medicine, University of Porto, Porto, Portugal,Radiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar e Universitário São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,i3S – Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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10
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Rodriguez K, Ashby CL, Varela VR, Sharma A. High-Resolution Computed Tomography of Fibrotic Interstitial Lung Disease. Semin Respir Crit Care Med 2022; 43:764-779. [PMID: 36307108 DOI: 10.1055/s-0042-1755563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While radiography is the first-line imaging technique for evaluation of pulmonary disease, high-resolution computed tomography (HRCT) provides detailed assessment of the lung parenchyma and interstitium, allowing normal anatomy to be differentiated from superimposed abnormal findings. The fibrotic interstitial lung diseases have HRCT features that include reticulation, traction bronchiectasis and bronchiolectasis, honeycombing, architectural distortion, and volume loss. The characterization and distribution of these features result in distinctive CT patterns. The CT pattern and its progression over time can be combined with clinical, serologic, and pathologic data during multidisciplinary discussion to establish a clinical diagnosis. Serial examinations identify progression, treatment response, complications, and can assist in determining prognosis. This article will describe the technique used to perform HRCT, the normal and abnormal appearance of the lung on HRCT, and the CT patterns identified in common fibrotic lung diseases.
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Affiliation(s)
- Karen Rodriguez
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christian L Ashby
- School of Medicine, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
| | - Valeria R Varela
- School of Medicine, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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11
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Lee JYT, Tikellis G, Glaspole I, Khor YH, Symons K, Holland AE. Self-management for pulmonary fibrosis: Insights from people living with the disease and healthcare professionals. PATIENT EDUCATION AND COUNSELING 2022; 105:956-964. [PMID: 34272128 DOI: 10.1016/j.pec.2021.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE People with pulmonary fibrosis (PF) consider self-management essential for maintaining health. This study aims to explore the needs and expectations of PF self-management from the patient and healthcare professionals (HCPs) perspectives. METHODS Semi-structured interviews were conducted with people with PF and HCPs. Purposive sampling was used to recruit participants. Thematic analysis was performed using the principles of grounded theory. RESULTS 18 individuals with PF and 15 HCPs were interviewed. Common self-management components reported included exercise, nutrition, maintaining healthy mind, avoiding infections, recognising deterioration and seeking help, managing symptoms and treatments, social support, and end-of-life planning. Both groups felt that effective self-management required individualised strategies, supports, and reliable information. People with PF identified access to personal health data and self-acceptance as part of self-management. HCPs highlighted the importance of accessible supports and managing patient expectations of disease course and treatments. Some HCPs concerned about missed detection of deterioration and suggested that self-management strategies for PF may differ to other lung diseases. CONCLUSION This study identified components important for self-management in PF and provides a basis for designing a PF self-management package. PRACTICE IMPLICATIONS Self-management of PF can be facilitated with individualised support from HCPs and reliable information that is accessible.
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Affiliation(s)
- Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Ian Glaspole
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia.
| | - Yet H Khor
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
| | - Karen Symons
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia.
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
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12
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Brown KK, Rajan SK, Shenoy P, Mehta M, Lopez M, Hegde RS, Gogtay J. The emerging role of mycophenolate mofetil in interstitial lung diseases. Expert Rev Respir Med 2021; 15:1539-1549. [PMID: 34758677 DOI: 10.1080/17476348.2021.2001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Mycophenolate mofetil (MMF), initially approved to prevent rejection in solid organ allograft, is now being increasingly used for other conditions. Over the last decade, MMF has emerged as a useful therapy for a variety of immune-mediated diseases. AREAS COVERED There has been a growing interest in the clinical use of MMF in the treatment of ILDs due to its versatile anti-inflammatory, immunomodulatory, anti-fibrotic and anti-proliferative properties. In this focussed review, we summarize the available literature using the Pubmed, Science Direct and EMBASE databases published until June 2021 on the efficacy and tolerability of MMF in various ILDs. EXPERT OPINION Other than idiopathic pulmonary fibrosis (IPF) and its broader category of progressive fibrosing ILD, there have been no drugs approved by relevant regulatory agencies for the treatment of the multiple other forms of ILD. Though results are limited, immunosuppressants such as MMF have shown promise as an effective and well-tolerated steroid-sparing agent, providing hope that the limited treatment armamentarium for ILDs can be expanded.
