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Dimakopoulou K, Tomos I, Manali ED, Papiris SA, Karakatsani A. Effects of short-term air pollution exposure on symptoms development in the course of idiopathic pulmonary fibrosis. Expert Rev Respir Med 2023; 17:1069-1078. [PMID: 37937867 DOI: 10.1080/17476348.2023.2281992] [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: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Lately a potential detrimental effect of air pollution to idiopathic pulmonary fibrosis emerged. We aimed to assess the effects of short-term air pollution exposure to the clinical course of IPF. RESEARCH DESIGN AND METHODS IPF patients were followed intensively for four nonconsecutive study periods between 13 July 2020 and 5 September 2021. Short-term exposure to O3, NO2 and PM10 concentrations was estimated using spatio-temporal land use regression models. Associations among symptoms, lung function, oxygen saturation, and short-term personal air pollutant exposure were assessed through multiple mixed effects logistic regression models. RESULTS Data for up to 24 IPF patients (mean age: 72.2 ± 7.6 years) were analyzed. We detected positive significant associations between cough and a 10 μg/m3 increase in same day mean level of NO2 (OR = 1.59, 95%CI: 1.00-2.53), PM10 (OR = 2.42, 95%CI: 1.54-3.79), and O3 (OR = 1.63, 95%CI: 1.14-2.32). A 10 μg/m3 increase in same day mean level of NO2 was also associated with the risk of appearance of wheezing (OR = 3.01, 95%CI: 1.00-9.04), while exposure to O3 was associated with common cold (OR = 6.30, 95%CI: 3.59-11.07). No significant associations were detected between short-term exposure to air pollutants and forced vital capacity or saturation of oxygen. CONCLUSIONS Short-term exposure to increased concentrations of air pollutants is an independent risk factor for IPF symptoms' aggravation.
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Affiliation(s)
- Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Tomos
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
| | - Spyros A Papiris
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
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Papiris SA, Kolilekas L, Kagouridis K, Maniati M, Manali ED. IPF-Acute Exacerbations: Advances and Future Perspectives. Front Pharmacol 2022; 13:836553. [PMID: 35496286 PMCID: PMC9047939 DOI: 10.3389/fphar.2022.836553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/15/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Spyros A. Papiris
- 2ndPulmonary Medicine Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Spyros A. Papiris,
| | | | - Konstantinos Kagouridis
- 2ndPulmonary Medicine Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2ndPulmonary Medicine Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Effrosyni D. Manali
- 2ndPulmonary Medicine Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Scala R, Guidelli L. Clinical Value of Bronchoscopy in Acute Respiratory Failure. Diagnostics (Basel) 2021; 11:diagnostics11101755. [PMID: 34679452 PMCID: PMC8534926 DOI: 10.3390/diagnostics11101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopy may be considered the “added value” in the diagnostic and therapeutic pathway of different clinical scenarios occurring in acute respiratory critically ill patients. Rigid bronchoscopy is mainly employed in emergent clinical situations due to central airways obstruction, haemoptysis, and inhaled foreign body. Flexible bronchoscopy (FBO) has larger fields of acute applications. In intensive care settings, FBO is useful to facilitate intubation in difficult airways, guide percutaneous dilatational tracheostomy, and mucous plugs causing lobar/lung atelectasis. FBO plays a central diagnostic role in acute respiratory failure caused by intra-thoracic tumors, interstitial lung diseases, and suspected severe pneumonia. “Bronchoscopic” sampling has to be considered when “non-invasive” techniques are not diagnostic in suspected ventilator-associated pneumonia and in non-ventilated immunosuppressed patients. The combined use of either noninvasive ventilation (NIV) or High-flow nasal cannula (HFNC) with bronchoscopy is useful in different scenarios; the largest body of proven successful evidence has been found for NIV-supported diagnostic FBO in non-ventilated high risk patients to prevent and avoid intubation. The expected diagnostic/therapeutic goals of acute bronchoscopy should be balanced against the potential severe risks (i.e., cardio-pulmonary complications, bleeding, and pneumothorax). Expertise of the team is fundamental to achieve the best rate of success with the lowest rate of complications of diagnostic and therapeutic bronchoscopic procedures in acute clinical circumstances.
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Tomos I, Dimakopoulou K, Manali ED, Papiris SA, Karakatsani A. Long-term personal air pollution exposure and risk for acute exacerbation of idiopathic pulmonary fibrosis. Environ Health 2021; 20:99. [PMID: 34461906 PMCID: PMC8406600 DOI: 10.1186/s12940-021-00786-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/20/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Urban air pollution is involved in the progress of idiopathic pulmonary fibrosis (IPF). Its potential role on the devastating event of Acute Exacerbation of IPF (AE-IPF) needs to be clarified. This study examined the association between long-term personal air pollution exposure and AE- IPF risk taking into consideration inflammatory mediators and telomere length (TL). METHODS All consecutive IPF-patients referred to our Hospital from October 2013-June 2019 were included. AE-IPF events were recorded and inflammatory mediators and TL measured. Long-term personal air pollution exposures were assigned to each patient retrospectively, for O3, NO2, PM2.5 [and PM10, based on geo-coded residential addresses. Logistic regression models assessed the association of air pollutants' levels with AE-IPF and inflammatory mediators adjusting for potential confounders. RESULTS 118 IPF patients (mean age 72 ± 8.3 years) were analyzed. We detected positive significant associations between AE-IPF and a 10 μg/m3 increase in previous-year mean level of NO2 (OR = 1.52, 95%CI:1.15-2.0, p = 0.003), PM2.5 (OR = 2.21, 95%CI:1.16-4.20, p = 0.016) and PM10 (OR = 2.18, 95%CI:1.15-4.15, p = 0.017) independent of age, gender, smoking, lung function and antifibrotic treatment. Introduction of TL in all models of a subgroup of 36 patients did not change the direction of the observed associations. Finally, O3 was positively associated with %change of IL-4 (p = 0.014) whilst PM2.5, PM10 and NO2 were inversely associated with %changes of IL-4 (p = 0.003, p = 0.003, p = 0.032) and osteopontin (p = 0.013, p = 0.013, p = 0.085) respectively. CONCLUSIONS Long-term personal exposure to increased concentrations of air pollutants is an independent risk factor of AE-IPF. Inflammatory mediators implicated in lung repair mechanisms are involved.
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Affiliation(s)
- Ioannis Tomos
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, “ATTIKON” University Hospital, 1, Rimini street, 12462 Haidari, Greece
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Effrosyni D. Manali
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, “ATTIKON” University Hospital, 1, Rimini street, 12462 Haidari, Greece
| | - Spyros A. Papiris
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, “ATTIKON” University Hospital, 1, Rimini street, 12462 Haidari, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, “ATTIKON” University Hospital, 1, Rimini street, 12462 Haidari, Greece
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Papiris SA, Bouros D, Markopoulou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Fouka E, Papakosta D, Daniil Z, Steiropoulos P, Gogali A, Papanikolaou IC, Xyfteri A, Haritou A, Korbila I, Tomos IP, Loukides S, Bellelli R, Kounti G, Rampiadou C, Karampitsakos T, Dimeas I, Kirgou P, Bompoki A, Vasarmidi E, Loverdos K, Antonogiannaki EM, Blizou M, Bouros E, Kagouridis K, Maniati M, Karakatsani A, Antoniou KM, Manali ED. Early COVID-19 lockdown in Greece and idiopathic pulmonary fibrosis: a beneficial "impact" beyond any expectation. Eur Respir J 2021; 57:13993003.03111-2020. [PMID: 33334934 DOI: 10.1183/13993003.03111-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Eva Fouka
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paschalis Steiropoulos
- Dept of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Athina Gogali
- Dept of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ioanna Korbila
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rita Bellelli
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kounti
- Pulmonary Dept, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Theodoros Karampitsakos
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Ilias Dimeas
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Andromachi Bompoki
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Elvira-Markela Antonogiannaki
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Blizou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina M Antoniou
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,These authors contributed equally to this work
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally to this work
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Tomos I, Karakatsani A, Manali ED, Kottaridi C, Spathis A, Argentos S, Papiris SA. Telomere length across different UIP fibrotic-Interstitial Lung Diseases: a prospective Greek case-control study. Pulmonology 2020; 28:254-261. [PMID: 33358512 DOI: 10.1016/j.pulmoe.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Short telomeres are recognized as risk factor for idiopathic pulmonary fibrosis (IPF). We aimed to assess the role of telomere length (TL) in fibrotic-Interstitial Lung Diseases (f-ILDs) associated with a usual interstitial pneumonia (UIP) pattern as well as in IPF acute exacerbation (IPF-AE). AIM AND METHODS TL was measured from peripheral white blood cells using a multiplex quantitative polymerase chain reaction in consecutive patients with f-ILDs, all presenting UIP pattern in the high-resolution chest-computed-tomography and compared to age-matched healthy controls. RESULTS Seventy-nine individuals were included (mean age 69.77 ± 0.72 years); 24 stable IPF, 18 IPF-AE, 10 combined pulmonary fibrosis and emphysema, 7 Rheumatoid arthritis-UIP-ILDs and 20 controls. TL in all patients was significantly shorter compared to controls [mean T/S ratio (SE) 0.77 (±0.05) vs 2.26 (±0.36), p < 0.001] as well as separately in each one of f-ILD subgroups. IPF-AE patients presented significantly shorter TL compared to stable IPF (p = 0.029). