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Jordon LH, Ganeshan B, Nadeem I, Hoy L, Mahdi N, Porter JC, Groves A, Win T. Can FDG-PET/CT imaging be used to predict decline in quality of life in interstitial lung disease? A prospective study of the relationship between FDG uptake and quality of life in a UK outpatient setting. BMJ Open 2024; 14:e081103. [PMID: 38816048 PMCID: PMC11141197 DOI: 10.1136/bmjopen-2023-081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND 18Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) CT imaging has been used in many inflammatory and infectious conditions to differentiate areas of increased metabolic activity. FDG uptake differs between areas of normal lung parenchyma and interstitial lung disease (ILD). OBJECTIVES In this study, we investigated whether FDG-PET/CT parameters were associated with a change in the quality of life (QoL) in patients with ILD over 4 years of follow-up. METHODS Patients underwent PET-CT imaging at diagnosis and were followed up with annual QoL assessment using the St George's Respiratory Questionnaire (SGRQ) until death or 4 years of follow-up. Maximum standard uptake value (SUVmax) and Tissue-to-Background Ratio (TBR) were assessed against SGRQ overall and subscale scores. RESULTS 193 patients (94 patients in the idiopathic pulmonary fibrosis (IPF) subgroup and 99 patients in the non-IPF subgroup) underwent baseline FDG-PET/CT imaging and QoL assessment. Weak-to-moderate correlation was observed between baseline SUVmax and SGRQ scores in both ILD subgroups. No relationship was observed between baseline SUVmax or TBR and change in SGRQ scores over 4 years of follow-up. In the IPF subgroup, surviving patients reported a decline in QoL at 4 years post diagnosis whereas an improvement in QoL was seen in surviving patients with non-IPF ILD. CONCLUSIONS Weak-to-moderate positive correlation between baseline SUVmax and SGRQ scores was observed in both ILD subgroups (IPF:rs=0.187, p=0.047, non-IPF: rs=0.320, p=0.001). However, baseline SUVmax and TBR were not associated with change in QoL in patients with IPF and non-IPF ILD over 4 years of follow-up. At 4 years post diagnosis, surviving patients with IPF reported declining QoL whereas improvement was seen in patients with ILD who did not have IPF.
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Affiliation(s)
- Louise Helen Jordon
- University of Cambridge, Cambridge, UK
- Department of Respiratory Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Balaji Ganeshan
- University College London Institute of Nuclear Medicine, London, UK
| | - Iftikhar Nadeem
- Department of Respiratory Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Luke Hoy
- University College London Institute of Nuclear Medicine, London, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Joanna C Porter
- ILD Centre, University College London Hospital, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Ashley Groves
- University College London Institute of Nuclear Medicine, London, UK
| | - Thida Win
- Department of Respiratory Medicine, Lister Hospital, Stevenage, UK
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Liu Q, Ren Y, Jia H, Yuan H, Tong Y, Kotha S, Mao X, Huang Y, Chen C, Zheng Z, Wang L, He W. Vanadium Carbide Nanosheets with Broad-Spectrum Antioxidant Activity for Pulmonary Fibrosis Therapy. ACS NANO 2023; 17:22527-22538. [PMID: 37933888 DOI: 10.1021/acsnano.3c06105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Idiopathic pulmonary fibrosis is a chronic and highly lethal lung disease that largely results from oxidative stress; however, effective antioxidant therapy by targeting oxidative stress pathogenesis is still lacking. The big challenge is to develop an ideal antioxidant material with superior antifibrotic effects. Herein, we report that V4C3 nanosheets (NSs) can serve as a potential antioxidant for treatment of pulmonary fibrosis by scavenging reactive oxygen and nitrogen species. Interestingly, subtle autoxidation can adjust the valence composition of V4C3 NSs and significantly improve their antioxidant behavior. Valence engineering triggers multiple antioxidant mechanisms including electron transfer, H atom transfer, and enzyme-like catalysis, thus endowing V4C3 NSs with broad-spectrum, high-efficiency, and persistent antioxidant capacity. Benefiting from antioxidant properties and good biocompatibility, V4C3 NSs can significantly prevent myofibroblast proliferation and extracellular matrix abnormality, thus alleviating the progression of bleomycin-induced pulmonary fibrosis in vivo by scavenging ROS, anti-inflammation, and rebuilding antioxidant defenses. This study not only provides an important strategy for designing excellent antioxidant nanomaterials, but also proposes a proof-of-concept demonstration for the treatment of pulmonary fibrosis and other oxidative stress-related diseases.
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Affiliation(s)
- Quan Liu
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, Henan 461000, P. R. China
- School of Materials, North China University of Water Resources and Electric Power, Zhengzhou, Henan 450045, P. R. China
| | - Yaping Ren
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, Henan 461000, P. R. China
- Laboratory for NanoMedical Photonics, School of Basic Medical Science, Henan University, Zhengzhou 450046, P. R. China
| | - Huimin Jia
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, Henan 461000, P. R. China
| | - Hao Yuan
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS-HKU Joint Laboratory of Metallomics on Health and Environment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Yuping Tong
- School of Materials, North China University of Water Resources and Electric Power, Zhengzhou, Henan 450045, P. R. China
| | - Sumasri Kotha
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Xiaobo Mao
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Yongwei Huang
- Laboratory for NanoMedical Photonics, School of Basic Medical Science, Henan University, Zhengzhou 450046, P. R. China
| | - Chunying Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China
| | - Zhi Zheng
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, Henan 461000, P. R. China
| | - Liming Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS-HKU Joint Laboratory of Metallomics on Health and Environment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Weiwei He
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, Henan 461000, P. R. China
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Xiong M, Wu Z, Zhao Y, Zhao D, Pan Z, Wu X, Liu W, Hu K. Intermittent hypoxia exacerbated depressive and anxiety-like behaviors in the bleomycin-induced pulmonary fibrosis mice. Brain Res Bull 2023; 198:55-64. [PMID: 37094614 DOI: 10.1016/j.brainresbull.2023.04.008] [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: 08/09/2022] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
Depression and anxiety are prevalent in patients with idiopathic pulmonary fibrosis (IPF). Recent researchers reveal that intermittent hypoxia (IH) increases the severity of bleomycin (BLM)-induced lung injury. However, experimental studies dealing with anxiety- and depression-like behavior in animal models of BLM-induced pulmonary fibrosis in a combination of IH are lacking, hence, this study aimed to investigate that. In this study, 80 C57BL/6J male mice were intratracheally injected with BLM or normal saline at day0 and then exposed to IH (alternating cycles of FiO2 21% for 60s and FiO2 10% for 30s, 40 cycles/hour, 8hours/day) or intermittent air (IA) for 21 days. Behavioral tests, including open field test (OFT), sucrose preference test (SPT) and tail suspension test (TST), were detected from day22 to day26. This study found that pulmonary fibrosis developed and lung inflammation were activated in BLM-induced mice, which were potentiated by IH. Significant less time in center and less frequency of entries in the centre arena in OFT were observed in BLM treated mice, and IH exposure further decreased that. Marked decreased percent of sucrose preference in SPT, and significant increased immobility time of the TST were detected in BLM treated mice and IH widen the gaps. The expression of ionized calcium-binding adaptor molecule (Iba1) was activated in the hippocampus of BLM instillation mice and IH enlarged it. Moreover, a positive correlation between hippocampal microglia activation and inflammatory factors was observed. Our results demonstrated that IH exacerbated depressive and anxiety-like behaviors in the BLM-induced pulmonary fibrosis mice. The changes in pulmonary inflammation-hippocampal microglia activation may be a potential mechanism in this phenomenon, which can be researched in future.
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Affiliation(s)
- Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Zuotian Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yang Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Zhou Pan
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Xiaofeng Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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Lee JH, Park HJ, Kim S, Kim YJ, Kim HC. Epidemiology and comorbidities in idiopathic pulmonary fibrosis: a nationwide cohort study. BMC Pulm Med 2023; 23:54. [PMID: 36739401 PMCID: PMC9898951 DOI: 10.1186/s12890-023-02340-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/25/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is frequently accompanied by comorbidities, with the management of these comorbidities crucial for clinical outcomes. This study investigated the prevalence, incidence, changes over time, and clinical impact of comorbidities in IPF patients, based on nationwide claims data in South Korea. METHODS This retrospective cohort study utilised nationwide health claim data in South Korea between 2011 and 2019. Patients with IPF were defined as those with ICD-10 code J84.1 and Rare Intractable Disease code V236 who made at least one claim per year. Patients were classified by sex, age, pirfenidone use and burden of comorbidities, and differences among groups were determined. RESULTS The yearly prevalence rate of IPF increased from 7.50 to 23.20 per 100,000 people, and the yearly incidence rate increased from 3.56 to 7.91 per 100,000 person-years over time. The most common respiratory comorbidity was chronic obstructive pulmonary disease (37.34%), followed by lung cancer (3.34%), whereas the most common non-respiratory comorbidities were gastro-oesophageal reflux disease (70.83%), dyslipidaemia (62.93%) and hypertension (59.04%). The proportion of some comorbidities differed by sex, age and use of pirfenidone. The proportion of lung cancer was higher in patients treated with pirfenidone, whereas the proportion of anxiety and depression were lower in patients not treated with pirfenidone. Charlson comorbidity index ≥ 4 was associated with increases in hospitalisations and total medical costs. CONCLUSIONS The yearly prevalence and incidence of IPF and comorbidities in Korea increased over time. These comorbidities affected the use of pirfenidone and medical resources.
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Affiliation(s)
- Jang Ho Lee
- grid.267370.70000 0004 0533 4667Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Hyung Jun Park
- grid.267370.70000 0004 0533 4667Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
| | - Seonok Kim
- grid.267370.70000 0004 0533 4667Department of Clinical Epidemiology and Biostatistics, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- grid.267370.70000 0004 0533 4667Department of Clinical Epidemiology and Biostatistics, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Cheol Kim
- grid.267370.70000 0004 0533 4667Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505 Republic of Korea
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Micco A, Carpentieri E, Di Sorbo A, Chetta A, Del Donno M. Palliative care and end of life management in patients with idiopathic pulmonary fibrosis. Multidiscip Respir Med 2023; 18:896. [PMID: 36909932 PMCID: PMC9994447 DOI: 10.4081/mrm.2023.896] [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: 11/15/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic disease with an unknown etiology that causes deterioration of the structure of the lung parenchyma, resulting in a severe and progressive decline in respiratory function and early mortality. IPF is essentially an incurable disease, with a mean overall survival of 5 years in approximately 20% of patients without treatment. The combination of a poor prognosis, uncertainty about the disease's progression, and the severity of symptoms has a significant impact on the quality of life of patients and their families. New antifibrotic drugs have been shown to slow disease progression, but their impact on health-related quality of life (HRQoL) has to be proven yet. To date, studies have shown that palliative care can improve symptom management, HRQoL, and end-of-life care (EoL) in patients with IPF, reducing critical events, hospitalization, and health costs. As a result, it is essential for proper health planning and patient management to establish palliative care early and in conjunction with other therapies, beginning with the initial diagnosis of the disease.
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Affiliation(s)
| | | | | | - Alfredo Chetta
- Pneumology Clinic, Department of Medicine and Surgery, University of Parma, Italy
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O’Shea O, Murphy G, Forde L, O’Reilly KMA. A qualitative exploration of people living with idiopathic pulmonary fibrosis experience of a virtual pulmonary rehabilitation programme. BMC Pulm Med 2022; 22:448. [PMCID: PMC9702935 DOI: 10.1186/s12890-022-02221-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) is recommended in the treatment of people with idiopathic pulmonary fibrosis (IPF). Little is known about the experiences of people with IPF of PR. Due to Covid-19 there has been a rapid shift of PR services to remote/virtual delivery. Objective To explore people living with IPFs experience of a virtual PR (VPR) programme. Methods All patients with a diagnosis of IPF in a stable phase of the disease were invited to participate in virtual PR: a 10 week exercise programme delivered twice-weekly for one hour. One-to-one semi- structured interviews were conducted within one week following the programme. All interviews were recorded, transcribed and analysed using Braun and Clarke thematic analysis by two independent assessors. Results N=13 participants took part in the semi-structured interviews, mean (standard deviation (SD)) age 69.5(10.4) years; 7M:6F. Mean (SD) FEV1 2.6(0.3)L, FVC 2.9(0.4)L. Four key themes were identified: 1) The impact of VPR on health and outlook, (2) The reality of VPR, (3) Being active after VPR and (4) Living with IPF during the COVID-19 Pandemic. Participants reported high levels of enjoyment and engagement with the programme regardless of the health benefits experienced. Most participants expressed a desire for a longer programme. Participants expressed different levels of maintenance with exercise since finishing the programme, specific motivators and strategies for maintenance included lung transplant, the maintenance of benefits from the programme and social support. COVID-19 and the restrictions imposed had some negative impacts on some participants lives, engaging with PR helped overcome some of these. Conclusion Despite the progressive nature of IPF, all participants expressed high levels of enjoyment with the programme. Future research should explore strategies for maintenance post PR and the optimum duration of PR for people with IPF. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02221-6.
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Affiliation(s)
- Orlagh O’Shea
- grid.4912.e0000 0004 0488 7120School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne Murphy
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Luke Forde
- grid.417080.a0000 0004 0617 9494Wexford General Hospital, Wexford, Ireland
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Patel H, Shah JR, Patel DR, Avanthika C, Jhaveri S, Gor K. Idiopathic pulmonary fibrosis: Diagnosis, biomarkers and newer treatment protocols. Dis Mon 2022:101484. [DOI: 10.1016/j.disamonth.2022.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ahmed L, Bergot E, Prévot G, Cottin V. Ethnographic survey of patients and caregiver's life journey in idiopathic pulmonary fibrosis. Respir Med Res 2022; 83:100955. [PMID: 36634553 DOI: 10.1016/j.resmer.2022.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease associated with high mortality. The IPF journey affects patients' and caregivers' quality of life, this should be taken into account as an important parameter for a better disease management. An ethnographic study was conducted between December 2019 and January 2020 to explore social disease representations, patients' and cargivers' experiences in the disease journey and consequences in their daily life, to identify the means of actions permitting a quality of life (QoL) improvement. PATIENTS/CAREGIVERS Twenty respondents, twelve patients aged 43 to 84 years old and eight caregivers in four French regions were met. Eleven patients were diagnosed with IPF between 2013 and 2017 and one patient in 1988 (at 12 years old). The lung function reported by patients ranged as follows: forced vital capacity from 112% to 40% and diffusing capacity of the lungs for carbon monoxide (DLCO) from 66% to <20%. RESULTS The survey included patients diagnosed at least three years ago. Collected data comprised disease representation, patients'/caregivers' experience of the disease, healthcare journey, and consequences for their daily life. The first signs identified by the patient or their caregiver may not have been taken seriously by the primary care physician. The pre-diagnosis period was considered particularly traumatic for most patients. The biopsy performed in 8 cases was experienced as violent by 4/8 patients, some of whom still feel pain. Patients/caregivers knew how to define their disease and spontaneously gave severe representations of the disease such as "Rare, incurable disease", "an organ being destroyed". DISCUSSION This study highlighted patients'/caregivers' common needs at each stage of the disease. The lack of disease knowledge from frontline practitioners (general physicians, community pulmonologists) can lead to significant diagnostic error. Patients require psychological support and more information on daily aspects in disease management, such as food good practices and importance of physical activity, along with information about disease progression. The fear caused by these shortages can be reduced through contact with patients' associations. CONCLUSIONS Numerous essential data were identified and should be considered for supporting actions that could allow to improve the QoL of patients with IPF.
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Affiliation(s)
| | | | | | - Vincent Cottin
- HCL UCBL - GH Est-Hôpital Louis Pradel, 69677 BRON, France.
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Saketkoo LA, Escorpizo R, Varga J, Keen KJ, Fligelstone K, Birring SS, Alexanderson H, Pettersson H, Chaudhry HA, Poole JL, Regardt M, LeSage D, Sarver C, Lanario J, Renzoni E, Scholand MB, Lammi MR, Kowal-Bielecka O, Distler O, Frech T, Shapiro L, Varju C, Volkmann ER, Bernstein EJ, Drent M, Obi ON, Patterson KC, Russell AM. World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease. Front Pharmacol 2022; 13:979788. [PMID: 36313333 PMCID: PMC9615472 DOI: 10.3389/fphar.2022.979788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022] Open
Abstract
Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new 'Personal Factors' emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. 'pf_embarrassed by cough' or 'pf_panic/afraid when can't get a breath'. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington, VT, United States
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kevin John Keen
- Department of Mathematics and Statistics and Health Research Institute, University of Northern British Columbia, Prince George, BC, Canada
- Department of Medicine, University of British Columbia & Centre for Heart Lung Innovation, Providence Research, Vancouver, BC, Canada
| | - Kim Fligelstone
- Patient Research Partner Scleroderma & Raynaud Society, UK (SRUK) and Federation of European Scleroderma Associations, London, United Kingdom
- Royal Free Hospital Scleroderma Unit, London, United Kingdom
| | - Surinder S. Birring
- Division of Asthma, Allergy and Lung Biology, King’s College London, London, United Kingdom
| | - Helene Alexanderson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Humza Ahmad Chaudhry
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Janet L. Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, United States
| | - Malin Regardt
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Daphne LeSage
- Patient Research Partner, New Orleans, LA, United States
| | | | - Joseph Lanario
- Research Fellow in Respiratory Health—Exeter Respiratory Institute Royal Devon University Hospitals NHS Foundation Trust, Exeter, United Kingdom
| | - Elisabetta Renzoni
- Royal Brompton Hospital, National Heart and Lung Institute, London, United Kingdom
| | - Mary Beth Scholand
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Matthew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tracy Frech
- Division of Rheumatology Vanderbilt University School of Medicine, Nashville, TN, United States
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, United States
- Steffens Scleroderma Foundation, Albany, NY, United States
| | - Cecilia Varju
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pecs, Hungary
| | - Elizabeth R. Volkmann
- Department of Medicine, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elana J. Bernstein
- Department of Medicine, Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Columbia University College of Physician2s and Surgeons, New York, NY, United States
| | - Marjolein Drent
- Department of Pulmonology, Interstitial Lung Diseases (ILD) Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Nieuwegein, Netherlands
| | - Ogugua Ndili Obi
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Karen C. Patterson
- Department of Clinical & Experimental Medicine, Brighton & Sussex Medical School, Falmer, United Kingdom
- Division Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anne-Marie Russell
- Respiratory Institute to Exeter Respiratory Innovation Center, University of Exeter, Exeter, United Kingdom
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, London, United Kingdom
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
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Matsuda Y, Kosugi T, Yamanaka M, Fukumori T, Inoue A, Horiki M, Matsunuma R, Kataoka Y, Kitamura H, Kataoka K, Matsuoka H, Tokoro A, Inoue Y. Expectations of respiratory physicians from psychologists in palliative care for patients with non-cancer respiratory diseases. Respir Investig 2021; 60:309-317. [PMID: 34872885 DOI: 10.1016/j.resinv.2021.11.002] [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: 06/17/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Psychological symptoms are common in patients with non-malignant respiratory disease (NMRD). Psychologists can likely play a role in NMRD palliative care. We aimed to explore the expectations of respiratory physicians from psychologists in NMRD palliative care. METHODS An ad hoc questionnaire was developed based on a free-descriptive questionnaire survey among respiratory physicians from four hospitals in Japan. Using this questionnaire, we surveyed respiratory physicians from eight hospitals in Japan and assessed their expectations of psychologists' support and outcomes. Expectations were compared between physicians with and without experience of working with psychologists. RESULTS The quantitative questionnaire was completed by 129 physicians. Data analysis from 108 participants revealed that the highly expected support included "getting early information on patients' psychological distress" (97.2%) and "counseling family members regarding anxiety caused by changes in patient's condition" (96.3%). Physicians also expected "relief in patient's psychological distress" (96.3%) and "providing the psychological support that families need" (95.4%) from psychologists. Compared to physicians with experience of working with psychologists, those without expected more in terms of "giving specific advice on the way of communication and psychological support" (p = 0.035) and "providing psychological support for difficult-to-handle patients and families on behalf of other medical staff" (p = 0.036). CONCLUSIONS Respiratory physicians may expect relief of psychological distress experienced by patients and their families from psychologists by getting information about their distress and providing psychological support. These results may be useful for psychologists to provide palliative care for patients with NMRD in collaboration with respiratory physicians.