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Affiliation(s)
- Kevin K Brown
- Department of Medicine National Jewish Health, Denver, CO, USA
| | - Sujeet K Rajan
- Department of Chest Medicine Bombay Hospital and Medical Research Centre, Bhatia Hospital, Mumbai, India
| | - Padmanabha Shenoy
- Department of Rheumatology Centre for Arthritis and Rheumatism Excellence (Care), Cochin, India
| | - Monali Mehta
- Department of Medical Services Cipla, Peninsula Business Park, Mumbai, India
| | - Meena Lopez
- Department of Medical Services Cipla, Peninsula Business Park, Mumbai, India
| | - Rashmi S Hegde
- Department of Medical Services Cipla, Peninsula Business Park, Mumbai, India
| | - Jaideep Gogtay
- Department of Medical Services Cipla, Peninsula Business Park, Mumbai, India
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13
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Tomlinson O, Duckworth A, Markham L, Wollerton R, Knight B, Spiers A, Gibbons M, Williams C, Scotton C. Feasibility of cardiopulmonary exercise testing in interstitial lung disease: the PETFIB study. BMJ Open Respir Res 2021; 8:8/1/e000793. [PMID: 33926958 PMCID: PMC8094359 DOI: 10.1136/bmjresp-2020-000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiopulmonary exercise testing (CPET) provides a series of biomarkers, such as peak oxygen uptake, which could assess the development of disease status in interstitial lung disease (ILD). However, despite use in research and clinical settings, the feasibility of CPET in this patient group has yet to be established. Methods Twenty-six patients with ILD (19 male) were recruited to this study. Following screening for contraindications to maximal exercise, participants underwent an incremental CPET to volitional exhaustion. Feasibility of CPET was assessed by the implementation, practicality, acceptability and demand, thus providing clinical-driven and patient-driven information on this testing procedure. Results Of the 26 recruited participants, 24 successfully completed at least one CPET, with 67/78 prospective tests being completed. Contraindications included hypertension, low resting oxygen saturation and recent pulmonary embolism. Of the CPETs undertaken, 63% successfully reached volitional exhaustion, with 31% being terminated early by clinicians due to excessive desaturation. Quantitative and qualitative feedback from participants revealed a positive experience of CPET and desire for it to be included as a future monitoring tool. Conclusion CPET is feasible in patients with ILD. Identification of common clinical contraindications, and understanding of patient perspectives will allow for effective design of future studies utilising CPET as a monitoring procedure.
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Affiliation(s)
- Owen Tomlinson
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Anna Duckworth
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Rebecca Wollerton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Bridget Knight
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Alexander Spiers
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Michael Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Craig Williams
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Scotton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK .,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
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14
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Møller J, Hilberg O, Bendstrup E. Design and rationale of ProSar, the first Danish sarcoidosis registry. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2021; 38:e2021044. [PMID: 35115751 PMCID: PMC8787369 DOI: 10.36141/svdld.v38i4.11605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Janne Møller
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus Denmark
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15
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Long COVID Mimicking Interstitial Lung Disease: A Case Series. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:469-473. [PMID: 35003784 PMCID: PMC8679157 DOI: 10.12865/chsj.47.03.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
Interstitial lung diseases (ILD) can occur due to various known or unknown causes. They usually present with dry cough and exertional dyspnea. On radiology usual findings are ground glass opacities (GGO's), reticular shadows, nodules etc. Some patients after acute COVID-19 (coronavirus disease 2019) suffer from persistent symptoms/manifestations. These have been called 'Long COVID'. Long COVID also has radiological features like GGO's, nodules and reticulations. Further, patients even without history of acute COVID-19, can also present with 'Long COVID'. In the present case series, we describe three such cases with no history of having suffered from COVID-19, presenting with ILD like features and diagnosed as Long COVID. We infer from these cases that 'Long COVID' can both clinically and radiologically mimic ILD's. Hence, emphasizing the fact that in the present COVID-19 pandemic situation, 'Long COVID should be a differential diagnosis to be considered while making a new diagnosis of ILD.
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16
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Raghu G, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter M, Vasakova M, Bargagli E, Chung JH, Collins BF, Bendstrup E, Chami HA, Chua AT, Corte TJ, Dalphin JC, Danoff SK, Diaz-Mendoza J, Duggal A, Egashira R, Ewing T, Gulati M, Inoue Y, Jenkins AR, Johannson KA, Johkoh T, Tamae-Kakazu M, Kitaichi M, Knight SL, Koschel D, Lederer DJ, Mageto Y, Maier LA, Matiz C, Morell F, Nicholson AG, Patolia S, Pereira CA, Renzoni EA, Salisbury ML, Selman M, Walsh SLF, Wuyts WA, Wilson KC. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e36-e69. [PMID: 32706311 PMCID: PMC7397797 DOI: 10.1164/rccm.202005-2032st] [Citation(s) in RCA: 459] [Impact Index Per Article: 114.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.
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17
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McLean-Tooke A, Moore I, Lake F. Idiopathic and immune-related pulmonary fibrosis: diagnostic and therapeutic challenges. Clin Transl Immunology 2019; 8:e1086. [PMID: 31709050 PMCID: PMC6831929 DOI: 10.1002/cti2.1086] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Interstitial lung disease (ILD) encompasses a large group of pulmonary conditions sharing common clinical, radiological and histopathological features as a consequence of fibrosis of the lung interstitium. The majority of ILDs are idiopathic in nature with possible genetic predisposition, but is also well recognised as a complication of connective tissue disease or with certain environmental, occupational or drug exposures. In recent years, a concerted international effort has been made to standardise the diagnostic criteria in ILD subtypes, formalise multidisciplinary pathways and standardise treatment recommendations. In this review, we discuss some of the current challenges around ILD diagnostics, the role of serological testing, especially, in light of the new classification of Interstitial Pneumonia with Autoimmune Features (IPAF) and discuss the evidence for therapies targeted at idiopathic and immune-related pulmonary fibrosis.
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Affiliation(s)
- Andrew McLean-Tooke
- Department of Clinical Immunology Sir Charles Gairdner Hospital Perth WA Australia.,Department of Laboratory Immunology PathWest QEII Medical Centre Perth WA Australia
| | - Irene Moore
- Department of Respiratory Medicine Fiona Stanley Hospital Perth WA Australia
| | - Fiona Lake
- Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth WA Australia
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18
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Joyseeree R, Otálora S, Müller H, Depeursinge A. Fusing learned representations from Riesz Filters and Deep CNN for lung tissue classification. Med Image Anal 2019; 56:172-183. [DOI: 10.1016/j.media.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/23/2018] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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19
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Stevenson BR, Thompson GA, Watson MC, Bundell CS, Klinken EM, John M, Lake FR, McLean-Tooke AP. Autoantibodies in interstitial lung diseases. Pathology 2019; 51:518-523. [PMID: 31230817 DOI: 10.1016/j.pathol.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022]
Abstract
The role of autoantibody testing for patients with interstitial lung disease is an evolving area. Recent guidelines recommend routine anti-nuclear antibodies, rheumatoid factor, and anti-citrullinated cyclic peptide antibody testing for patients undergoing diagnostic evaluation for interstitial lung disease, with further autoantibody testing reserved for selected cases guided by rheumatological features. Even this approach may miss patients with clinically significant autoantibodies when interstitial lung disease is the dominant or first manifestation of autoimmune disease. We retrospectively performed autoimmune serology in a clinically well characterised cohort of interstitial lung disease patients. Using stored serum, additional testing was performed to ensure all patients had complete autoantibody profiles including anti-nuclear antibodies, extractable nuclear antigen antibodies, double-stranded DNA antibodies, rheumatoid factor, anti-citrullinated cyclic peptide antibodies, anti-neutrophil cytoplasmic antibodies, and myositis antibodies. Eighty patients with interstitial lung disease, and available stored serum, were assessed. Mean age at interstitial lung disease diagnosis was 65.2 years and 42 patients were male. Positive autoimmune serology was found in 56 of 80 (70.0%) patients; the most common positive result was anti-nuclear antibodies (n=34; 42.5%). Myositis antibodies were detected in 13 of 80 (16.2%) patients. Four (5%) patients had elevated anti-citrullinated cyclic peptide antibodies, and two (2.5%) patients had detectable myeloperoxidase antibodies. Eleven (13.7%) patients with negative anti-nuclear antibodies had other significant disease associated autoantibodies. An extended panel of autoantibody testing may detect cases of connective tissue disease associated interstitial lung disease, regardless of clinical or radiological subtype, and prior to extra-pulmonary manifestations of systemic autoimmunity.
