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Bevanda L, Mok V, Lin K, Assayag D, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Sadatsafavi M, Wong AW, Ryerson CJ. Validation of a Dyspnea Visual Analog Scale in Fibrotic Interstitial Lung Disease. Ann Am Thorac Soc 2024; 21:1007-1014. [PMID: 38315632 DOI: 10.1513/annalsats.202307-658oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024] Open
Abstract
Rationale: A visual analog scale (VAS) is a simple and easily administered tool for measuring the impact of disease; however, little is known about the use of a dyspnea VAS in interstitial lung disease (ILD). Objectives: To validate the use of a dyspnea VAS in a large and heterogeneous cohort of patients with fibrotic ILD, including its minimal clinically important difference (MCID), responsiveness to change, and prognostic significance. Methods: Patients with fibrotic ILD were identified from a large prospective registry. The validity of a 100-mm dyspnea VAS was assessed by testing its correlation in change score with other measures of ILD severity, including the University of California San Diego Shortness of Breath Questionnaire, the King's Brief Interstitial Lung Disease quality of life questionnaire Breathlessness and Activities Domain, the European Quality of Life VAS, forced vital capacity, and diffusing capacity of the lung for carbon monoxide. The responsiveness of the dyspnea VAS was qualitatively confirmed on the basis of there being an observable difference in the change in dyspnea VAS across tertiles of change in anchor variables. The MCID in dyspnea VAS was calculated using both anchor (linear regression) and distribution (one-half standard deviation) approaches, with anchors including the above variables that had a correlation with dyspnea VAS (|r| ≥ 0.30). The association of dyspnea VAS with time to death or transplant was determined. Results: The cohort included 826 patients with fibrotic ILD, including 127 patients with follow-up measurements at 6 months. The mean baseline dyspnea VAS was 53 ± 24 mm. Dyspnea VAS change scores were moderately correlated with the University of California San Diego Shortness of Breath Questionnaire (|r| = 0.55) and the King's Brief Interstitial Lung Disease quality of life questionnaire Breathlessness and Activities Domain (|r| = 0.44) and weakly correlated with the European Quality of Life VAS (|r| = 0.19), forced vital capacity percent predicted (|r| = 0.21), and diffusing capacity of the lung for carbon monoxide percent predicted (|r| = 0.05). The MCID was 2.7 to 4.5 using the more reliable anchor-based methods and 12.0 based on distribution-based methods. Dyspnea VAS was associated with time to death or transplant in unadjusted models and after adjustment for age and sex (hazard ratios, 1.16 and 1.15, respectively; P < 0.05 for both). Conclusions: This study provides support for the use of the dyspnea VAS in patients with fibrotic ILD, with an estimated anchor-based MCID of 5 mm.
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Affiliation(s)
| | | | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; and
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alyson W Wong
- Department of Medicine and
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine and
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
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O'Shea O, Murphy G, Fox L, O'Reilly KMA. Changes in physical activity in people with idiopathic pulmonary fibrosis before and after virtual pulmonary rehabilitation: a feasibility study. BMC Pulm Med 2024; 24:215. [PMID: 38698361 PMCID: PMC11064383 DOI: 10.1186/s12890-024-03030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is recommended for the treatment of people with idiopathic pulmonary fibrosis (IPF). Physical activity is an important health behaviour, closely linked to survival in people with IPF. Little is known about the impact of virtual (V) PR on physical activity in people with IPF. OBJECTIVE To explore the feasibility of conducting a trial to explore effect of virtual PR on objectively measured physical activity in people with IPF. METHODS All patients with a diagnosis of IPF in a stable phase of the disease were invited to participate in VPR: a 10 week exercise programme delivered twice-weekly for one hour. Data were collected at baseline (BL) and post VPR (10 weeks): Kings Brief Interstitial Lung Disease (K-BILD), Exercise capacity (6-minute walk test (6MWT) or 1-minute sit-to-stand (STS)) and Physical Activity. Physical activity was measured with a triaxial accelerometer for seven days. Screening, recruitment, adherence and safety data were collected. RESULTS 68 people were screened for this study. N = 16 participants were recruited to the study. There was one dropout. N = 15 completed VPR. All results reported in mean (standard deviation) (SD). Participants attended 18.1(2.0) of the 20 sessions. No adverse events were detected. The mean age of participants was 71.5(11.5) years, range: 47-95 years; 7 M:9 F. Mean (SD) FEV1 2.3(0.3)L, FVC 2.8(0.7)L. No statistically significant changes were observed in outcome measures apart from exercise capacity. Light physical activity increased from 152(69.4) minutes per day (n = 16) to 161.9(88.7) minutes per day (n = 14), mean change (SD) (CI) p-value: 9.9 (39.8) [-12.3 to 30.9] p = 0.4. Moderate-to-vigorous physical activity increased from 19.1(18.6) minutes per day (n = 16) to 25.7(28.3) minutes per day (n = 14), mean change (SD) (CI) p-value: 6.7 (15.5) [-2.1 to 15.1] p = 0.1. Step count increased from 3838(2847) steps per day (n = 16) to 4537(3748) steps per day (n = 14), mean change (SD) (CI) p-value: 738 (1916) [-419.3 to 1734.6] p = 0.2. K-BILD (n = 15) increased from 55.1(7.4) at BL to 55.7(7.9) post VPR mean change (SD) [95% confidence interval] (CI) p-value: 1.7(6.5) [-1.7 to 5.3], p = 0.3. 6MWT (n = 5) increased from 361.5(127.1) to 452.2(136.1) meters, mean change (SD) (CI) p-value: 63.7 (48.2) [-3.8 to 123.6], p = 0.04 and 1-minute STS increased from 17.6(3.0) (n = 11) to 23.7(6.3) (n = 10), mean change (SD) (CI) p-value 5.8 (4.6) [2.6 to 9.1], p = 0.003. CONCLUSION VPR can improve physical activity in people with IPF. A number of important feasibility issues included recruitment, retention, adherence and safety have been reported which are crucial for future research in this area. A fully powered trial is needed to determine the response of people with IPF to PR with regard to physical activity.
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Affiliation(s)
- Orlagh O'Shea
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Grainne Murphy
- Department of Physiotherapy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lynn Fox
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine M A O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Trivedi P, Patel S, Edwards G, Jenkins T, Man WDC, Nolan CM. Five-Repetition Sit-to-Stand Test: Responsiveness and Minimal Important Difference in Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2024; 21:577-584. [PMID: 37847730 PMCID: PMC10995545 DOI: 10.1513/annalsats.202306-561oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Rationale: Standing from a sitting position is an important activity of daily living. The five-repetition sit-to-stand test (5STS) is a simple physical performance test that measures the fastest time taken to stand five times from a chair with arms folded. It can be measured in most healthcare settings and at home, where traditional field walking tests may not be possible. The 5STS has been validated in community-dwelling older adults and people with chronic obstructive pulmonary disease, but data in idiopathic pulmonary fibrosis (IPF) are limited.Objectives: The aims of this cohort study were to establish the construct validity, responsiveness to pulmonary rehabilitation (PR), and minimal important difference (MID) of the 5STS in IPF.Methods: In 149 people with IPF, we compared the 5STS with measures of lung function, exercise capacity, quadriceps strength, breathlessness, and health-related quality of life. Responsiveness and effect sizes were determined by measuring the 5STS before and after PR. The MID was estimated using anchor- and distribution-based methods.Results: The 5STS correlated significantly with incremental shuttle walk test (ISW) (r = -0.55), isometric quadriceps maximum voluntary contraction (QMVC) (r = -0.45), Medical Research Council dyspnea scale score (r = 0.40), Chronic Respiratory Questionnaire-Total (r = -0.21), and King's Brief Interstitial Lung Disease Questionnaire-Total (r = -0.21) but not forced vital capacity percentage predicted or quadriceps one-repetition maximum (1RM). There was a significant but very weak correlation between change in 5STS and changes in Medical Research Council (r = 0.18), ISW (r = -0.21), and Chronic Respiratory Questionnaire-Total (r = -0.26) but no significant correlation with change in 1RM (r = -0.12) or QMVC (r = -0.18). 5STS time improved with PR (median [25th percentile, 75th percentile] change, -1.97 [-3.47, -0.62] s; P < 0.001). The effect size for the 5STS was 0.66 and higher than quadriceps 1RM, QMVC, and ISW. The mean (range) MID estimate was -1.93 (-1.85 to -2.10) seconds.Conclusions: In people with IPF, the 5STS is a valid physical performance measure that is responsive to exercise-based interventions and suitable for use in most healthcare settings.
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Affiliation(s)
- Puja Trivedi
- Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, and
| | - Suhani Patel
- Harefield Respiratory Research Group, Heart, Lung, and Critical Care Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - George Edwards
- Harefield Respiratory Research Group, Heart, Lung, and Critical Care Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Timothy Jenkins
- Harefield Respiratory Research Group, Heart, Lung, and Critical Care Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - William D.-C. Man
- Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, and
- Harefield Respiratory Research Group, Heart, Lung, and Critical Care Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Claire M. Nolan
- Harefield Respiratory Research Group, Heart, Lung, and Critical Care Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Health Sciences, College of Medicine, Health, and Life Sciences, Brunel University London, London, United Kingdom
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Sarmento A, King K, Sanchez-Ramirez DC. Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study. Life (Basel) 2024; 14:265. [PMID: 38398774 PMCID: PMC10890249 DOI: 10.3390/life14020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges. OBJECTIVES We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored. MATERIAL AND METHODS Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team. RESULTS Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64). CONCLUSIONS The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.
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Affiliation(s)
| | | | - Diana C. Sanchez-Ramirez
- Department of Respiratory Therapy, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (A.S.); (K.K.)
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Dasouki S, Quach S, Mancopes R, Mitchell SC, Goldstein R, Brooks D, Oliveira A. A Non-Pharmacological Cough Therapy for People with Interstitial Lung Diseases: A Case Report. Physiother Can 2023; 75:389-394. [PMID: 38037577 PMCID: PMC10686298 DOI: 10.3138/ptc-2021-0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 02/04/2022] [Indexed: 12/02/2023]
Abstract
Purpose To explore the feasibility of a non-pharmacological cough control therapy (CCT) customized for a client with interstitial lung disease (ILD). Client Description An 83-year-old female with hypersensitivity pneumonitis, and chronic cough for 18 years treated previously with pharmacological treatment for the underlying lung disease and gastroesophageal reflux disease, as well as lozenges and breathing and relaxation strategies. Intervention Four cough education and self-management sessions (45-60 minutes each) facilitated by a physiotherapist and speech-language pathologist via videoconference were conducted. Session topics included mechanisms of cough in ILD, breathing and larynx role in cough control, trigger identification, cough suppression and control strategies, and psychosocial support towards behaviour change using motivational interviewing. Measures and Outcome The following assessments were conducted prior to and one week after the intervention: semi-structured interviews, Leicester Cough Questionnaire, King's Brief Interstitial Lung Disease questionnaire, Functional Assessment of Chronic Illness Therapy Fatigue Scale, modified Borg Scale for severity and intensity of cough, and the Global Rating of Change Questionnaire. Implications Implementing the CCT was feasible. The client reported increased perceived cough control, a reduction in exhaustion from coughing bouts, and a better understanding of the mechanisms behind cough management and suppression. Improvements were also observed in cough-related quality of life, severity, and intensity.
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Affiliation(s)
- Sabrina Dasouki
- From the:
Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Shirley Quach
- From the:
Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Renata Mancopes
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Swallowing Rehabilitation Research Laboratory, Toronto, Ontario, Canada
| | - Sarah Chamberlain Mitchell
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Roger Goldstein
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Physical Therapy and Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- From the:
Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Physical Therapy and Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ana Oliveira
- From the:
Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Lab3R – Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
- Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
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Nolan CM, Schofield SJ, Maddocks M, Patel S, Barker RE, Walsh JA, Polgar O, George PM, Molyneaux PL, Maher TM, Cullinan P, Man WDC. Change in gait speed and adverse outcomes in patients with idiopathic pulmonary fibrosis: A prospective cohort study. Respirology 2023; 28:649-658. [PMID: 36958946 DOI: 10.1111/resp.14494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Gait speed is associated with survival in individuals with idiopathic pulmonary fibrosis (IPF). The extent to which four-metre gait speed (4MGS) decline predicts adverse outcome in IPF remains unclear. We aimed to examine longitudinal 4MGS change and identify a cut-point associated with adverse outcome. METHODS In a prospective cohort study, we recruited 132 individuals newly diagnosed with IPF and measured 4MGS change over 6 months. Death/first hospitalization at 6 months were composite outcome events. Complete data (paired 4MGS plus index event) were available in 85 participants; missing 4MGS data were addressed using multiple imputation. Receiver-Operating Curve plots identified a 4MGS change cut-point. Cox proportional-hazard regression assessed the relationship between 4MGS change and time to event. RESULTS 4MGS declined over 6 months (mean [95% CI] change: -0.05 [-0.09 to -0.01] m/s; p = 0.02). A decline of 0.07 m/s or more in 4MGS over 6 months had better discrimination for the index event than change in 6-minute walk distance, forced vital capacity, Composite Physiologic Index or Gender Age Physiology index. Kaplan-Meier curves demonstrated a significant difference in time to event between 4MGS groups (substantial decline: >-0.07 m/s versus minor decline/improvers: ≤-0.07 m/s; p = 0.007). Those with substantial decline had an increased risk of hospitalization/death (adjusted hazard ratio [95% CI] 4.61 [1.23-15.83]). Similar results were observed in multiple imputation analysis. CONCLUSION In newly diagnosed IPF, a substantial 4MGS decline over 6 months is associated with shorter time to hospitalization/death at 6 months. 4MGS change has potential as a surrogate endpoint for interventions aimed at modifying hospitalization/death.
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Affiliation(s)
- Claire M Nolan
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susie J Schofield
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Wessex Academic Health Science Network, Southampton, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Keck Medicine, University of Southern California, Los Angeles, California, USA
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College London, London, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Edwards GD, Polgar O, Patel S, Barker RE, Walsh JA, Harvey J, Man WDC, Nolan CM. Mood disorder in idiopathic pulmonary fibrosis: response to pulmonary rehabilitation. ERJ Open Res 2023; 9:00585-2022. [PMID: 37228278 PMCID: PMC10204825 DOI: 10.1183/23120541.00585-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
Background Pulmonary rehabilitation improves mood disorder in COPD, but there are limited data in idiopathic pulmonary fibrosis (IPF). The aims of this cohort study were to investigate whether pulmonary rehabilitation reduces mood disorder in IPF, and estimate the minimal important difference (MID) of the Hospital Anxiety and Depression Scale (HADS). Methods HADS and core pulmonary rehabilitation outcomes were measured in 166 participants before and after an 8-week, in-person, outpatient pulmonary rehabilitation programme. Anchor- and distribution-based methods were used to calculate the MID of HADS-Anxiety (A) and HADS-Depression (D). Results Suggestive or probable anxiety and depression (HADS ≥8) were present in 35% and 37% of participants, respectively, at baseline, and this reduced significantly following pulmonary rehabilitation (post-pulmonary rehabilitation: HADS-A 23%, HADS-D 26%). Overall, there was a significant reduction in HADS-D (mean change -1.1, 95% CI -1.6- -0.5), but not HADS-A (-0.6, -1.3-0.15) with pulmonary rehabilitation. Subgroup analysis of those with HADS ≥8 revealed significant improvements in HADS domains (mean change: HADS-A -4.5, 95% CI -5.7- -3.4; median change: HADS-D -4.0, interquartile range -6.0- -1.0). The mean (range) MID estimates for HADS-A and HADS-D were -2 (-2.3- -1.7) and -1.2 (-1.9- -0.5), respectively. Conclusion In people with IPF and suggestive or probable mood disorder, pulmonary rehabilitation reduces anxiety and depression.