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan; Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
| | - Takako Kosugi
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masako Yamanaka
- Department of Nursing Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Takaki Fukumori
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Horiki
- Department of Gastroenterology and Hepatology, Itami City Hospital, Itami, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Hiroto Matsuoka
- Department of Respiratory Medicine, Osaka Habikino Medical Center, Habikino, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan; Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
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11
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Kirsten D, de Vries U, Costabel U, Koschel D, Bonella F, Günther A, Behr J, Claussen M, Schwarz S, Prasse A, Kreuter M. [Linguistic Validation of the "German Lung Fibrosis Health Related Quality of Life Questionnaire"]. Pneumologie 2021; 75:753-760. [PMID: 34428830 DOI: 10.1055/a-1334-2745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Health status and quality of life are impaired in patients with idiopathic pulmonary fibrosis (IPF) and idiopathic non-specific interstitial fibrosis (iNSIP). In Germany exists only the K-BILD questionnaire for patients with ILD 1 in a professional translation by Kreuter et al. 2 This questionnaire focuses on the main problems in patients with progressive lung fibrosis in a limited manner. Therefore a new quality of life questionnaire for patients with idiopathic pulmonary fibrosis was developed and linguistically validated. METHODS The linguistic validation of our questionnaire was carried out in a multistage process in collaboration with the developer of the questionnaire and bilingual, professional translators. Review by the developers and back translations as well as clinical assessment by IPF- and iNSIP-patients ensured that the translated questionnaire reflected the intention of the original English version of our questionnaire.Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). RESULTS The new questionnaire concerning the health status was composed in English and German language. The questions cover five scales (sensitivity, selectivity and symptoms like breathlessness and cough and a visual analog scale on general health status) with 23 items. CONCLUSIONS The results show that the FFB maps the special needs of the patients with IPF and iNSIP well and can support clinical and scientific questions and can be helpful in monitoring the clinical course.
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Affiliation(s)
| | - U de Vries
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - U Costabel
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | | | - F Bonella
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | - A Günther
- Medizinische Klinik Universität Gießen
| | - J Behr
- Medzinische Klinik und Poliklinik V, LMU Klinikum, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | | | - S Schwarz
- Asklepios Klinikum Harburg, Lungenabteilung
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Deutsches Zentrum für Lungenforschung, Heidelberg
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12
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Zinellu A, Collu C, Nasser M, Paliogiannis P, Mellino S, Zinellu E, Traclet J, Ahmad K, Mangoni AA, Carru C, Pirina P, Fois AG, Cottin V. The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis. J Clin Med 2021; 10:jcm10184134. [PMID: 34575245 PMCID: PMC8466198 DOI: 10.3390/jcm10184134] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/30/2022] Open
Abstract
Variable patterns of disease progression are typically observed in patients with idiopathic pulmonary fibrosis (IPF). We sought to determine the prognostic capacity of blood cell count indexes, derived from routine complete blood cell (CBC) count, in a cohort of IPF patients. The neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were calculated at baseline in a consecutive series of 82 IPF patients followed for four years. After adjusting for age, gender, body mass index, smoking status, and disease stage, only the AISI was significantly associated with mortality (HR 1.0013, 95% CI 1.0003–1.0023, p = 0.015). Patients with AISI <434 and ≥434 had a median survival from the diagnosis of 35.3 ± 15.2 and 26.6 ± 16.3 months (p = 0.015), and a four-year survival rate of 54% and 34%, respectively. The AISI, easily derivable from routine laboratory tests, is independently associated with mortality in patients with IPF. Prospective studies in larger cohorts are required to confirm this association.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (S.M.); (C.C.)
- Correspondence:
| | - Claudia Collu
- Department of Clinical, Surgical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (C.C.); (P.P.); (A.G.F.)
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, 69677 Lyon, France; (M.N.); (J.T.); (K.A.); (V.C.)
| | - Panagiotis Paliogiannis
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (S.M.); (C.C.)
| | - Sabrina Mellino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (S.M.); (C.C.)
| | - Elisabetta Zinellu
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy;
| | - Julie Traclet
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, 69677 Lyon, France; (M.N.); (J.T.); (K.A.); (V.C.)
| | - Kais Ahmad
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, 69677 Lyon, France; (M.N.); (J.T.); (K.A.); (V.C.)
| | - Arduino Aleksander Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (S.M.); (C.C.)
| | - Pietro Pirina
- Department of Clinical, Surgical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (C.C.); (P.P.); (A.G.F.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy;
| | - Alessandro Giuseppe Fois
- Department of Clinical, Surgical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (C.C.); (P.P.); (A.G.F.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy;
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, 69677 Lyon, France; (M.N.); (J.T.); (K.A.); (V.C.)
- Claude Bernard University Lyon 1, UMR754, IVPC, 69007 Lyon, France
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13
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Kirsten D, de Vries U, Costabel U, Koschel D, Bonella F, Günther A, Behr J, Claussen M, Schwarz S, Prasse A, Kreuter M. A New Tool to Assess Quality of Life in Patients with Idiopathic Pulmonary Fibrosis or Non-specific Interstitial Pneumonia. Pneumologie 2021; 76:25-34. [PMID: 34521147 PMCID: PMC8789482 DOI: 10.1055/a-1579-7618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background
Quality of life (QoL) is significantly impaired in patients with pulmonary fibrosis, however reliable tools to assess QoL issues specific for this group of patients are still missing. We thus aimed to develop a new questionnaire called “Quality of life in patients with idiopathic pulmonary fibrosis” (QPF) to measure QoL in patients with fibrotic idiopathic interstitial pneumonias (IIP).
Methods
An item pool was created on the basis of a German expert group with support of patients suffering from pulmonary fibrosis. In a 1st step, this version of the questionnaire was completed by 52 patients with idiopathic pulmonary fibrosis (IPF) or non-specific interstitial pneumonia (NSIP). Following this, an item- and an exploratory factor analysis was carried out and a 2nd version created. In a multicenter validation study in a one-group pre-post design, the questionnaire was filled in by 200 patients with IIP (IPF = 190, iNSIP = 10) at 2 time points with an interval of 6 months. Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ).
Results
The mean age of the patients was 71.0 years (50–90 years), 82.5 % were male. Item analysis revealed that most of Cronbach alpha and selectivity values of QPF-scales could be considered as sufficient (e. g. QPF-scale “condition” [alpha = 0.827], “impairment” [alpha = 0.882]). At scale level, there were significant differences in terms of a deterioration or improvement in the QPF-condition and QPF-breathlessness scales and also in the SGRQ-activity scale. Analysis of construct validation of QPF and SGRQ showed moderate correlations between both questionnaires. A deterioration in health status from the patient’s and doctorʼs perspective was seen in the scales “impairment”, “shortness of breath” and “health status” of the QPF. The QPF was able to detect a change in the patientʼs mood (“condition” scale) in the course of treatment.
Conclusion
This newly developed questionnaire maps the special needs of the patients well. The QPF is suitable for screening of quality of life as well as for supplementing the medical history and for monitoring the course of disease in fibrotic IIPs.
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Affiliation(s)
| | - Ulrike de Vries
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Ulrich Costabel
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | | | | | | | - Jürgen Behr
- Department of Internal Medicine V, LMU Klinikum, University of Munich and German Center for Lung Research
| | | | | | - Antje Prasse
- Medizinische Hochschule Hannover, Klinik für Pneumologie; Pneumologie und Beatmungsmedizin
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung ResearchHeidelberg, Germany
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14
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Aronson KI, Danoff SK, Russell AM, Ryerson CJ, Suzuki A, Wijsenbeek MS, Bajwah S, Bianchi P, Corte TJ, Lee JS, Lindell KO, Maher TM, Martinez FJ, Meek PM, Raghu G, Rouland G, Rudell R, Safford MM, Sheth JS, Swigris JJ. Patient-centered Outcomes Research in Interstitial Lung Disease: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e3-e23. [PMID: 34283696 PMCID: PMC8650796 DOI: 10.1164/rccm.202105-1193st] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: In the past two decades, many advances have been made to our understanding of interstitial lung disease (ILD) and the way we approach its treatment. Despite this, many questions remain unanswered, particularly those related to how the disease and its therapies impact outcomes that are most important to patients. There is currently a lack of guidance on how to best define and incorporate these patient-centered outcomes in ILD research. Objectives: To summarize the current state of patient-centered outcomes research in ILD, identify gaps in knowledge and research, and highlight opportunities and methods for future patient-centered research agendas in ILD. Methods: An international interdisciplinary group of experts was assembled. The group identified top patient-centered outcomes in ILD, reviewed available literature for each outcome, highlighted important discoveries and knowledge gaps, and formulated research recommendations. Results: The committee identified seven themes around patient-centered outcomes as the focus of the statement. After a review of the literature and expert committee discussion, we developed 28 research recommendations. Conclusions: Patient-centered outcomes are key to ascertaining whether and how ILD and interventions used to treat it affect the way patients feel and function in their daily lives. Ample opportunities exist to conduct additional work dedicated to elevating and incorporating patient-centered outcomes in ILD research.
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15
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Papadogiannis G, Bouloukaki I, Mermigkis C, Michelakis S, Ermidou C, Mauroudi E, Moniaki V, Tzanakis N, Antoniou KM, Schiza SE. Patients with idiopathic pulmonary fibrosis with and without obstructive sleep apnea: differences in clinical characteristics, clinical outcomes, and the effect of PAP treatment. J Clin Sleep Med 2021; 17:533-544. [PMID: 33108270 DOI: 10.5664/jcsm.8932] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is associated with worse mortality and clinical outcome. We aimed to assess differences between patients with IPF with and without OSA and the effect of positive airway pressure treatment on sleep and overall life quality, morbidity, and mortality in these patients. METHODS Forty-five patients with newly diagnosed IPF underwent polysomnography. Using an apnea-hypopnea index ≥ 15 events/h for OSA diagnosis resulted in 16 patients with IPF and 29 with IPF-OSA. The patients completed the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Functional Outcomes in Sleep Questionnaire, Fatigue Severity Scale, Short Form-36 life questionnaire, and Beck Depression Inventory before and at the end of the follow-up period. RESULTS Patients with IPF-OSA showed the most severe functional impairments in questionnaires, especially for General Health component of the Short Form-36 life questionnaire (37 vs 58, P = .03). At the 7-year follow-up, 16 (36%) patients had died, 6 (38%) in the IPF group and 10 (35%) in IPF-OSA group. Patients with ≥6-hour positive airway pressure use had better survival compared with patients with <6-hour use (P = .04). Significant improvement was also observed in Epworth Sleepiness Scale (3 vs 6, P = .03), Pittsburgh Sleep Quality Index (5 vs 8, P = .01), and Fatigue Severity Scale (37 vs 48, P = .008) score in patients with ≥4-hour positive airway pressure use. CONCLUSIONS OSA plays a significant role on clinical features and quality of life in patients with IPF. Effective positive airway pressure treatment results in a significant improvement in sleepiness, fatigue, sleep quality, and mortality. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: CPAP Therapy in Patients With Idiopathic Pulmonary Fibrosis and Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/record/NCT01637831; Identifier: NCT01637831.
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Affiliation(s)
- George Papadogiannis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Christina Ermidou
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Interstitial Lung Disease Unit, Pneumonology Molecular & Cellular Lab, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
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16
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Matsuda Y, Morita T, Oyamada S, Ariyoshi K, Yamaguchi T, Iwase S. Study protocol for a randomised, placebo-controlled, single-blind phase II study of the efficacy of morphine for dyspnoea in patients with interstitial lung disease (JORTC-PAL 15). BMJ Open 2021; 11:e043156. [PMID: 34006542 PMCID: PMC8130746 DOI: 10.1136/bmjopen-2020-043156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Dyspnoea is common in patients with interstitial lung disease (ILD) and often refractory to conventional treatment. Little is known about the efficacy of systemic morphine for dyspnoea in patients with ILD. The aim of this study is to estimate the efficacy of a single subcutaneous morphine injection for dyspnoea in patients with ILD. METHODS AND ANALYSIS We will conduct a multicentre, prospective, randomised, placebo-controlled, single-blinded phase II study of a single subcutaneous morphine injection for dyspnoea in patients with ILD. In patients with ILD who have dyspnoea at rest refractory to conventional treatment will be eligible for participation in this study. The morphine dose will be 2 mg. The primary endpoint is changes in dyspnoea intensity from baseline to 60 min after treatment as measured using an 11-point Numerical Rating Scale and compared between the morphine and placebo groups. ETHICS AND DISSEMINATION Ethical approval has been obtained by the Osaka City University Certified Review Board. The results of this study will be submitted for publication in an international peer-reviewed journal and the findings will be presented at international scientific conferences. TRIAL REGISTRATION NUMBER jRCTs051190030; pre-results.
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organisation Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Moroyama, Japan
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17
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Cox IA, Borchers Arriagada N, de Graaff B, Corte TJ, Glaspole I, Lartey S, Walters EH, Palmer AJ. Health-related quality of life of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/158/200154. [PMID: 33153990 DOI: 10.1183/16000617.0154-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease presenting in persons 50 years and older. Through a comprehensive review of available studies, we aimed to assess health-related quality of life (HRQoL) of people living with IPF and the instruments used in this assessment.Searches were conducted up to May, 2020. Quality appraisal and data extraction were performed using pre-designed forms. Narrative synthesis approach was used to report results of the systematic review and a random effects model was used for the meta-analysis. A leave-one-out sensitivity analysis was performed, and a trim and fill method was used to assess publication bias.The review included 134 studies. The most used instruments to measure HRQoL were St George's Respiratory Questionnaire (SGRQ), Short Form 36 (SF36) and EuroQoL (EQ5D). Standardised mean scores (95% confidence interval) for these instruments were as follows: SGRQ total score: 44.72 (42.21-47.22); SF36 physical component score (PCS): 37.00 (34.74-39.26) SF36 mental component score (MCS): 50.18 (48.41-51.95); King's Brief Interstitial Lung Disease questionnaire total score: 58.38 (55.26-61.51); and EQ5D utility: 0.73 (0.68-0.79). Analysis of standardised means for both SGRQ and SF36 demonstrated worse scores in physical health domains as compared to mental health domains.This systematic review confirms that IPF negatively affected HRQoL, mostly impacting the physical health domains. This study also demonstrated that a diverse number of instruments are used to evaluate HRQoL. In view of this diversity, a standardised approach to measurement of HRQoL for IPF is important to ensure that comparisons made are reliable.
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Affiliation(s)
- Ingrid A Cox
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia
| | | | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Tamera J Corte
- Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, The University of Sydney, Camperdown, Australia.,Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ian Glaspole
- Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia.,Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Stella Lartey
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - E Haydn Walters
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia .,Centre of Research Excellence for Pulmonary Fibrosis, Royal Prince Alfred Hospital, Camperdown, Australia.,Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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18
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Naoum P, Athanasakis K, Skroumpelos A, Kyriopoulos J. Idiopathic Pulmonary Fibrosis: Utilization of Health Services and Out-Of-Pocket Health Expenditures in Greece. Value Health Reg Issues 2020; 22:44-48. [PMID: 32777730 DOI: 10.1016/j.vhri.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Idiopathic pulmonary fibrosis (IPF) is a severe progressive disease with poor prognosis. Patients show an increased healthcare utilization pattern consisting of regular physician consultations and monitoring tests. The aim of the present study was to estimate healthcare resource utilization and out-of-pocket expenditures for IPF patients in Greece. METHODS An IPF-specific questionnaire was constructed, which focused on retrospective healthcare resource utilization and out-of-pocket expenditures within a 6-month period. Upon informed consent, the questionnaires were completed anonymously. RESULTS The study sample included 123 IPF patients. Within a 6-month period, 85.4% of the patients visited their treating physician (mean, 2.35; standard deviation [SD], 1.400), 29.4% visited other physicians for IPF-related reasons (mean, 1.90; SD, 1.595), 42.9% visited a healthcare setting, and 10.6% required hospitalization (mean duration, 2.86 days; SD, 3.338). Spirometry (98.1%) and blood tests (88.5%) were the most common tests for IPF monitoring. Almost half of the respondents (48.6%) stated they had private expenditures for IPF medication, physician visits, hospital services, medical tests, or other IPF-related reasons. CONCLUSIONS IPF management requires regular contact with healthcare services and uptake of specific medical tests. Considering the high proportion of patients bearing out-of-pocket costs, along with the decline of incomes in Greece, improvement of the disease management is important, and action should be taken to lower the financial burden imposed on patients.
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Affiliation(s)
- Panagiota Naoum
- Department of Health Economics, National School of Public Health, Athens, Greece.
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | | | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
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19
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Oliveira EPD, Medeiros Junior P. Palliative care in pulmonary medicine. ACTA ACUST UNITED AC 2020; 46:e20190280. [PMID: 32638839 PMCID: PMC7572288 DOI: 10.36416/1806-3756/e20190280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/08/2020] [Indexed: 01/07/2023]
Abstract
Palliative care was initially developed for patients with advanced cancer. The concept has evolved and now encompasses any life-threatening chronic disease. Studies carried out to compare end-of-life symptoms have shown that although symptoms such as pain and dyspnea are as prevalent in patients with lung disease as in patients with cancer, the former receive less palliative treatment than do the latter. There is a need to refute the idea that palliative care should be adopted only when curative treatment is no longer possible. Palliative care should be provided in conjunction with curative treatment at the time of diagnosis, by means of a joint decision-making process; that is, the patient and the physician should work together to plan the therapy, seeking to improve quality of life while reducing physical, psychological, and spiritual suffering.
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Wapenaar M, Bendstrup E, Molina-Molina M, Stessel MKN, Huremovic J, Bakker EW, Kardys I, Aerts JGJV, Wijsenbeek MS. The effect of the walk-bike on quality of life and exercise capacity in patients with idiopathic pulmonary fibrosis: a feasibility study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:192-202. [PMID: 33093783 PMCID: PMC7569562 DOI: 10.36141/svdld.v37i2.9433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/15/2020] [Indexed: 01/03/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by progressive loss of pulmonary function and exercise capacity, leading to loss of quality of life and often social isolation. A new walking aid, the walk-bike, showed an improvement in exercise performance in COPD patients. Aims of this pilot study were to evaluate feasibility of a homebased walk-bike intervention study in IPF patients and to explore the effect of the walk-bike on quality of life (QoL) and exercise capacity. Twenty-three patients with IPF were included in a randomized multicenter crossover study with 8 weeks of standard care and 8 weeks of walk-bike use at home. Ten patients completed both study phases. Study barriers included reluctance to participate and external factors (e.g. weather and road conditions) that hampered adherence. Patients’ satisfaction and experience with the walk-bike varied greatly. After training with the walk-bike, health-related QoL (St. George’s Respiratory and King’s Brief Interstitial Lung Disease questionnaires) demonstrated a tendency towards improvement, exercise capacity did not. A clinically important difference was found between 6-minute walk test with the walk-bike and the standard test; median (range) respectively 602 m (358-684) and 486 m (382-510). Conclusions: Due to practical barriers a larger study with the walk-bike in patients with IPF seems not feasible. Individual patients may benefit from the use of a walk-bike as it improved action radius and showed a tendency towards improvement in QoL. No effect on exercise capacity was observed. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 192-202)
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Affiliation(s)
- Monique Wapenaar
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus
| | | | - Maarten K N Stessel
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jasmina Huremovic
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Eric W Bakker
- Division Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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21
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Disease Severity and Quality of Life in Patients With Idiopathic Pulmonary Fibrosis. Chest 2020; 157:1188-1198. [DOI: 10.1016/j.chest.2019.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/20/2022] Open
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23
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Kaner RJ, Bajwa EK, El-Amine M, Gorina E, Gupta R, Lazarus HM, Luckhardt TR, Mouded M, Posada K, Richeldi L, Stauffer J, Tutuncu A, Martinez FJ. Design of Idiopathic Pulmonary Fibrosis Clinical Trials in the Era of Approved Therapies. Am J Respir Crit Care Med 2020; 200:133-139. [PMID: 30985215 DOI: 10.1164/rccm.201903-0592pp] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert J Kaner
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.,2 Department of Genetic Medicine, Weill Cornell Medicine, New York, New York
| | | | | | - Eduard Gorina
- 5 Pliant Therapeutics, Inc., South San Francisco, California
| | - Renu Gupta
- 6 Promedior, Inc., Lexington, Massachusetts
| | - Howard M Lazarus
- 7 Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Tracy R Luckhardt
- 8 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Kaity Posada
- 10 Acceleron Pharma, Inc., Cambridge, Massachusetts
| | - Luca Richeldi
- 11 Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - John Stauffer
- 12 Genentech, Inc., South San Francisco, California; and
| | | | - Fernando J Martinez
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
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24
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Kalafatis D, Gao J, Pesonen I, Carlson L, Sköld CM, Ferrara G. Gender differences at presentation of idiopathic pulmonary fibrosis in Sweden. BMC Pulm Med 2019; 19:222. [PMID: 31771560 PMCID: PMC6880431 DOI: 10.1186/s12890-019-0994-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a disease with poor prognosis mainly affecting males. Differences in clinical presentation between genders may be important both for the diagnostic work-up and for follow-up. In the present study, we therefore explored potential gender differences at presentation in a Swedish cohort of IPF-patients. Methods We studied patients included in the Swedish IPF- registry over a three-year period from its launch in 2014. A cross-sectional analysis was performed for data concerning demographics, lung function, 6- min walking test (6MWT) and quality of life (QoL) (King’s Brief Interstitial Lung Disease (K-BILD) score). Results Three hundred forty- eight patients (250 (72%) males, 98 (28%) females, median age 72 years in both genders) were included in the registry during the study period. Smoking history (N = 169 (68%) vs. N = 53 (54%), p < 0.05), baseline lung function (Forced vital capacity, % of predicted (FVC%): 68.9% ± 14.4 vs. 73.0% ± 17.7, p < 0.05; Total lung capacity, % of predicted (TLC%): 62.2% ± 11.8 vs. 68.6% ± 11.3%, p < 0.001) were significantly different at presentation between males and females, respectively. Comorbidities such as coronary artery disease (OR: 3.5–95% CI: 1.6–7.6) and other cardiovascular diseases (including atrial fibrillation and heart failure) (OR: 3.8–95% CI: 1.9–7.8) also showed significant differences between the genders. The K- BILD showed poor quality of life, but no difference was found between genders in total score (54 ± 11 vs. 54 ± 10, p = 0.61 in males vs. females, respectively). Conclusions This study shows that female patients with IPF have a more preserved lung function than males at inclusion, while males have a significant burden of cardiovascular comorbidities. However, QoL and results on the 6MWT did not differ between the groups. These gender differences may be of importance both at diagnosis and follow- up of patients with IPF.
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Affiliation(s)
- Dimitrios Kalafatis
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jing Gao
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ida Pesonen
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Carlson
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Giovanni Ferrara
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. .,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
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Pumar MI, Roll M, Fung P, Rolls TA, Walsh JR, Bowman RV, Fong KM, Yang IA. Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation. J Thorac Dis 2019; 11:S2238-S2253. [PMID: 31737351 DOI: 10.21037/jtd.2019.10.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The study aimed to determine the effects of adding cognitive behavioural therapy (CBT) to pulmonary rehabilitation to treat patients with chronic lung disease and comorbid anxiety and/or depression symptoms. Methods An open, parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. CBT was delivered in 2 face-to-face sessions and 4 phone sessions to patients with depression or anxiety undergoing pulmonary rehabilitation. The main outcome measures were change in Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI); secondary outcomes were St. Georges Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT) and pulmonary rehabilitation attendance. Results A total of 65 patients were randomized to Intervention (n=24) and Control (n=41) groups. Of the 24 patients in the Intervention group, 6 patients (25%) withdrew and 4 patients (12.5%) failed to attend more than 2 CBT sessions, which was significantly more than the Control group. The majority of patients (75.4%) had chronic obstructive pulmonary disease. Fourteen (21.5%) had symptoms of depression only, 12 (18.4%) had symptoms of anxiety only, and 39 (60.0%) had symptoms of both anxiety and depression. In the Intervention group, GDS significantly improved at the end of pulmonary rehabilitation (mean difference -3.1, 95% CI: -4.39 to -1.70; P=0.0001), 3 months follow-up (mean difference -1.5, 95% CI: -4.17 to -0.75; P=0.008), and at 12 months follow-up (mean difference -1.6, 95% CI: -3.29 to -0.03, P=0.04), compared to baseline. The Control group demonstrated improvement in GDS by the end of pulmonary rehabilitation (mean difference -1.3, 95% CI: -2.4 to -0.27; P=0.01) which was not maintained at 3 months (P=0.14) and 12 months (P=0.25). GAI significantly improved by the end of rehabilitation in both the Intervention (mean difference -2.6, 95% -4.69 to -0.57; P=0.01) and Control groups (mean difference -2.6, 95% -4.16 to -1.14; P=0.001) and there was no significant improvement at 3 and 12 months. No statistically significant differences in changes in GDS or GAI were observed between the Intervention and Control groups at any time point. There was no significant improvement in SGRQ or 6MWT. There was a significant increase in attended pulmonary rehabilitation sessions in the Intervention group, compared to the Control group (mean difference 1.59; 95% CI: 0.11 to 3.07; P=0.03). Conclusions In this RCT of patients with chronic lung diseases attending pulmonary rehabilitation, there was no evidence found for improved symptoms of anxiety or depression or health-related quality of life with the addition of CBT given in a mixed face-to-face and telephone format, compared to usual care. Slower than anticipated recruitment, leading to a smaller than planned sample size, and a high dropout rate in the group allocated to CBT may have limited the effectiveness of the behavioural intervention approach in this study.
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Affiliation(s)
- Marsus I Pumar
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Immunology and Allergy, Royal Melbourne Hospital, Victoria, Australia
| | - Mark Roll
- Physiotherapy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Pamela Fung
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tricia A Rolls
- Psychology Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - James R Walsh
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Rayleen V Bowman
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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26
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Current advances in idiopathic pulmonary fibrosis: the pathogenesis, therapeutic strategies and candidate molecules. Future Med Chem 2019; 11:2595-2620. [PMID: 31633402 DOI: 10.4155/fmc-2019-0111] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a type of chronic, progressive lung disease with unknown cause, which is characterized by increasing dyspnea and destruction of lung function with a high mortality rate. Evolving evidence demonstrated that the pathogenesis of IPF involved multiple signaling pathways such as inflammation, oxidative stress and fibrosis. However, drug discovery to prevent or revert IPF has been insufficient to cope with the development. Drug discovery targeting multiple links should be considered. In this review, we will brief the pathogenesis of IPF and discuss several small chemical entities toward the pathogenesis for IPF studied in animal models and clinical trials. The field of novel anti-IPF agents and the future directions for the prevention and treatment of IPF are detailed thoroughly discussed.
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Sköld CM, Arnheim-Dahlström L, Bartley K, Janson C, Kirchgaessler KU, Levine A, Ferrara G. Patient journey and treatment patterns in adults with IPF based on health care data in Sweden from 2001 to 2015. Respir Med 2019; 155:72-78. [DOI: 10.1016/j.rmed.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022]
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28
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Margaritopoulos GA, Kokosi MA, Wells AU. Diagnosing complications and co-morbidities of fibrotic interstitial lung disease. Expert Rev Respir Med 2019; 13:645-658. [PMID: 31215263 DOI: 10.1080/17476348.2019.1632196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Interstitial lung diseases (ILDs) represent a heterogeneous group of rare disorders that include more than 200 entities, mostly associated with high mortality. In recent years, the progress regarding the understanding of the pathogenesis of these diseases led to the approval of specific treatments. In ILDs, the presence of comorbidities has a significant impact on the quality of life and the survival of patients and, therefore, their diagnosis and treatment has a pivotal role in management and could improve overall outcome. Areas covered: We discuss key diagnostic issues with regard to the most frequent comorbidities in ILDs. Treatment options are also discussed as the decision to investigate more definitively in order to identify specific comorbidities (including lung cancer, pulmonary hypertension, GE reflux, and obstructive sleep apnoea) is critically dependent upon whether comorbidity-specific treatments are likely to be helpful in individual patients, judged on a case by case basis. Expert opinion: The extent to which clinicians proactively pursue the identification of comorbidities depends on realistic treatment goals in individual patients.
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Affiliation(s)
| | - Maria A Kokosi
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
| | - Athol U Wells
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
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29
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Graney BA, Au DH, Barón AE, Cheng A, Combs SA, Glorioso TJ, Paden G, Parsons EC, Rabin BA, Ritzwoller DP, Stonecipher JJ, Turvey C, Welsh CH, Bekelman DB. Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial to improve quality of life: a study protocol for a randomized clinical trial. Trials 2019; 20:355. [PMID: 31196156 PMCID: PMC6567600 DOI: 10.1186/s13063-019-3417-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/08/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND People living with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) suffer impaired quality of life due to burdensome symptoms and depression. The Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial aims to determine the effect of a multidisciplinary, team-based intervention on quality of life in people with these common diseases. METHODS/DESIGN The ADAPT trial is a two-site, patient-level randomized clinical trial that examines the effectiveness of the ADAPT intervention compared to usual care on patient-reported quality of life at 6 months in veterans with CHF, COPD or ILD with poor quality of life and increased risk for hospitalization or death. The ADAPT intervention involves a multidisciplinary team-a registered nurse, social worker, palliative care specialist, and primary care provider (with access to a pulmonologist and cardiologist)-who meet weekly to make recommendations and write orders for consideration by participants' individual primary care providers. The nurse and social worker interact with participants over six visits to identify and manage a primary bothersome symptom and complete a structured psychosocial intervention and advance care planning. The primary outcome is change in patient-reported quality of life at 6 months as measured by the Functional Assessment of Chronic Illness Therapy-General questionnaire. Secondary outcomes at 6 months include change in symptom distress, depression, anxiety, disease-specific quality of life hospitalizations, and advance care planning communication and documentation. Intervention implementation will be assessed using a mixed-methods approach including a qualitative assessment of participants' and intervention personnel experiences and a quantitative assessment of care delivery, resources, and cost. DISCUSSION The ADAPT trial studies an innovative intervention designed to improve quality of life for veterans with common, burdensome illnesses by targeting key underlying factors-symptoms and depression-that impair quality of life but persist despite disease-specific therapies. Leveraging the skills of affiliate health providers with physician supervision will extend the reach of palliative care and improve quality of life for those with advanced disease within routine outpatient care. The hybrid effectiveness/implementation design of the ADAPT trial will shorten the time to broader dissemination if effective and create avenues for future research. TRIAL REGISTRATION ClinicalTrials.gov, NCT02713347 . Registered March 19, 2016.