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Affiliation(s)
- Brittany R Stevenson
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Grace A Thompson
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Monalyssa C Watson
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Christine S Bundell
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Elizabeth M Klinken
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mina John
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Royal Perth Hospital, Perth, WA, Australia; Institute for Immunology and Infectious Diseases (IIID), Murdoch University, Perth, WA, Australia
| | - Fiona R Lake
- UWA Medical School, The University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Andrew P McLean-Tooke
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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20
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Mari P, G. Jones M, Richeldi L. Contemporary Concise Review 2018: Interstitial lung disease. Respirology 2019; 24:809-816. [DOI: 10.1111/resp.13572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Pier‐Valerio Mari
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversitá Cattolica del Sacro Cuore Rome Italy
| | - Mark G. Jones
- NIHR Southampton Biomedical Research Centre and Clinical and Experimental Sciences University of Southampton UK
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversitá Cattolica del Sacro Cuore Rome Italy
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21
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Kolb M, Vašáková M. The natural history of progressive fibrosing interstitial lung diseases. Respir Res 2019; 20:57. [PMID: 30871560 PMCID: PMC6417262 DOI: 10.1186/s12931-019-1022-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
A proportion of patients with certain types of interstitial lung disease (ILD), including chronic hypersensitivity pneumonitis and ILDs associated with autoimmune diseases, develop a progressive fibrosing phenotype that shows similarities in clinical course to idiopathic pulmonary fibrosis. Irrespective of the clinical diagnosis, these progressive fibrosing ILDs show commonalities in the underlying pathogenetic mechanisms that drive a self-sustaining process of pulmonary fibrosis. The natural history of progressive fibrosing ILDs is characterized by decline in lung function, worsening of symptoms and health-related quality of life, and early mortality. Greater impairment in forced vital capacity or diffusion capacity of the lungs for carbon monoxide, and a greater extent of fibrotic changes on a computed tomography scan, are predictors of mortality in patients with fibrosing ILDs. However, the course of these diseases is heterogenous and cannot accurately be predicted for an individual patient. Data from ongoing clinical trials and patient registries will provide a better understanding of the clinical course and impact of progressive fibrosing ILDs.
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Affiliation(s)
- Martin Kolb
- McMaster University and St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Martina Vašáková
- Department of Respiratory Medicine, Thomayer Hospital, Videnska 800, 14059 Prague, Czech Republic
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22
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Abstract
More than 100 different conditions are grouped under the term interstitial lung disease (ILD). A diagnosis of an ILD primarily relies on a combination of clinical, radiological, and pathological criteria, which should be evaluated by a multidisciplinary team of specialists. Multiple factors, such as environmental and occupational exposures, infections, drugs, radiation, and genetic predisposition have been implicated in the pathogenesis of these conditions. Asbestosis and other pneumoconiosis, hypersensitivity pneumonitis (HP), chronic beryllium disease, and smoking-related ILD are specifically linked to inhalational exposure of environmental agents. The recent Global Burden of Disease Study reported that ILD rank 40th in relation to global years of life lost in 2013, which represents an increase of 86% compared to 1990. Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrotic ILD. A recent study from the United States reported that the incidence and prevalence of IPF are 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively. These data suggests that, in large populated areas such as Brazil, Russia, India, and China (the BRIC region), there may be approximately 2 million people living with IPF. However, studies from South America found much lower rates (0.4–1.2 cases per 100,000 per year). Limited access to high-resolution computed tomography and spirometry or to multidisciplinary teams for accurate diagnosis and optimal treatment are common challenges to the management of ILD in developing countries.