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Affiliation(s)
- George D. Edwards
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Suhani Patel
- National Heart and Lung Institute, Imperial College London, London, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Ruth E. Barker
- National Heart and Lung Institute, Imperial College London, London, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Wessex Academic Health Science Network, Southampton, UK
| | - Jessica A. Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Jennifer Harvey
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - William D-C. Man
- National Heart and Lung Institute, Imperial College London, London, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- These authors contributed equally
| | - Claire M. Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Brunel University London, College of Medicine, Health and Life Sciences, Department of Health Sciences, London, UK
- These authors contributed equally
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Tikellis G, Corte T, Glaspole IN, Goh N, Khor YH, Wrobel J, Symons K, Fuhrmeister L, Glenn L, Chirayath S, Troy L, Holland AE. Understanding the telehealth experience of care by people with ILD during the COVID-19 pandemic: what have we learnt? BMC Pulm Med 2023; 23:113. [PMID: 37024848 PMCID: PMC10078026 DOI: 10.1186/s12890-023-02396-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in a rapid transformation of health services. This study aimed to understand the experiences of healthcare by people with interstitial lung disease (ILD), to inform future service delivery. METHODS Four specialist clinics in tertiary centres in Australia (Victoria:2 sites; New South Wales: 1 site; Western Australia: 1 site) recruited patients with ILD during an 8-week period from March 2021. Participants completed a COVID-specific questionnaire focused on health-related experiences during 2020. RESULTS Ninety nine (65% of 153) participants completed the questionnaire. 47% had idiopathic pulmonary fibrosis or connective tissue disease-associated ILD, 62% were female and the average age was 66 years. Whilst 56% rated their overall health in 2020 as the same as months prior, 38% indicated a worsening in health attributed to reduced physical activity and fear of contracting the virus. Access to healthcare professionals was 'good' in 61%, and 'fair-to-poor' for 37% due to missed respiratory assessments, with telehealth (mainly telephone) being perceived as less effective. 89% had contact with respiratory physicians, 68% with general practitioners, predominantly via telephone, with few video consultations. High satisfaction with care was reported by 78%, with lower satisfaction attributed to delays in assessments, disruption to usual services such as pulmonary rehabilitation, and dissatisfaction with telehealth. CONCLUSION People with ILD were generally satisfied with their care during 2020, however reduced access to healthcare professionals was challenging for those experiencing a deterioration in health. Telehealth was largely well received but did not always meet the needs of people with ILD particularly when unwell.
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Affiliation(s)
- Gabriella Tikellis
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ian N Glaspole
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole Goh
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Jeremy Wrobel
- Fiona Stanley Hospital, Perth, WA, Australia
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Lisa Fuhrmeister
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Laura Glenn
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Lauren Troy
- Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
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9
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Nakshbandi G, Moor CC, Antoniou K, Cottin V, Hoffmann-Vold AM, Koemans EA, Kreuter M, Molyneaux PL, Wuyts WA, Wijsenbeek MS. Study protocol of an international patient-led registry in patients with pulmonary fibrosis using online home monitoring: I-FILE. BMC Pulm Med 2023; 23:51. [PMID: 36732734 PMCID: PMC9893651 DOI: 10.1186/s12890-023-02336-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pulmonary fibrosis (PF) is caused by a heterogeneous group of diseases, with a high inter-individual variability in disease trajectory. Identifying disease progression in patients with PF has impact on clinical management decisions. However, strategies to early identify and predict disease progression for these patients are currently lacking. In this study, we aim to assess long-term FVC change in patients with PF measured with home spirometry, and evaluate the feasibility of a multinational patient-led registry in PF. In addition, we will assess validity of patient-reported outcomes (PROMs) for the different subgroups of patients with PF. METHODS In this international, prospective, multicenter, observational study, we aim to include 700 patients across seven European countries. Patients will monitor their disease course for a period of two years using an online home monitoring program (I-FILE), which includes home spirometry, pulse oximetry, and PROMs. Results will be directly sent to the hospital via the online application. Patients will be asked to perform daily home spirometry and pulse oximetry in the first three months, followed by once weekly measurements for a period of two years. PROMs will be completed in the online I-FILE application every six months, including the King's brief Interstitial Lung Disease Health Status, The EuroQol five dimensions five-level, Visual Analogue Scales on cough, dyspnea, fatigue and general complaints, Leicester Cough Questionnaire, Fatigue Assessment Scale, Work Productivity and Activity Impairment Questionnaire, Global Rating of Change Scale, and Living with Pulmonary Fibrosis questionnaire. DISCUSSION This study will provide much needed insights in disease trajectories of the different subgroups of patients with PF. Simultaneously, the I-FILE study will yield valuable information on the use and feasibility of home-based data collection. This international patient-led registry will facilitate trans-border collaboration to further optimize care and research for patients with PF. TRIAL REGISTRATION The study was registered on the 12th of March 2020 in the International Clinical Trial Registry, www. CLINICALTRIALS gov ; Identifier: NCT04304898.
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Affiliation(s)
- Gizal Nakshbandi
- grid.5645.2000000040459992XCentre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Catharina C. Moor
- grid.5645.2000000040459992XCentre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Katerina Antoniou
- grid.8127.c0000 0004 0576 3437Dept of Thoracic Medicine and Laboratory of Cellular and Molecular Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Vincent Cottin
- grid.413858.3Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Lyon, France ,grid.7849.20000 0001 2150 7757UMR 754, Claude Bernard University, Lyon, France
| | - Anna-Maria Hoffmann-Vold
- grid.55325.340000 0004 0389 8485Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | - Michael Kreuter
- grid.7700.00000 0001 2190 4373Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany ,grid.452624.3German Center for Lung Research, Heidelberg, Germany ,Department of Pneumology, RKH Clinics Ludwigsburg, Ludwigsburg, Germany
| | - Philip L. Molyneaux
- grid.420545.20000 0004 0489 3985Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Wim A. Wuyts
- grid.410569.f0000 0004 0626 3338Unit for Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marlies S. Wijsenbeek
- grid.5645.2000000040459992XCentre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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10
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Oliveira A, Habash R, Ellerton L, Maybank A, Alsubheen S, Marques A, Goldstein R, Brooks D. Interstitial lung diseases specific measures in exercise interventions: A systematic review of measurement properties. Ann Phys Rehabil Med 2023; 66:101682. [PMID: 35659584 DOI: 10.1016/j.rehab.2022.101682] [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: 10/21/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Effects of exercise-based interventions (EBIs) on people with interstitial lung disease (ILD) are not yet fully understood. Reasons may include the limited use of ILD-specific measures and/or the lack of adequate information regarding their measurement properties. The purpose of this review was to summarize the ILD-specific outcome measures used in EBI studies and their measurement properties. METHODS This was a two-phase systematic review: phase 1 identified ILD-specific measures used in EBI studies; phase 2 reviewed their measurement properties. PubMed, Web of Science, Scopus, EBSCO and EMBASE were searched up to March 2021. One reviewer extracted data, and 2 reviewers independently assessed studies risk of bias as well as the quality of measurement properties using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations. RESULTS Phase 1 identified 18 records. The St George's Respiratory Questionnaire for Interstitial Pulmonary Fibrosis (SGRQ-IPF) was the only ILD-specific outcome measure used (n = 2 trials). Phase 2 resulted in 31 eligible records; measurement properties were reported for 12 measures. Measures presented sufficient content validity, internal consistency (Cronbach's alpha 0.61-0.96), test-retest reliability (intraclass correlation coefficient 0.39; 0.96), hypothesis testing and responsiveness but were insufficient for measurement error and indeterminate for cross-cultural and structural validity. The outcome measures King's Brief Interstitial Lung Disease and SGRQ-IPF had higher evidence of adequate measurement properties than other measures. Quality of the evidence was mostly very low to moderate. CONCLUSIONS ILD-specific outcome measures are used infrequently in EBI trials, and there is scarce information regarding their measurement properties. DATABASE REGISTRATION CRD42018112466.
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Affiliation(s)
- Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; West Park Healthcare Centre, Toronto, Ontario, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | | | | | - Aline Maybank
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Sanaa Alsubheen
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Roger Goldstein
- West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, Physical Therapy and Rehabilitation Science Institute, University of Toronto, Ontario, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, Physical Therapy and Rehabilitation Science Institute, University of Toronto, Ontario, Canada
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11
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Shingai K, Matsuda T, Kondoh Y, Kimura T, Kataoka K, Yokoyama T, Yamano Y, Ogawa T, Watanabe F, Hirasawa J, Reid WD, Kozu R. Physical activity in idiopathic pulmonary fibrosis: Longitudinal change and minimal clinically important difference. Chron Respir Dis 2023; 20:14799731231221818. [PMID: 38108832 DOI: 10.1177/14799731231221818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Reference values of physical activity to interpret longitudinal changes are not available in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to define the minimal clinical important difference (MCID) of longitudinal changes in physical activity in patients with IPF. METHODS Using accelerometry, physical activity (steps per day) was measured and compared at baseline and 6-months follow-up in patients with IPF. We calculated MCID of daily step count using multiple anchor-based and distribution-based methods. Forced vital capacity and 6-minute walk distance were applied as anchors in anchor-based methods. Effect size and standard error of measurement were used to calculate MCID in distribution-based methods. RESULTS One-hundred and five patients were enrolled in the study (mean age: 68.5 ± 7.5 years). Step count significantly decreased from baseline to 6-months follow-up (-461 ± 2402, p = .031). MCID calculated by anchor-based and distribution-based methods ranged from 570-1358 steps. CONCLUSION Daily step count significantly declined over 6-months in patients with IPF. MCID calculated by multiple anchor-based and distribution-based methods was 570 to 1358 steps/day. These findings contribute to interpretation of the longitudinal changes of physical activity that will assist its use as a clinical and research outcome in patients with IPF.