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Affiliation(s)
- Bridget A Graney
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA. .,University of Colorado Anschutz Medical Campus, Aurora, USA. .,National Jewish Health, Anschutz Medical Campus, 12700 East 19th Avenue, Research 2, 9th Floor, Box C272, Aurora, CO, 80045, USA.
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA
| | - Anna E Barón
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Cheng
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara A Combs
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas J Glorioso
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
| | - Grady Paden
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Elizabeth C Parsons
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Borsika A Rabin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | | | - Carolyn Turvey
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Center for Access and Delivery Research and Evaluation, Department of Veterans Affairs, Iowa City Health Care System, Iowa City, IA, USA
| | - Carolyn H Welsh
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
| | - David B Bekelman
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.,Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, USA
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Masefield S, Cassidy N, Ross D, Powell P, Wells A. Communication difficulties reported by patients diagnosed with idiopathic pulmonary fibrosis and their carers: a European focus group study. ERJ Open Res 2019; 5:00055-2019. [PMID: 31192248 PMCID: PMC6546939 DOI: 10.1183/23120541.00055-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023] Open
Abstract
This paper explores commonalities in the experience and unmet needs of idiopathic pulmonary fibrosis (IPF) patients and carers in Europe throughout the care pathway, focusing specifically on the unmet communication needs of patients and carers. Four patient organisations/groups in Europe held focus groups (Italy (seven patients and four carers); Belgium (six patients); Ireland (23 patients and 10 carers); and England, UK (five patients and three carers)). A focus group schedule was provided and translated into the language of each focus group by the European Lung Foundation (ELF). Content analysis was conducted by the ELF and verified by the authors of the paper. Three main themes emerged: professional-patient, professional-professional and patient-patient communication. Within these themes, eight priority areas were highlighted by two or more of the focus groups. In addition, 17 suggested action points were identified. Patients and carers in Europe have unmet communication needs, which could be met by specialist physicians and specialist centres providing more effective information and signposting to support services, including support groups and patient organisations.
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Affiliation(s)
| | | | - Derek Ross
- European Lung Foundation, Sheffield, UK.,Irish Lung Fibrosis Association, Dublin, Ireland.,Royal Brompton and Harefield Hospital, London, UK
| | | | - Athol Wells
- Royal Brompton and Harefield Hospital, London, UK
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31
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Wallaert B, Duthoit L, Drumez E, Behal H, Wemeau L, Chenivesse C, Grosbois JM. Long-term evaluation of home-based pulmonary rehabilitation in patients with fibrotic idiopathic interstitial pneumonias. ERJ Open Res 2019; 5:00045-2019. [PMID: 30972352 PMCID: PMC6452059 DOI: 10.1183/23120541.00045-2019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have examined the benefits of pulmonary rehabilitation in patients with fibrotic idiopathic pulmonary pneumonia (f-IIP). Here, we report the results of an observational study in routine clinical practice of home-based pulmonary rehabilitation for f-IIP patients. Methods A total of 112 consecutive patients (61 with idiopathic pulmonary fibrosis and 51 with fibrotic nonspecific interstitial pneumonitis) were enrolled, of whom 65 had mild-to-moderate disease (forced vital capacity (FVC) ≥50% predicted and diffusing capacity of the lung for carbon monoxide (DLCO) ≥30% predicted) and 47 had severe disease (FVC <50% predicted and/or DLCO <30% predicted). The 2-month pulmonary rehabilitation programme consisted of a once-weekly visit with retraining, therapeutic education and psychosocial support. Patients were provided with an individualised action plan and were followed-up bimonthly for 12 months. Exercise tolerance (6-min stepper test (6MST)), mood (Hospital Anxiety and Depression Scale (HADS)) and quality of life (QoL) (Visual Simplified Respiratory Questionnaire (VSRQ)) were assessed before (T0), immediately after (T2), 6 months after (T8) and 12 months after (T14) the end of the pulmonary rehabilitation programme. Results 6MST strokes, HADS Anxiety score and VSRQ score were each significantly improved at T2 (n=101), T8 (n=76) and T14 (n=62) compared with T0 values. The improvements in outcomes were not influenced by disease severity or subtype. Patients who completed the study had significantly better baseline FVC and DLCO values than those who did not. Conclusions Home-based pulmonary rehabilitation provides long-term benefits in exercise tolerance, anxiety and QoL for patients with f-IIP. Pulmonary rehabilitation should be prescribed systematically as part of the therapeutic arsenal for these patients. This 12-month follow-up study shows that home-based pulmonary rehabilitation (PR) provides long-term benefits for patients with fibrotic idiopathic interstitial pneumonias. Home-based PR offers an alternative to in-hospital or outpatient PR programmes.http://ow.ly/JVdw30nSOYz
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Affiliation(s)
- Benoit Wallaert
- CHU Lille, Hopital Calmette, Service de Pneumologie et ImmunoAllergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France.,These two authors contributed equally to this work
| | - Louise Duthoit
- CHU Lille, Hopital Calmette, Service de Pneumologie et ImmunoAllergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France.,These two authors contributed equally to this work
| | - Elodie Drumez
- CHU Lille, Dept of Biostatistics, Université de Lille, EA 2694, Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Hélène Behal
- CHU Lille, Dept of Biostatistics, Université de Lille, EA 2694, Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Lidwine Wemeau
- CHU Lille, Hopital Calmette, Service de Pneumologie et ImmunoAllergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France
| | - Cécile Chenivesse
- CHU Lille, Hopital Calmette, Service de Pneumologie et ImmunoAllergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France
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Quality of life in idiopathic pulmonary fibrosis: The impact of sleep disordered breathing. Respir Med 2019; 147:51-57. [DOI: 10.1016/j.rmed.2018.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/13/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022]
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Tudorache V, Traila D, Marc M, Oancea C, Manolescu D, Tudorache E, Timar B, Albai A, Fira-Mladinescu O. Impact of moderate to severe obstructive sleep apnea on the cognition in idiopathic pulmonary fibrosis. PLoS One 2019; 14:e0211455. [PMID: 30707735 PMCID: PMC6358087 DOI: 10.1371/journal.pone.0211455] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive lung disease with a fatal prognosis to whose rapid evolution multiple comorbidities may contribute, one of the most common being obstructive sleep apnea (OSA). There are several potential factors and conditions for the emergence of a cognitive deficit in relation to IPF or associated morbidities. Objectives The goals of this study were to assess cognition in patients with IPF in stable phase and to identify clinical cognition modifiers. Methods In a cross-sectional study, 23 patients with IPF were evaluated using Montreal Cognitive Assessment (MoCA), an instrument for detecting mild cognitive impairments and were screened for OSA through overnight cardiorespiratory polygraphy and for anxiety and depression with three specific scale (Generalized Anxiety Disorder 7-item scale: GAD-7; the Patient Health Questionnaire: PHQ-9; Hospital Anxiety and Depression Scale: HADS). Results MoCA score was lower in patients with IPF when compared to controls subjects (24 [21,26] vs. 27 [26,28], p = 0.003) but not as significantly as in COPD patients (21 [18.8,23.3], p<0.0001). OSA was diagnosed in 19 (82.6%) IPF patients, 12 patients showed the presence of moderate-severe forms (63.15%). IPF patients with cognitive impairment (MoCA<23) exhibit a higher severity of OSA (apneea hypopnea index–AHI: 33.0±19.1 vs. 12.44±8.2, p = 0.018), and a higher Epworth score (7.1±3.3 vs. 4.3±1.8, p = 0.013). Anxiety and depression scores were not correlated with MoCA results. Conclusions Impaired cognition in patients with IPF is mild and affect the areas of visuospatial abilities, language and working memory. OSA could be a possible predictor of IPF cognition deficit. Given the high prevalence of multiple types of sleep disorders in IPF patients, these should be investigated at least by cardiorespiratory polygraphy.
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Affiliation(s)
- Voicu Tudorache
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Daniel Traila
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
- * E-mail:
| | - Monica Marc
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Diana Manolescu
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Bogdan Timar
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alin Albai
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
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Rong Y, Cao B, Liu B, Li W, Chen Y, Chen H, Liu Y, Liu T. A novel Gallic acid derivative attenuates BLM-induced pulmonary fibrosis in mice. Int Immunopharmacol 2018; 64:183-191. [DOI: 10.1016/j.intimp.2018.08.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/11/2018] [Accepted: 08/18/2018] [Indexed: 01/25/2023]
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Igai Y. A narrative literature review of palliative care regarding patients with idiopathic pulmonary fibrosis. Nurs Open 2018; 5:536-545. [PMID: 30338099 PMCID: PMC6177544 DOI: 10.1002/nop2.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/27/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of this study was to examine the reported characteristics of extant studies on palliative care for patients with idiopathic pulmonary fibrosis. DESIGN Narrative review. METHODS A comprehensive search of the following electronic databases in English and Japanese commenced from 2002 - December 2017. Eligibility criteria was determined by the inclusion and exclusion criteria. RESULTS Nineteen articles were eligible. The characteristics of palliative care for patients with idiopathic pulmonary fibrosis were symptoms relief, start time of palliative care and palliative care needs of patients and care partners. Also, patients' education of disease management including advanced care planning and developing a palliative care system by the healthcare provider including multidisciplinary professional teams was identified. The care provided was a "care conference" and integrated palliative care was carried out in the patient's home. The majority of the studies were qualitative and retrospective in design. The palliative care system and the development of palliative care were limited.