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Partida-Zavala N, Ponce-Gallegos MA, Buendía-Roldán I, Falfán-Valencia R. Type 2 macrophages and Th2 CD4+ cells in interstitial lung diseases (ILDs): an overview. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2018; 35:98-108. [PMID: 32476888 PMCID: PMC7170082 DOI: 10.36141/svdld.v35i2.6691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/06/2018] [Indexed: 12/23/2022]
Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group characterized mainly by damage to pulmonary parenchyma, through histopathological processes such as granulomatous pneumopathy, inflammation and fibrosis. Factors that generate susceptibility to ILDs include age, exposure to occupational and environmental compounds, genetic, family history, radiation and chemotherapy/immunomodulatory and cigarette smoke. IFN-γ, IL-1β, and LPS are necessary to induce a classical activation of macrophages, whereas cytokines as IL-4 and IL-13 can induce an alternative activation in macrophages, through the JAK-STAT mediated signal transduction. M2 macrophages are identified based on the gene transcription or protein expression of a set of M2 markers. These markers include transmembrane glycoproteins, scavenger receptors, enzymes, growth factors, hormones, cytokines, and cytokine receptors with diverse and often yet unexplored functions. Fibrotic lung disorders may have a M2 polarization background. The Th2 pathway with an elevated CCL-18 (marker of M2) concentration in the bronchoalveolar lavage fluid (BALF) is linked to fibrosis in ILDs. Besides the role of M2 in tissue repair and ECM remodeling, activated fibroblasts summon and stimulate macrophages by producing MCP-1, M-CSF and other chemokines, as well as activated macrophages secrete cytokines that attract and stimulate proliferation, survival and migration of fibroblast mediated by platelet-derived growth factor (PDGF). (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 98-108).
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Affiliation(s)
- Neftali Partida-Zavala
- Universidad Autónoma de Nayarit, Unidad Académica de Medicina. Tepic, Nayarit. México. Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Ciudad de México, Mexico
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas City, Mexico
| | - Marco Antonio Ponce-Gallegos
- Universidad Autónoma de Nayarit, Unidad Académica de Medicina. Tepic, Nayarit. México. Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Ciudad de México, Mexico
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas City, Mexico
| | - Ivette Buendía-Roldán
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas City, Mexico
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas City, Mexico
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Joyseeree R, Müller H, Depeursinge A. Rotation-covariant tissue analysis for interstitial lung diseases using learned steerable filters: Performance evaluation and relevance for diagnostic aid. Comput Med Imaging Graph 2018; 64:1-11. [DOI: 10.1016/j.compmedimag.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
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25
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The effects of inspiratory muscle training based on the perceptions of patients with advanced lung disease: a qualitative study. Braz J Phys Ther 2017; 22:215-221. [PMID: 29258735 DOI: 10.1016/j.bjpt.2017.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advanced lung disease is a chronic non-neoplastic disease that compromises activities of daily living. Treatment includes pulmonary rehabilitation and inspiratory muscle training. Studies have shown the effectiveness of inspiratory muscle training in lung disease patients, but literature is scarce on the patients' perceptions about this topic. OBJECTIVE To explore the perceptions of patients with advanced lung disease about inspiratory muscle training. METHODS Qualitative study. Interviews were conducted using a semi-structured questionnaire regarding topics on the participation of patients in inspiratory muscle training and on daily activities performed before and after training. Interviews were transcribed and analyzed according to thematic content analysis. RESULTS Ten patients (eight women and 2 men, ranging in age from 27 to 89 years) with inspiratory muscle weakness (maximal inspiratory pressure=44±13.9cmH2O) were included. Five patients were diagnosed with Chronic Obstructive Pulmonary Disease, two with bronchiectasis and three with pulmonary fibrosis. All patients completed at least 80% of the total training sessions. The reports were grouped into four thematic categories: (1) impact of inspiratory muscle training on breathlessness (e.g., "I wasn't feeling as tired as I previously felt."); (2) change in daily activities (e.g., "I needed to go to the supermarket, I felt less tired doing it."); (3) improved mobility (e.g., "I could not stand for long periods […] walking, for example […] Now I stand more, I have more capability."); and (4) increased communication (e.g., "More power, right? Even in speaking […] When I could, I felt my voice coming out better."). CONCLUSION There were improvements in breathlessness, daily activities, mobility, and communication, which positively affected the psychological and social aspects of the patients.