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Affiliation(s)
- Kazuya Shingai
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Jun Hirasawa
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Ryo Kozu
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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12
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Lemmers JM, Vonk MC, van den Ende CH. Patient-reported outcomes to assess dyspnoea in interstitial lung disease and pulmonary hypertension: a systematic literature review of measurement properties. Eur Respir Rev 2022; 31:31/166/220091. [PMID: 36543348 PMCID: PMC9879339 DOI: 10.1183/16000617.0091-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This COnsensus-based Standards for the selection of health measurement INstruments (COSMIN)-based systematic review aims to identify and summarise the quality of measurement properties of dyspnoea-specific patient-reported outcome measures (PROMs) for patients with interstitial lung disease (ILD), pulmonary hypertension (PH) or connective tissue diseases (CTDs). METHODS AND RESULTS Relevant articles in PubMed and Embase were screened. Based on COSMIN analysis and the Grading of Recommendations, Assessment, Development and Evaluation approach, overall rating and level of evidence were assessed to formulate recommendations. We identified 26 publications on 10 PROMs. For patients with ILD, including CTD-associated ILD, nine PROMs were evaluated, of which the Dyspnea-12 (D12), EXACT-Respiratory Symptoms Idiopathic Pulmonary Fibrosis Breathlessness subscale (ERS-IPF-B), King's Brief Interstitial Lung Disease Health Status Questionnaire breathlessness and activities subscale (KBILD-B) and the University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) had high-quality evidence for sufficient internal consistency, without high-quality evidence of insufficient measurement properties. We reached this same conclusion regarding the D12 for use in patients with PH, including CTD-associated PH. Most PROMs in this systematic review have moderate- or low-quality evidence on construct validity and responsiveness. CONCLUSION Four dyspnoea-specific PROMs, D12, ERS-IPF-B, KBILD-B and UCSD-SOBQ, can be recommended for use in patients with ILD, including CTD-associated ILD. Of these four, the D12, despite the limited evidence and the lack of evidence on several important domains, is also suitable for use in patients with PH, including CTD-associated PH.
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Affiliation(s)
- Jacqueline M.J. Lemmers
- Dept of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands,Corresponding author: Jacqueline M.J. Lemmers ()
| | - Madelon C. Vonk
- Dept of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Agarwal R, Sehgal IS, Muthu V, Dhooria S, Prasad KT, Aggarwal AN. Estimating the minimal important difference in FEV 1for patients with allergic bronchopulmonary aspergillosis. Eur Respir J 2022; 60:13993003.01242-2022. [DOI: 10.1183/13993003.01242-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/26/2022] [Indexed: 11/05/2022]
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14
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]. Rev Mal Respir 2022; 39:e35-e106. [PMID: 35752506 DOI: 10.1016/j.rmr.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et soins intensifs respiratoires, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétence de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean-Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de pneumologie, GHRMSA, hôpital Emile-Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre-Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor-Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis-Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude-Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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15
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French practical guidelines for the diagnosis and management of idiopathic pulmonary fibrosis - 2021 update. Full-length version. Respir Med Res 2022; 83:100948. [PMID: 36630775 DOI: 10.1016/j.resmer.2022.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Since the latest 2017 French guidelines, knowledge about idiopathic pulmonary fibrosis has evolved considerably. METHODS Practical guidelines were drafted on the initiative of the Coordinating Reference Center for Rare Pulmonary Diseases, led by the French Language Pulmonology Society (SPLF), by a coordinating group, a writing group, and a review group, with the involvement of the entire OrphaLung network, pulmonologists practicing in various settings, radiologists, pathologists, a general practitioner, a health manager, and a patient association. The method followed the "Clinical Practice Guidelines" process of the French National Authority for Health (HAS), including an online vote using a Likert scale. RESULTS After a literature review, 54 guidelines were formulated, improved, and then validated by the working groups. These guidelines addressed multiple aspects of the disease: epidemiology, diagnostic procedures, quality criteria and interpretation of chest CT scans, lung biopsy indication and procedures, etiological workup, methods and indications for family screening and genetic testing, assessment of the functional impairment and prognosis, indication and use of antifibrotic agents, lung transplantation, management of symptoms, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are intended to guide the diagnosis and practical management of idiopathic pulmonary fibrosis.
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Strykowski R, Patel DC, Neto MR, Hena KM, Gulati M, Maier LIA, Patterson K. Rationale and design of the SARCoidosis Outcomes in all respiratory Viral Infectious Diseases (SARCOVID) Study. BMJ Open Respir Res 2022; 9:9/1/e001254. [PMID: 35882424 PMCID: PMC9329732 DOI: 10.1136/bmjresp-2022-001254] [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] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Respiratory infections are ubiquitous. The COVID-19 pandemic has refocused our attention on how morbid and potentially fatal they can be, and how host factors have an impact on the clinical course and outcomes. Due to a range of vulnerabilities, patients with sarcoidosis may be at higher risk of poor outcomes from respiratory infections. The objective of the SARCoidosis Outcomes in all respiratory Viral Infectious Diseases (SARCOVID) Study is to determine the short-term and long-term impacts of respiratory viral illnesses (COVID-19 and non-COVID-19) in sarcoidosis. METHODS AND ANALYSIS Up to 20 clinical sites across the USA are participating in the recruitment of 2000 patients for this observational, prospective study. To ensure that the study cohort is representative of the general population with sarcoidosis, participating sites include those dedicated to reaching under-represented minorities or patients from non-urban areas. Baseline data on demographic features, comorbidities, sarcoidosis characteristics and pre-enrolment lung function will be captured at study entry. During this 3-year study, all acute respiratory infectious events (from SARS-CoV-2 and any other respiratory pathogen) will be assessed and recorded at quarterly intervals. The level of required medical care and survival outcomes determine infection severity, and the impact of infection on quality of life measures will be recorded. Post-infection lung function and imaging results will measure the long-term impact on the trajectory of sarcoidosis. Patients will be analysed according to the clinical phenotypes of cardiac and fibrotic pulmonary sarcoidosis. Control groups include non-infected patients with sarcoidosis and patients with non-sarcoidosis interstitial lung disease. ETHICS AND DISSEMINATION Each site received local institutional review board approval prior to enrolling patients, with the consent process determined by local institution standards. Data will be published in a timely manner (goal <12 months) at the conclusion of the 3-year follow-up period and will be made available upon request.
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Affiliation(s)
- Rachel Strykowski
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Divya C Patel
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Manny Ribeiro Neto
- Pulmonary Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kerry M Hena
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University, New York, New York, USA
| | - Mridu Gulati
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - LIsa A Maier
- Divisions of Cardiology and Pulmonary Medicine, National Jewish Health, Denver, Colorado, USA
| | - Karen Patterson
- Medicine, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medicine, Brighton and Sussex Medical School, Brighton, UK
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17
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Wong AW, Koo J, Ryerson CJ, Sadatsafavi M, Chen W. A systematic review on the economic burden of interstitial lung disease and the cost-effectiveness of current therapies. BMC Pulm Med 2022; 22:148. [PMID: 35443657 PMCID: PMC9020025 DOI: 10.1186/s12890-022-01922-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background The economic burden of interstitial lung disease (ILD) is unknown, limiting informed resource allocation and planning. We sought to conduct the first systematic review on the direct, indirect, and overall costs associated with ILD and to evaluate the cost-effectiveness of current therapies globally. Methods We conducted systematic reviews of ILD disease cost studies and cost-effectiveness analyses (CEAs) using MEDLINE, Embase, and Web of Science databases between 2000 and 2020. We compared ILD costs between countries according to the share of costs towards each country’s respective gross domestic product (GDP) per capita. Costs are reported in 2020 USD. Results We identified 25 disease cost studies and 7 CEAs. The direct medical costs ranged between $1824 and $116,927 annually per patient (median $32,834; 14–180% of GDP per capita in Western countries). The leading drivers of direct costs were inpatient (55%), outpatient (22%), and medication costs (18%), based on pooled estimates. Annual indirect costs ranged from $7149 to $10,902 per employed patient (median $9607; 12–23% of GDP per capita). Among the 7 CEAs, only 1 study (14%) showed an ILD therapy (ambulatory oxygen) was cost-effective compared to best supportive care. Conclusion The direct and indirect costs associated with ILD are consistently high in all countries with available data, with cost-effectiveness profiles of new therapies generally undesirable. Globally, the median total direct cost for ILD equates to 51% of a country’s GDP per capita and has been increasing over time. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01922-2.
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Affiliation(s)
- Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, Canada. .,Centre for Heart Lung Innovation, St. Paul's Hospital, Ward 8B - Providence Wing, 1081 Burrard St., Vancouver, V6Z 1Y6, Canada.
| | - John Koo
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Ward 8B - Providence Wing, 1081 Burrard St., Vancouver, V6Z 1Y6, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Wenjia Chen
- Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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18
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Wu Z, Banya W, Chaudhuri N, Jakupovic I, Maher TM, Patel B, Spencer LG, Thillai M, West A, Westoby J, Wijsenbeek M, Smith J, Molyneaux PL. PAciFy Cough-a multicentre, double-blind, placebo-controlled, crossover trial of morphine sulphate for the treatment of pulmonary Fibrosis Cough. Trials 2022; 23:184. [PMID: 35236391 PMCID: PMC8889046 DOI: 10.1186/s13063-022-06068-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a progressive disease that leads to lung scarring. Cough is reported by 85% of patients with IPF and can be a distressing symptom with a significant impact on patients’ quality of life. There are no proven effective therapies for IPF-related cough. Whilst morphine is frequently used as a palliative agent for breathlessness in IPF, its effects on cough have never been tested. PAciFy Cough is a multicenter, double-blind, placebo-controlled, crossover trial of morphine sulphate for the treatment of cough in IPF. Methods We will recruit 44 subjects with IPF prospectively from three interstitial lung disease units in the UK, namely the Royal Brompton Hospital, Manchester University NHS Foundation Trust (MFT) and Aintree University Hospital NHS Foundation Trust. Patients will be randomised (1:1) to either placebo twice daily or morphine sulphate 5 mg twice daily for 14 days. They will then crossover after a 7-day washout period. The primary endpoint is the percent change in daytime cough frequency (coughs per hour) from baseline as assessed by objective cough monitoring at day 14 of treatment. Discussion This multicentre, randomised trial will assess the effect of opioids on cough counts and cough associated quality of life in IPF subjects. If proven to be an effective intervention, it represents a readily available treatment for patients. Trial registration The study was approved by the UK Medicines and Healthcare Regulatory Agency (Ref: CTA 21268/0224/001-0001 – EUDRACT 2019-003571-19 – Protocol Number RBH2019/001) on 08 April 2020, in compliance with the European Clinical Trials Directive and the Medicines for Human Use (Clinical Trials) Regulations 2004 and its subsequent amendments. The study was provided with ethical approval by the London Brent Research Ethics Committee (Ref: 20/LO/0368) on 21 May 2020 and is registered with clinicaltrials.gov (NCT04429516) on 12 June 2020, available at https://clinicaltrials.gov/ct2/show/NCT04429516 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06068-4.
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Affiliation(s)
- Zhe Wu
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Winston Banya
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Ira Jakupovic
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toby M Maher
- Keck School of Medicine, University of Southern California, Lon Angeles, USA
| | - Brijesh Patel
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Muhunthan Thillai
- Royal Papworth Hospital; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Westoby
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, London, UK
| | - Marlies Wijsenbeek
- Centre for Interstitial Lung Disease and Sarcoidosis, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jaclyn Smith
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Philip L Molyneaux
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
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19
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Amin R, Vaishali K, Maiya GA, Mohapatra AK, Yadav UN, Parsekar SS. Effect of home-based pulmonary rehabilitation on functional capacity in people with idiopathic pulmonary fibrosis-a systematic review protocol. Syst Rev 2021; 10:297. [PMID: 34782011 PMCID: PMC8591795 DOI: 10.1186/s13643-021-01853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is one of the common types of interstitial lung disease having high prevalence and mortality worldwide. As a result of patient-centred hindering factors of adherence to centre-based pulmonary rehabilitation (PR), home-based PR is an alternate mode of rehabilitating individuals with IPF. This systematic review will evaluate the effectiveness of unsupervised home-based PR on functional capacity and health-related quality of life (HRQoL) in individuals with IPF. METHODS Clinically stable, high resolution computed tomography and physician diagnosed IPF participants having modified Medical Research Council score below 5 will be considered for the systematic review. Studies involving home-based PR as an intervention to treat individuals with IPF will be considered. Randomised controlled trials and quasi-randomised studies (with two groups followed up) are eligible to be included. Outcomes of our interest are functional capacity (6-min walk distance, shuttle walk test and incremental shuttle walk test) and secondary outcome measure would include assessment of quality of life and adverse effects of intervention. Electronic databases such as SCOPUS, Medline (PubMed and Web of Science), PEDRo and CINAHL will be searched using database specific terms. Additionally, forward and backward citations of included studies will be searched to identify potential records. Two review authors, independently, will conduct the screening, data extraction using a customised standard tool, and critical appraisal using Cochrane Risk of Bias 2 tool of included studies. If data permits, meta-analysis will be conducted. In case of substantial heterogeneity, we will do a narrative synthesis. Subgroup analysis will be undertaken based on various contextual and interventional factors. DISCUSSION This review will provide comprehensive evidence on the effectiveness of unsupervised home-based PR to physiotherapists, policy makers and researchers who are interested in IPF management. Findings from this review may guide the development and evaluation of more robust evidence based home-based PR that aimed to improve functional capacity among people with IPF. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020213883.
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Affiliation(s)
- Revati Amin
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India.
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
| | | | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, MAHE, Manipal, India
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20
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Birring SS, Bushnell DM, Baldwin M, Mueller H, Male N, Rohr KB, Inoue Y. The psychometric properties of the King's Brief Interstitial Lung Disease questionnaire and thresholds for meaningful treatment response in patients with progressive fibrosing interstitial lung diseases. Eur Respir J 2021; 59:13993003.01790-2021. [PMID: 34764181 PMCID: PMC9160394 DOI: 10.1183/13993003.01790-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022]
Abstract
Background There is a lack of fully validated patient-reported outcome measures for progressive fibrosing interstitial lung disease (ILD). We aimed to validate the King's Brief Interstitial Lung Disease (K-BILD) questionnaire for measuring health-related quality of life (HRQoL) in these patients. We also aimed to estimate the meaningful change threshold for interpreting stabilisation of HRQoL as a clinical end-point in progressive fibrosing ILD, where the current goal of treatment is disease stability and slowing progression. Methods This analysis evaluated data from 663 patients with progressive fibrosing ILD other than idiopathic pulmonary fibrosis from the INBUILD trial. Validation of the measurement properties was assessed for internal consistency, test–retest reliability, construct validity, known-groups validity and responsiveness. We calculated meaningful change thresholds for treatment response using anchor-based (within-patient) and distribution-based methods. Results K-BILD had strong internal consistency (Cronbach's α was 0.94 for total score, 0.88 for breathlessness and activities, 0.91 for psychological, and 0.79 for chest symptoms). The test–retest reliability intraclass correlation coefficient was 0.74 for K-BILD total score. K-BILD demonstrated weak correlations with forced vital capacity (FVC) percent predicted. Known-groups validity showed significant differences in K-BILD scores for patient groups with different disease severity based on use of supplemental oxygen or baseline FVC % pred (≤70% or >70%). We estimated a meaningful change threshold of ≥ –2 units for K-BILD total score for defining patients who remain stable/improved versus those with progressive deterioration. Conclusions Our results validate K-BILD as a tool for assessing HRQoL in patients with progressive fibrosing ILD and set a meaningful change threshold of ≥ –2 units for K-BILD total score. The King's Brief Interstitial Lung Disease (K-BILD) questionnaire is a valid tool for measuring health-related quality of life in patients with progressive fibrosing ILD. The meaningful change threshold for K-BILD total score is ≥ −2 units.https://bit.ly/3v9rU0M
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Affiliation(s)
- Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences Faculty of Life Sciences & Medicine, King's College London, UK
| | | | - Michael Baldwin
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Heiko Mueller
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Natalia Male
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Klaus B Rohr
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Yoshikazu Inoue
- Clinical Research Centre, National Hospital Organization Kinki-Chuo Chest Medical Centre, Osaka, Japan
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21
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Pulmonary rehabilitation in idiopathic pulmonary fibrosis and COPD: a propensity matched real-world study. Chest 2021; 161:728-737. [PMID: 34699771 PMCID: PMC8941605 DOI: 10.1016/j.chest.2021.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/23/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The adherence to and clinical efficacy of pulmonary rehabilitation in idiopathic pulmonary fibrosis (IPF), particularly in comparison to people with chronic obstructive pulmonary disease (COPD), remains uncertain. The objectives of this real-world study were to compare the responses of patients with IPF with a matched group of patients with COPD undergoing the same supervised, outpatient pulmonary rehabilitation program, and to determine whether pulmonary rehabilitation is associated with survival in IPF. RESEARCH QUESTION Do people with IPF improve to the same extent with pulmonary rehabilitation as a matched group of individuals with COPD, and are non-completion of and/or non-response to pulmonary rehabilitation associated with one-year all-cause mortality in IPF? STUDY DESIGN AND METHODS Using propensity score matching, 163 patients with IPF were matched 1:1 with a control group of 163 patients with COPD referred to pulmonary rehabilitation. We compared between-group pulmonary rehabilitation completion rates and response. Survival status in the IPF cohort was recorded over one-year following pulmonary rehabilitation discharge. Cox proportional-hazards regression explored the association between pulmonary rehabilitation status and all-cause mortality. RESULTS Similar pulmonary rehabilitation completion rates (IPF: 69%; COPD: 63%; p=0.24) and improvements in exercise response were observed in both groups with no significant mean (95% confidence interval (CI)) between-group differences in incremental shuttle walk (ISW) change (2 (-18 to 22) meters). Pulmonary rehabilitation non-completion (hazard ratio (HR) (95%CI) 5.62 (2.24 to 14.08)) and non-response (HR (95%CI) 3.91 (1.54 to 9.93)) were independently associated with increased one-year all-cause mortality in IPF. INTERPRETATION Compared with a matched group of patients with COPD, this real-word study demonstrates that patients with IPF have similar completion rates and magnitude of response to pulmonary rehabilitation. In IPF, non-completion of and non-response to pulmonary rehabilitation were associated with increased all-cause mortality. These data reinforce the benefits of pulmonary rehabilitation in patients with IPF.