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Affiliation(s)
- Yasuko Igai
- St. Luke's International UniversityTokyoJapan
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Matsuda Y, Morita T, Miyaji T, Ogawa T, Kato K, Kawaguchi T, Tokoro A, Iwase S, Yamaguchi T, Inoue Y. Morphine for Refractory Dyspnea in Interstitial Lung Disease: A Phase I Study (JORTC-PAL 05). J Palliat Med 2018; 21:1718-1723. [PMID: 30129820 DOI: 10.1089/jpm.2018.0272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Dyspnea is common in interstitial lung disease (ILD) patients and often refractory to conventional treatment. Little is known regarding the safety of systemic morphine in ILD patients. Objective: The objective of this study is to evaluate the safety of a single subcutaneous morphine injection and to determine the recommended dose of morphine for alleviating dyspnea in ILD patients. Design: We conducted a dose-escalation Phase I study for investigating the recommended dose of a single subcutaneous morphine injection to alleviate dyspnea in ILD patients. Setting/Subjects: Eligible subjects were ILD inpatients with dyspnea at rest who were refractory to conventional dyspnea treatment. The morphine doses used were 1 mg and 2 mg in cohort 1 and cohort 2, respectively. The primary endpoint was dose-limiting toxicity, which was defined as (1) respiratory depression, that is, 30% reduction of respiratory rate and 10 Torr increase of PaCO2 compared with baseline; (2) hypotension, that is, 20% reduction of systemic blood pressure compared with baseline and presentation of hypotension-related symptoms; or (3) grade 3, 4, or 5 treatment-emergent adverse events graded by Common Terminology Criteria for Adverse Events (version 4). Results: A total of six patients were enrolled, with three patients each in cohorts 1 and 2. No dose-limiting toxicities were observed; three patients experienced worsened somnolence, but no patients experienced sedation. Conclusion: We conclude that 2 mg of morphine has a tolerable safety profile in ILD patients with dyspnea, and can be tested in further clinical trials.
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
- Clincal Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Ogawa
- Department of Pharmacy, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kuniko Kato
- Department of Nursing, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
- Clincal Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Saitama, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikazu Inoue
- Clincal Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
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Cardoso AV, Pereira N, Neves I, Santos V, Jesus JM, Melo N, Mota PC, Morais A, Drummond M. Obstructive sleep apnoea in patients with fibrotic diffuse parenchymal lung disease-characterization and treatment compliance assessment. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2018; 54:35-40. [PMID: 30996642 PMCID: PMC6422053 DOI: 10.29390/cjrt-2018-005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recent studies have reported a high prevalence of obstructive sleep apnoea (OSA) among patients with diffuse parenchymal lung disease (DPLD), mainly idiopathic pulmonary fibrosis (IPF). Effective OSA treatment appears to have a positive impact on morbidity and mortality in these patients. However, poor compliance to positive airway pressure (PAP) treatment in fibrotic DPLD patients has been reported. The aims of our study were to characterize patients with fibrotic DPLD and OSA and to assess their compliance to PAP treatment. METHODS Forty-nine patients with fibrotic DPLD underwent level III polysomnography. Auto-adjusting PAP (APAP) treatment was proposed for those patients with moderate-to-severe OSA and those with mild OSA with daytime sleepiness and/or cardiovascular disease. The APAP treatment compliance was assessed after 1 month of therapy. RESULTS The distribution of the 49 fibrotic DPLD patients included was as follows: 21 with chronic hypersensitivity pneumonitis, 12 with IPF, 10 with connective-tissue associated DPLD, 4 with stage IV sarcoidosis, 1 with idiopathic pleuropulmonary fibroelastosis, and 1 with DPLD-associated vasculitis. Thirty-four (69.4%) of the patients presented with OSA; 22 had mild OSA, and 12 had moderate-to-severe OSA. APAP treatment was prescribed in 17 of the patients. After 1 month of therapy, all patients used APAP more than 70% of the nights for more than 4 h per night. CONCLUSION We found a high prevalence of OSA among all of the patients with fibrotic DPLD (not only IPF). Despite certain difficulties, it was possible to achieve good APAP compliance in these patients.
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Affiliation(s)
| | - Nuno Pereira
- Faculty of Medicine of Porto University, Oporto, Portugal
| | - Inês Neves
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Oporto, Portugal
| | - Vanessa Santos
- Pulmonology Department, Centro Hospitalar São João, Oporto, Portugal
| | - José Miguel Jesus
- Radiology Department, Centro Hospitalar de São João, Oporto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar São João, Oporto, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Department, Centro Hospitalar São João, Oporto, Portugal
- Faculty of Medicine of Porto University, Oporto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar São João, Oporto, Portugal
- Faculty of Medicine of Porto University, Oporto, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar São João, Oporto, Portugal
- Faculty of Medicine of Porto University, Oporto, Portugal
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Zhang Y, Xin Q, Wu Z, Wang C, Wang Y, Wu Q, Niu R. Application of Isobaric Tags for Relative and Absolute Quantification (iTRAQ) Coupled with Two-Dimensional Liquid Chromatography/Tandem Mass Spectrometry in Quantitative Proteomic Analysis for Discovery of Serum Biomarkers for Idiopathic Pulmonary Fibrosis. Med Sci Monit 2018; 24:4146-4153. [PMID: 29909421 PMCID: PMC6036962 DOI: 10.12659/msm.908702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The present study was performed to explore the presence of informative protein biomarkers of human serum proteome in idiopathic pulmonary fibrosis (IPF). Material/Methods Serum samples were profiled using iTRAQ coupled with two-dimensional liquid chromatography/tandem mass spectrometry (2D-LC-MS/MS) technique, and ELISA was used to validate candidate biomarkers. Results A total of 394 proteins were identified and 97 proteins were associated with IPF. Four biomarker candidates generated from iTRAQ experiments – CRP, fibrinogen-α chain, haptoglobin, and kininogen-1 – were successfully verified using ELISA. Conclusions The present study demonstrates that levels of CRP and fibrinogen-α are higher and levels of haptoglobin and kininogen-1 are lower in patients with IPF compared to levels in healthy controls. We found they are useful candidate biomarkers for IPF.
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Affiliation(s)
- Ying Zhang
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Qian Xin
- Central Laboratory, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Zhen Wu
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Chaochao Wang
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Yongbin Wang
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Qian Wu
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Rui Niu
- Department of Respiratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
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Abstract
PURPOSE OF REVIEW The palliative care needs of people with interstitial lung disease (ILD) have recently been highlighted by the National Institute for Health and Care Excellence. All people with progressive ILD should receive best supportive care to improve symptom control and quality of life and where possible this should be evidence based. RECENT FINDINGS Deaths from ILD are increasing and deaths in hospital are more common compared to home. People with ILD experience a wide range of symptoms including breathlessness and cough. People living with ILD often suffer unmet physical and psychological needs throughout the disease journey. Few appropriately validated outcome measures exist for ILD which has hampered research on the longitudinal experience of symptoms and quality of life and the evaluation of interventions. Recent recommendations from the National Institute of Clinical Excellence promote the use of a new palliative care needs assessment tool. Use of a tool in busy respiratory clinics may help to highlight those requiring specialist input. SUMMARY Further research into the role of opioids, oxygen and neuromodulatory agents in symptom management are needed. In addition, exploration of breathlessness and case conference interventions in transitioning patients from the hospital to community settings is a priority. Further work is needed to identify a core set of validated ILD-specific patient-reported outcome measures for the robust evaluation of interventions.
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Igai Y. End-of-life trajectory of coping and self-care of patients with idiopathic pulmonary fibrosis: A meta-synthesis using meta-ethnography. Jpn J Nurs Sci 2018; 16:47-61. [PMID: 29774649 DOI: 10.1111/jjns.12213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/23/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to extract patient narratives regarding the end-of-life trajectory of their self-care and coping experiences as patients with idiopathic pulmonary fibrosis and to use meta-ethnography to discover common metaphors of their experience in order to inform the development of nursing interventions. METHODS A comprehensive search of qualitative research using electronic databases, in English and Japanese, regarding patients with IPF, identified four articles. The meta-ethnography approach followed seven steps, which provided a synthesis of the phenomena from both comparative and cumulative analyses of the qualitative data. RESULTS Seven key concepts and metaphors were synthesized: (i) an extended period before obtaining a diagnosis ("Waiting for the other shoe to drop"); (ii) suffering as the pathway of illness ("Gloom and doom"); (iii) the burden of the symptoms and loss of independence ("Staggering under the load"); (iv) acceptance and living with the restrictions of home oxygen therapy ("A double-edged sword"); (v) changes in the family role ("All in the same boat"); (vi) existential suffering ("Dead-end streets and rays of hope"); and (vii) challenges to maintain independent living ("Making the best of it"). Reciprocal, refutational, and line-of-argument modes of synthesis revealed the relationships of the metaphors. Meta-ethnography provided a mechanism for a cumulative knowledge base for necessary nursing interventions. CONCLUSIONS The critical nursing interventions were: the relief of symptoms, particularly dyspnea and cough; coordinating lifestyle changes; providing psychological support for living with an illness beginning from the time of diagnosis; and carefully starting the end-of-life discussions with patients and families.
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Affiliation(s)
- Yasuko Igai
- Doctoral Program, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Sildenafil added to pirfenidone in patients with advanced idiopathic pulmonary fibrosis and risk of pulmonary hypertension: A Phase IIb, randomised, double-blind, placebo-controlled study – Rationale and study design. Respir Med 2018; 138:13-20. [DOI: 10.1016/j.rmed.2018.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/19/2023]
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Lipsi R, Mazzola D, Caminati A, Elia D, Lonati C, Harari S. Severe idiopathic pulmonary fibrosis: A clinical approach. Eur J Intern Med 2018; 50:20-27. [PMID: 29361476 DOI: 10.1016/j.ejim.2018.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating progressive disease associated with a high mortality rate. Novel antifibrotic therapies have been recently demonstrated to slow disease progression and improve survival. However, the management of IPF remains a difficult challenge, since lung complications can still occur, particularly in patients with advanced-stage disease. This paper highlights the most common complications and difficult tasks related to severe IPF such as acute exacerbation of the disease, development of lung cancer, rapid disease progression, and indication for lung transplantation.