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26
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Singh S, Collins BF, Sharma BB, Joshi JM, Talwar D, Katiyar S, Singh N, Ho L, Samaria JK, Bhattacharya P, Gupta R, Chaudhari S, Singh T, Moond V, Pipavath S, Ahuja J, Chetambath R, Ghoshal AG, Jain NK, Devi HJG, Kant S, Koul P, Dhar R, Swarnakar R, Sharma SK, Roy DJ, Sarmah KR, Jankharia B, Schmidt R, Katiyar SK, Jindal A, Mangal DK, Singh V, Raghu G. Interstitial Lung Disease in India. Results of a Prospective Registry. Am J Respir Crit Care Med 2017; 195:801-813. [PMID: 27684041 DOI: 10.1164/rccm.201607-1484oc] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. OBJECTIVES To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. METHODS Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. MEASUREMENTS AND MAIN RESULTS A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. CONCLUSIONS Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.
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Affiliation(s)
| | | | | | - Jyotsna M Joshi
- 4 Department of Pulmonary Medicine, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India
| | - Deepak Talwar
- 5 Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, India
| | - Sandeep Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | | | | | - Jai Kumar Samaria
- 8 Department of Chest Disease, Banaras Hindu University, Varanasi, India
| | | | - Rakesh Gupta
- 10 Department of Respiratory Medicine, JLN Medical College & Hospital, Ajmer, India
| | - Sudhir Chaudhari
- 11 Department of Chest and Tuberculosis, GSVM Medical College, Kanpur, India
| | - Tejraj Singh
- 12 Research Division, Asthma Bhawan, Jaipur, India
| | | | | | | | - Ravindran Chetambath
- 15 Department of Pulmonary Medicine, Government Medical College, Kozhikode, India
| | - Aloke G Ghoshal
- 16 National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Nirmal K Jain
- 17 Department of Respiratory Medicine, SoniManipal Hospital, Jaipur, India
| | - H J Gayathri Devi
- 18 Department of Chest Medicine, MS Ramaiah Medical College, Bangalore, India
| | - Surya Kant
- 19 Department of Pulmonary Medicine, King George's Medical University, Lucknow, India
| | - Parvaiz Koul
- 20 Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raja Dhar
- 21 Department of Pulmonology & Critical Care, Fortis Hospital, Kolkata, India
| | - Rajesh Swarnakar
- 22 Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, India
| | - Surendra K Sharma
- 23 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhrubajyoti J Roy
- 24 Department of Respiratory Medicine, Pulmonary and Sleep Clinic, Kolkata, India
| | - Kripesh R Sarmah
- 25 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati, India
| | - Bhavin Jankharia
- 26 Department of Radiology, Jankharia Imaging, Mumbai, India; and
| | - Rodney Schmidt
- 27 Department of Pathology, Center for Interstitial Lung Diseases, University of Washington, Seattle, Washington
| | - Santosh K Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | - Arpita Jindal
- 28 Department of Pathology, SMS Medical College, Jaipur, India
| | - Daya K Mangal
- 29 Department of Research, IIHMR University, Jaipur, India
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27
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Kreuter M, Cottin V. The yin and yang of idiopathic pulmonary fibrosis. Eur Respir J 2017; 49:49/2/1602316. [PMID: 28232416 DOI: 10.1183/13993003.02316-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany and Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research (DZL)
| | - Vincent Cottin
- Dept of Pulmonary Medicine and National Reference Center for Rare Pulmonary Diseases, Competence Center for Pulmonary Arterial Hypertension, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
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