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22
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Aronson KI, Suzuki A. Health Related Quality of Life in Interstitial Lung Disease: Can We Use the Same Concepts Around the World? Front Med (Lausanne) 2021; 8:745908. [PMID: 34692737 PMCID: PMC8526733 DOI: 10.3389/fmed.2021.745908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 01/17/2023] Open
Abstract
Health-Related Quality of Life (HRQOL) is increasingly viewed as an important patient-centered outcome by leading health organizations, clinicians, and patients alike. This is especially true in the interstitial lung disease community where patients often struggle with progressive and debilitating disease with few therapeutic options. In order to test the effectiveness of new pharmacologic therapies and non-pharmacologic interventions globally in ILD, this will require expansion of clinical research studies to a multinational level and HRQOL will be an important endpoint to many. In order to successfully expand trials across multiple nations and compare the results of studies between different communities we must recognize that there are differences in the concepts of HRQOL across the world and have strategies to address these differences. In this review, we will describe the different global influences on HRQOL both generally and in the context of ILD, discuss the processes of linguistic translation and cross-cultural adaptation of HRQOL Patient Reported Outcome Measures (PROMs), and highlight the gaps and opportunities for improving HRQOL measurement in ILD across the world.
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Affiliation(s)
- Kerri I. Aronson
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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23
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Kim JW, Clark A, Birring SS, Atkins C, Whyte M, Wilson AM. Psychometric properties of patient reported outcome measures in idiopathic pulmonary fibrosis. Chron Respir Dis 2021; 18:14799731211033925. [PMID: 34609156 PMCID: PMC8495510 DOI: 10.1177/14799731211033925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Various patient reported outcome measures (PROMs) are used in idiopathic pulmonary fibrosis (IPF). We aimed to describe their psychometric properties, assess their relationship with 1-year mortality and determine their minimal clinically important differences (MCIDs). METHODS In a prospective multicentre study, participants with IPF completed the King's Brief Interstitial Lung Disease Questionnaire (K-BILD), the modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and University of California, San Diego shortness of breath questionnaire (UCSD-SOBQ) three-monthly intervals over a 12-month period. Forced vital capacity (FVC) was matched with questionnaires and mortality was captured. Anchor- and distribution-based methods were used to derive MCID. RESULTS Data were available from 238 participants. All PROMs had good internal consistency and high degree of correlations with other tools (except UCSD-SOBQ correlated poorly with FVC). There were significant associations with mortality for K-BILD (hazard ratio 16.67; 95% CI 2.38-100) and SGRQ (hazard ratio 4.65; 95% CI 1.32-16.62) but not with the other PROMs or FVC. The median MCID (range) for K-BILD was 6.3 (4.1-7.0), SGRQ was 7.0 (3.8-9.6), mMRC was 0.4 (0.1-0.5) and UCSD-SOBQ was 9.6 (4.1-14.2). CONCLUSIONS The K-BILD was related to other severity measures and had the strongest relationship with mortality.
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Affiliation(s)
- Jee Whang Kim
- Norwich Medical School, 6106University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, 6106University of East Anglia, Norwich, UK
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Moira Whyte
- The Queen's Medical Research Institute, 3124The University of Edinburgh, Edinburgh, UK
| | - Andrew M Wilson
- Norwich Medical School, 6106University of East Anglia, Norwich, UK
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24
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Gersten RA, Moale AC, Seth B, Vick JB, Brown H, Eakin MN, Mathai SC, Danoff SK. A scoping review of palliative care outcome measures in interstitial lung disease. Eur Respir Rev 2021; 30:30/161/210080. [PMID: 34348982 DOI: 10.1183/16000617.0080-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Interstitial lung disease (ILD) confers a high mortality and symptom burden, substantially impacting quality of life. Studies evaluating palliative care in ILD are rapidly expanding. Uniform outcome measures are crucial to assessing the impact of palliative care in ILD. This scoping review evaluates existing outcome measures in general health-related quality of life (HRQoL), physical health, mental health, social health and advance care planning (ACP) domains in patients with ILD. Articles in English with quantitative assessment of at least one measure of general HRQoL, physical health, mental health, social health or ACP in patients with ILD were included. Searches across three databases yielded 3488 non-duplicate articles. 23 met eligibility criteria and included three randomised controlled trials (RCTs) or secondary analysis of an RCT (13%), three cross-sectional studies or secondary analysis of cross-sectional study (13%), one prospective study (4%) and 16 retrospective studies (70%). Among eligible articles, 25 distinct instruments were identified. Six studies assessed general HRQoL (26%), 16 assessed physical health (70%), 11 assessed mental health (48%), six assessed social health (26%) and 16 assessed ACP (70%). The ability to compare results across studies remains challenging given the heterogeneity in outcome measures. Future work is needed to develop core palliative care outcome measures in ILD.
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Affiliation(s)
- Rebecca A Gersten
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA .,Joint first authors
| | - Amanda C Moale
- Dept of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.,Joint first authors
| | - Bhavna Seth
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Judith B Vick
- Dept of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hannah Brown
- Dept of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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25
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Kang M, Marts L, Kempker JA, Veeraraghavan S. Minimal clinically important difference in idiopathic pulmonary fibrosis. Breathe (Sheff) 2021; 17:200345. [PMID: 34295421 PMCID: PMC8291912 DOI: 10.1183/20734735.0345-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing lung disease with an estimated median survival of 2–5 years and a significant impact on quality of life (QoL). Current approved medications, pirfenidone and nintedanib, have shown a reduction in annual decline of forced vital capacity but no impact on QoL. The minimal clinically important difference (MCID) is a threshold value for a change in a parameter that is considered meaningful by the patient rather than solely relying on statistically significant change in the parameter. This review provides a brief overview of the MCID methodology along with detailed discussion of reported MCID values for commonly used physiological measures and patient-reported outcome measures in IPF. While there is no gold standard methodology for determining MCID, there are certain limitations in the MCID literature in IPF, mainly the choice of death, hospitalisation and pulmonary function tests as sole anchors, and pervasive use of distribution-based methods which do not take into account the patient's input. There is a critical need to identify accurate thresholds of outcome measures that reflect patient's QoL over time in order to more precisely design and evaluate future clinical trials and to develop algorithms for patient-oriented management of IPF in outpatient clinics. Minimal clinically important difference (MCID) values for common physiological and patient-reported outcome measures have been estimated in IPF, but have limitations. MCID research can help advance patient-oriented management of IPF.https://bit.ly/314Q5iH
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Affiliation(s)
- Mohleen Kang
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucian Marts
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jordan A Kempker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Srihari Veeraraghavan
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
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26
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Wong AW, Danoff SK. Providing Patient-Centered Care in Interstitial Lung Disease. Clin Chest Med 2021; 42:337-346. [PMID: 34024408 DOI: 10.1016/j.ccm.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There have been growing interest in and emphasis on health systems adopting a patient-centered care (PCC) approach, which focuses on providing care that is respectful and responsive to patient preferences, needs, and values. The features of PCC can fall into 3 domains: structure, process, and outcomes. These domains encompass the necessary infrastructure and culture required to facilitate respectful and compassionate care and patient engagement. This review discusses the features that characterize each of these PCC domains and how they can be applied specifically to clinical care and research within the field of interstitial lung disease.
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Affiliation(s)
- Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Ward 8B - 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD 21287, USA.
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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: 44] [Impact Index Per Article: 14.7] [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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Chen T, Tsai APY, Hur SA, Wong AW, Sadatsafavi M, Fisher JH, Johannson KA, Assayag D, Morisset J, Shapera S, Khalil N, Fell CD, Manganas H, Cox G, To T, Gershon AS, Hambly N, Halayko AJ, Wilcox PG, Kolb M, Ryerson CJ. Validation and minimum important difference of the UCSD Shortness of Breath Questionnaire in fibrotic interstitial lung disease. Respir Res 2021; 22:202. [PMID: 34238283 PMCID: PMC8265065 DOI: 10.1186/s12931-021-01790-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
RATIONALE The University of California, San Diego Shortness of Breath Questionnaire (UCSDSOBQ) is a frequently used domain-specific dyspnea questionnaire; however, there is little information available regarding its use and minimum important difference (MID) in fibrotic interstitial lung disease (ILD). We aimed to describe the key performance characteristics of the UCSDSOBQ in this population. METHODS UCSDSOBQ scores and selected anchors were measured in 1933 patients from the prospective multi-center Canadian Registry for Pulmonary Fibrosis. Anchors included the St. George's Respiratory Questionnaire (SGRQ), European Quality of Life 5 Dimensions 5 Levels questionnaire (EQ-5D-5L) and EQ visual analogue scale (EQ-VAS), percent-predicted forced vital capacity (FVC%), diffusing capacity of the lung for carbon monoxide (DLCO%), and 6-min walk distance (6MWD). Concurrent validity, internal consistency, ceiling and floor effects, and responsiveness were assessed, followed by estimation of the MID by anchor-based (linear regression) and distribution-based methods (standard error of measurement). RESULTS The UCSDSOBQ had a high level of internal consistency (Cronbach's alpha = 0.97), no obvious floor or ceiling effect, strong correlations with SGRQ, EQ-5D-5L, and EQ-VAS (|r| > 0.5), and moderate correlations with FVC%, DLCO%, and 6MWD (0.3 < |r| < 0.5). The MID estimate for UCSDSOBQ was 5 points (1-8) for the anchor-based method, and 4.5 points for the distribution-based method. CONCLUSION This study demonstrates the validity of UCSDSOBQ in a large and heterogeneous population of patients with fibrotic ILD, and provides a robust MID estimate of 5-8 points.
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Affiliation(s)
- Tao Chen
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Amy Po Yu Tsai
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seo Am Hur
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Julie Morisset
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Gerard Cox
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nathan Hambly
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Andrew J Halayko
- Departments of Internal Medicine and Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada. .,Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, 8B Providence Wing, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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29
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Nolan CM, Patel S, Barker RE, Walsh JA, Polgar O, Maddocks M, George PM, Renzoni EA, Wells AU, Molyneaux PL, Kouranos V, Chua F, Maher TM, Man WDC. Muscle stimulation in advanced idiopathic pulmonary fibrosis: a randomised placebo-controlled feasibility study. BMJ Open 2021; 11:e048808. [PMID: 34083348 PMCID: PMC8174518 DOI: 10.1136/bmjopen-2021-048808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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
OBJECTIVES To assess the acceptability of neuromuscular electrical stimulation (NMES) of the quadriceps muscles in people with idiopathic pulmonary fibrosis (IPF) and to identify whether a future definitive trial is feasible. DESIGN A randomised, parallel, two-group, participant and assessor-blinded, placebo-controlled feasibility trial with embedded qualitative interviews. SETTING Outpatient department, Royal Brompton and Harefield Hospitals. PARTICIPANTS Twenty-two people with IPF: median (25th, 75th centiles) age 76 (74, 82) years, forced vital capacity 62 (50, 75) % predicted, 6 min walk test distance 289 (149, 360) m. INTERVENTIONS Usual care (home-based exercise, weekly telephone support, breathlessness management leaflet) with either placebo or active NMES for 6 weeks, with follow-up at 6 and 12 weeks. PRIMARY OUTCOME MEASURES Feasibility of recruitment and retention, treatment uptake and adherence, outcome assessments, participant and outcome assessor blinding and adverse events related to interventions. SECONDARY OUTCOME MEASURES Outcome measures with potential to be primary or secondary outcomes in a definitive clinical trial. In addition, purposively sampled participants were interviewed to capture their experiences and acceptability of the trial. RESULTS Out of 364 people screened, 23 were recruited: 11 were allocated to each group and one was withdrawn prior to randomisation. Compared with the control group, a greater proportion of the intervention group completed the intervention, remained in the trial blinded to group allocation and experienced intervention-related adverse events. Assessor blinding was maintained. The secondary outcome measures were feasible with most missing data associated with the accelerometer. Small participant numbers precluded identification of an outcome measure suitable for a definitive trial. Qualitative findings demonstrated that trial process and active NMES were acceptable but there were concerns about the credibility of placebo NMES. CONCLUSIONS Primarily owing to recruitment difficulties, a definitive trial using the current protocol to evaluate NMES in people with IPF is not feasible. TRIAL REGISTRATION NUMBER NCT03499275.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elisabetta A Renzoni
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athol U Wells
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vasilis Kouranos
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felix Chua
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Keck Medicine, University of Southern California, Los Angeles, California, USA
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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30
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Kalluri M, Luppi F, Vancheri A, Vancheri C, Balestro E, Varone F, Mogulkoc N, Cacopardo G, Bargagli E, Renzoni E, Torrisi S, Calvello M, Libra A, Pavone M, Bonella F, Cottin V, Valenzuela C, Wijsenbeek M, Bendstrup E. Patient-reported outcomes and patient-reported outcome measures in interstitial lung disease: where to go from here? Eur Respir Rev 2021; 30:30/160/210026. [PMID: 34039675 PMCID: PMC9488962 DOI: 10.1183/16000617.0026-2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/02/2021] [Indexed: 12/03/2022] Open
Abstract
Patient-reported outcome measures (PROMs), tools to assess patient self-report of health status, are now increasingly used in research, care and policymaking. While there are two well-developed disease-specific PROMs for interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF), many unmet and urgent needs remain. In December 2019, 64 international ILD experts convened in Erice, Italy to deliberate on many topics, including PROMs in ILD. This review summarises the history of PROMs in ILD, shortcomings of the existing tools, challenges of development, validation and implementation of their use in clinical trials, and the discussion held during the meeting. Development of disease-specific PROMs for ILD including IPF with robust methodology and validation in concordance with guidance from regulatory authorities have increased user confidence in PROMs. Minimal clinically important difference for bidirectional changes may need to be developed. Cross-cultural validation and linguistic adaptations are necessary in addition to robust psychometric properties for effective PROM use in multinational clinical trials. PROM burden of use should be reduced through appropriate use of digital technologies and computerised adaptive testing. Active patient engagement in all stages from development, testing, choosing and implementation of PROMs can help improve probability of success and further growth. PROMs are essential tools for research and care in ILD and IPF. They report patient perceptions of the impact of disease and its treatments on whole-person wellbeing and can guide research to make care more patient-centred.https://bit.ly/3s7Y0a8
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Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada .,Shared first and last authorship
| | - Fabrizio Luppi
- Respiratory Diseases Unit, University of Milano-Bicocca. "S. Gerardo" Hospital, Monza, Italy.,Shared first and last authorship
| | - Ada Vancheri
- Regional Referral Center for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", Catania, Italy
| | - Carlo Vancheri
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Elisabetta Balestro
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesco Varone
- UOC Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Nesrin Mogulkoc
- Dept of Pulmonology, Ege University Hospiral, Bornova, Izmir, Turkey
| | - Giulia Cacopardo
- UOSD UTIR, A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Siena University, Siena, Italy
| | - Elizabeth Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Sebastiano Torrisi
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | | | - Alessandro Libra
- Regional Referral Center for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", Catania, Italy
| | - Mauro Pavone
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Bonella
- Pneumology Dept, Centre for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Vincent Cottin
- Dept of Respiratory Medicine, National Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,University of Lyon, INRAE, IVPC, Lyon, France
| | - Claudia Valenzuela
- Pulmonology Dept, Hospital Universitario de la Princesa, Universidad Autonoma Madrid, Madrid, Spain.,Shared first and last authorship
| | - Marlies Wijsenbeek
- Centre of excellence, Interstitial Lung Diseases and Sarcoidosis, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Shared first and last authorship
| | - Elisabeth Bendstrup
- Dept of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Shared first and last authorship
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31
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Jacobs SS, Krishnan JA, Lederer DJ, Ghazipura M, Hossain T, Tan AYM, Carlin B, Drummond MB, Ekström M, Garvey C, Graney BA, Jackson B, Kallstrom T, Knight SL, Lindell K, Prieto-Centurion V, Renzoni EA, Ryerson CJ, Schneidman A, Swigris J, Upson D, Holland AE. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e121-e141. [PMID: 33185464 PMCID: PMC7667898 DOI: 10.1164/rccm.202009-3608st] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.
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32
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Moor CC, Mostard RLM, Grutters JC, Bresser P, Aerts JGJV, Chavannes NH, Wijsenbeek MS. Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis. A Randomized Controlled Trial. Am J Respir Crit Care Med 2020; 202:393-401. [DOI: 10.1164/rccm.202002-0328oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Catharina C. Moor
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rémy L. M. Mostard
- Department of Respiratory Medicine, Zuyderland Medical, Heerlen, the Netherlands
| | - Jan C. Grutters
- Department of Pulmonology, Interstitial Lung Diseases Centre of Excellence, St. Antonius Hospital, Nieuwegein, the Netherlands
- Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul Bresser
- Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; and
| | | | - Niels H. Chavannes
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Center, Leiden, the Netherlands
| | - Marlies S. Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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33
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Prior TS, Hoyer N, Hilberg O, Shaker SB, Davidsen JR, Bendstrup E. Responsiveness and minimal clinically important difference of SGRQ-I and K-BILD in idiopathic pulmonary fibrosis. Respir Res 2020; 21:91. [PMID: 32316976 PMCID: PMC7175493 DOI: 10.1186/s12931-020-01359-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/12/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) specific version of St. George's Respiratory Questionnaire (SGRQ-I) and King's Brief Interstitial Lung Disease questionnaire (K-BILD) are validated health-related quality of life (HRQL) instruments, but no or limited data exist on their responsiveness and minimal clinically important difference (MCID). The objectives of this study were to assess responsiveness of SGRQ-I and K-BILD and determine MCID separately for deterioration and improvement in a large, prospective cohort of patients with IPF in a real-world setting. METHODS Consecutive patients with IPF were recruited. SGRQ-I, K-BILD, SGRQ, Shortness of Breath Questionnaire, pulmonary function tests and 6-min walk test measurements were obtained at baseline and at six and 12 months; at six and 12 months, patients also completed Global Rating of Change Scales. Responsiveness was assessed using correlation coefficients and linear regression. Cox regression was used for mortality analyses. MCID was estimated using receiver operating characteristic curves with separate analyses for improvement and deterioration. RESULTS A total of 150 IPF patients were included and 124 completed the 12-month follow-up. Based on all HRQL anchors and most physiological anchors, responsiveness analyses supported the evidence pointing towards SGRQ-I and K-BILD as responsive instruments. Multivariate analyses showed an association between SGRQ-I and mortality (HR: 1.18, 95% CI: 1.02 to 1.36, p = 0.03) and a trend was found for K-BILD (HR: 0.82, 95% CI: 0.64 to 1.05, p = 0.12). MCID was estimated for all domains of SGRQ-I and K-BILD. MCID for improvement differed from deterioration for both SGRQ-I Total (3.9 and 4.9) and K-BILD Total (4.7 and 2.7). CONCLUSIONS SGRQ-I and K-BILD were responsive to change concerning both HRQL and most physiological anchors. MCID was determined separately for improvement and deterioration, resulting in different estimates; especially a smaller estimate for deterioration compared to improvement in K-BILD. TRIAL REGISTRATION Clinicaltrials.gov, no. NCT02818712. Registered 30 June 2016.
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Affiliation(s)
- Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Nils Hoyer
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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34
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George PM, Wells AU. Contemporary Concise Review 2019: Interstitial lung disease. Respirology 2020; 25:756-763. [PMID: 32187808 DOI: 10.1111/resp.13803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/04/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Peter M George
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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35
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Flaherty KR, Wells AU, Cottin V, Devaraj A, Walsh SLF, Inoue Y, Richeldi L, Kolb M, Tetzlaff K, Stowasser S, Coeck C, Clerisme-Beaty E, Rosenstock B, Quaresma M, Haeufel T, Goeldner RG, Schlenker-Herceg R, Brown KK. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med 2019; 381:1718-1727. [PMID: 31566307 DOI: 10.1056/nejmoa1908681] [Citation(s) in RCA: 1172] [Impact Index Per Article: 234.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preclinical data have suggested that nintedanib, an intracellular inhibitor of tyrosine kinases, inhibits processes involved in the progression of lung fibrosis. Although the efficacy of nintedanib has been shown in idiopathic pulmonary fibrosis, its efficacy across a broad range of fibrosing lung diseases is unknown. METHODS In this double-blind, placebo-controlled, phase 3 trial conducted in 15 countries, we randomly assigned patients with fibrosing lung disease affecting more than 10% of lung volume on high-resolution computed tomography (CT) to receive nintedanib at a dose of 150 mg twice daily or placebo. All the patients met criteria for progression of interstitial lung disease in the past 24 months despite treatment and had a forced vital capacity (FVC) of at least 45% of the predicted value and a diffusing capacity of the lung for carbon monoxide ranging from 30 to less than 80% of the predicted value. Randomization was stratified according to the fibrotic pattern (a pattern of usual interstitial pneumonia [UIP] or other fibrotic patterns) on high-resolution CT. The primary end point was the annual rate of decline in the FVC, as assessed over a 52-week period. The two primary populations for analysis were the overall population and patients with a UIP-like fibrotic pattern. RESULTS A total of 663 patients were treated. In the overall population, the adjusted rate of decline in the FVC was -80.8 ml per year with nintedanib and -187.8 ml per year with placebo, for a between-group difference of 107.0 ml per year (95% confidence interval [CI], 65.4 to 148.5; P<0.001). In patients with a UIP-like fibrotic pattern, the adjusted rate of decline in the FVC was -82.9 ml per year with nintedanib and -211.1 ml per year with placebo, for a difference of 128.2 ml (95% CI, 70.8 to 185.6; P<0.001). Diarrhea was the most common adverse event, as reported in 66.9% and 23.9% of patients treated with nintedanib and placebo, respectively. Abnormalities on liver-function testing were more common in the nintedanib group than in the placebo group. CONCLUSIONS In patients with progressive fibrosing interstitial lung diseases, the annual rate of decline in the FVC was significantly lower among patients who received nintedanib than among those who received placebo. Diarrhea was a common adverse event. (Funded by Boehringer Ingelheim; INBUILD ClinicalTrials.gov number, NCT02999178.).
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Affiliation(s)
- Kevin R Flaherty
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Athol U Wells
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Vincent Cottin
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Anand Devaraj
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Simon L F Walsh
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Yoshikazu Inoue
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Luca Richeldi
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Martin Kolb
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Kay Tetzlaff
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Susanne Stowasser
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Carl Coeck
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Emmanuelle Clerisme-Beaty
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Bernd Rosenstock
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Manuel Quaresma
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Thomas Haeufel
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Rainer-Georg Goeldner
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Rozsa Schlenker-Herceg
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
| | - Kevin K Brown
- From the Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor (K.R.F.); the National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust (A.U.W.), the National Heart and Lung Institute, Imperial College (A.U.W., A.D., S.L.F.W.), and the Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust (A.D.) - all in London; the National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Unité Mixte de Recherche 754, Lyon, France (V.C.); the Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan (Y.I.); Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome (L.R.); McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada (M.K.); Boehringer Ingelheim International, Ingelheim am Rhein (K.T., S.S., E.C.-B., M.Q., T.H.), the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.), and Boehringer Ingelheim Pharma, Biberach (B.R., R.-G.G.) - all in Germany; Boehringer Ingelheim, Brussels (C.C.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.S.-H.); and the Department of Medicine, National Jewish Health, Denver (K.K.B.)
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