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Affiliation(s)
- R Lipsi
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - D Mazzola
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - A Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - D Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - C Lonati
- U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - S Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy; U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
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Cuidados paliativos en la enfermedad pulmonar intersticial difusa: resultados de una encuesta de ámbito nacional. Arch Bronconeumol 2018; 54:123-127. [DOI: 10.1016/j.arbres.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
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Sgalla G, Iovene B, Calvello M, Ori M, Varone F, Richeldi L. Idiopathic pulmonary fibrosis: pathogenesis and management. Respir Res 2018; 19:32. [PMID: 29471816 PMCID: PMC5824456 DOI: 10.1186/s12931-018-0730-2] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/28/2018] [Indexed: 12/21/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive disease characterized by the aberrant accumulation of fibrotic tissue in the lungs parenchyma, associated with significant morbidity and poor prognosis. This review will present the substantial advances achieved in the understanding of IPF pathogenesis and in the therapeutic options that can be offered to patients, and will address the issues regarding diagnosis and management that are still open. Main body Over the last two decades much has been clarified about the pathogenic pathways underlying the development and progression of the lung scarring in IPF. Sustained alveolar epithelial micro-injury and activation has been recognised as the trigger of several biological events of disordered repair occurring in genetically susceptible ageing individuals. Despite multidisciplinary team discussion has demonstrated to increase diagnostic accuracy, patients can still remain unclassified when the current diagnostic criteria are strictly applied, requiring the identification of a Usual Interstitial Pattern either on high-resolution computed tomography scan or lung biopsy. Outstanding achievements have been made in the management of these patients, as nintedanib and pirfenidone consistently proved to reduce the rate of progression of the fibrotic process. However, many uncertainties still lie in the correct use of these drugs, ranging from the initial choice of the drug, the appropriate timing for treatment and the benefit-risk ratio of a combined treatment regimen. Several novel compounds are being developed in the perspective of a more targeted therapeutic approach; in the meantime, the supportive care of these patients and their carers should be appropriately prioritized, and greater efforts should be made toward the prompt identification and management of relevant comorbidities. Conclusions Building on the advances in the understanding of IPF pathobiology, the further investigation of the role of gene variants, epigenetic alterations and other molecular biomarkers reflecting disease activity and behaviour will hopefully enable earlier and more confident diagnosis, improve disease phenotyping and support the development of novel agents for personalized treatment of IPF.
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Affiliation(s)
- Giacomo Sgalla
- Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Largo A. Gemelli, 8 -00168, Rome, Italy.
| | - Bruno Iovene
- Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Largo A. Gemelli, 8 -00168, Rome, Italy
| | - Mariarosaria Calvello
- Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Largo A. Gemelli, 8 -00168, Rome, Italy
| | - Margherita Ori
- Dipartimento di Scienze Mediche e Chirurgiche, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Struttura Complessa di Malattie dell'Apparato respiratorio , Via Del Pozzo, 71-41124, Modena, Italy
| | - Francesco Varone
- Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Largo A. Gemelli, 8 -00168, Rome, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Largo A. Gemelli, 8 -00168, Rome, Italy
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Ferrara G, Luppi F, Birring SS, Cerri S, Caminati A, Sköld M, Kreuter M. Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions. Eur Respir Rev 2018; 27:27/147/170076. [PMID: 29436402 DOI: 10.1183/16000617.0076-2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 11/05/2022] Open
Abstract
Best supportive care (BSC) is generally defined as all the interventions and the multiprofessional approach aimed to improve and optimise quality of life (QoL) in patients affected by progressive diseases. In this sense, it excludes and might be complementary to other interventions directly targeting the disease. BSC improves survival in patients with different types of cancer. Patients with idiopathic pulmonary fibrosis (IPF) experience a vast range of symptoms during the natural history of the disease and might have a beneficial effect of BSC interventions. This review highlights the current evidence on interventions targeting QoL and gaps for the clinical assessment of BSC in the treatment of IPF patients. Very few interventions to improve QoL or improve symptom control are currently supported by well-designed studies. Sound methodology is paramount in evaluating BSC in IPF, as well as the use of validated tools to measure QoL and symptom control in this specific group of patients.
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Affiliation(s)
- Giovanni Ferrara
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden .,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Antonella Caminati
- Section of Respiratory Medicine, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Magnus Sköld
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Michael Kreuter
- University of Heidelberg and Center for Interstitial and Rare Lung Disease, Division of Respiratory Medicine, University of Heidelberg, Heidelberg, Germany
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Capparelli I, Fernandez M, Saadia Otero M, Steimberg J, Brassesco M, Campobasso A, Palacios S, Caro F, Alberti ML, Rabinovich RA, Paulin F. Traducción al español y validación del cuestionario Saint George específico para fibrosis pulmonar idiopática. Arch Bronconeumol 2018; 54:68-73. [DOI: 10.1016/j.arbres.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/12/2017] [Accepted: 09/18/2017] [Indexed: 01/17/2023]
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Oxygen Therapy for Interstitial Lung Disease: Physicians’ Perceptions and Experiences. Ann Am Thorac Soc 2017; 14:1772-1778. [DOI: 10.1513/annalsats.201705-372oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Magnani D, Lenoci G, Balduzzi S, Artioli G, Ferri P. Effectiveness of support groups to improve the quality of life of people with idiopathic pulmonary fibrosis a pre-post test pilot study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:5-12. [PMID: 29189700 PMCID: PMC6357579 DOI: 10.23750/abm.v88i5-s.6870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Idiopathic Pulmonary Fibrosis (IPF) is an interstitial lung disease, which progressively leads to severe disability and death. The average survival expectancy, ranges from 3 to 5 years from diagnosis, and the available medicines do not lead to healing. The progression of IPF lead to a decline in forced vital capacity (FVC), dyspnea, cough, continuous sleep interruptions, resulting in increased fatigue and deteriorating quality of life (QOL), progressive limitation of daily life activities and social life, with repercussions on psychological and emotional well-being, aggravated by anxiety, loss of sense of self-confidence and depression. The aim of the study was to evaluate how the support groups influence the psychological well-being of people with IPF and their family members. METHODS A pre-post test pilot study with a single group was conducted in a university hospital in Northern Italy, a centre for diagnosis and treatment of IPF. A support group was conducted by a nurse and entirely dedicated to people with IPF and their family members. Eighteen participants were enrolled in the support group. To measure the changes in psychological well-being was chosen the Psychological General Well-Being Index (PGWBI), which was administered at the time of enrolment to the group and after six months of attendance. RESULTS Even if the effect is not statistically significant, the paired t-test showed that the participation in a support group conducted by a nurse, could increase psychological well-being in all of its dimensions: anxiety, depression, positivity, self-control, overall health, and vitality. CONCLUSIONS Despite the null association, the increase of psychological well-being, closely related to the quality of life, indicates the need to further studies. In the absence of effective pharmacological treatments for healing, the support groups represent an opportunity for the wellbeing of the IPF patients and their caregivers.
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare pulmonary disease with a poor prognosis and severe impact on quality of life. Early diagnosis is still challenging and important delays are registered before final diagnosis can be reached. Available tools fail to predict the variable course of the disease and to evaluate response to antifibrotic drugs. Despite the recent approval of pirfenidone and nintedanib, significant challenges remain to improve prognosis and quality of life. It is hoped that the new insights gained in pathobiology in the last few years will lead to further advances in the diagnosis and management of IPF. Currently, early diagnosis and prompt initiation of treatments reducing lung function loss offer the best hope for improved outcomes. This article aims at providing an overview of recent advances in managing patients with IPF and has a particular focus on how to reach a diagnosis, manage comorbidities and lung transplantation, care for the non-pharmacological needs of patients, and address palliative care.
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Affiliation(s)
- Chiara Scelfo
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Antonella Caminati
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Sergio Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
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Karatzas E, Bourdakou MM, Kolios G, Spyrou GM. Drug repurposing in idiopathic pulmonary fibrosis filtered by a bioinformatics-derived composite score. Sci Rep 2017; 7:12569. [PMID: 28974751 PMCID: PMC5626774 DOI: 10.1038/s41598-017-12849-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022] Open
Abstract
Idiopathic Pulmonary Fibrosis (IPF) is a rare disease of the respiratory system in which the lungs stiffen and get scarred, resulting in breathing weakness and eventually leading to death. Drug repurposing is a process that provides evidence for existing drugs that may also be effective in different diseases. In this study, we present a computational pipeline having as input a number of gene expression datasets from early and advanced stages of IPF and as output lists of repurposed drugs ranked with a novel composite score. We have devised and used a scoring formula in order to rank the repurposed drugs, consolidating the standard repurposing score with structural, functional and side effects' scores for each drug per stage of IPF. The whole pipeline involves the selection of proper gene expression datasets, data preprocessing and statistical analysis, selection of the most important genes related to the disease, analysis of biological pathways, investigation of related molecular mechanisms, identification of fibrosis-related microRNAs, drug repurposing, structural and literature-based analysis of the repurposed drugs.
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Affiliation(s)
- E Karatzas
- Department of Informatics and Telecommunications, University of Athens, 15784, Ilissia Athens, Greece
| | - M M Bourdakou
- Center of Systems Biology, Biomedical Research Foundation, Academy of Athens, Soranou Ephessiou 4, 115 27, Athens, Greece
- Bioinformatics ERA Chair, The Cyprus Institute of Neurology and Genetics, 6 International Airport Avenue, Nicosia, 2370, Cyprus
| | - G Kolios
- Laboratory of Pharmacology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G M Spyrou
- Bioinformatics ERA Chair, The Cyprus Institute of Neurology and Genetics, 6 International Airport Avenue, Nicosia, 2370, Cyprus.
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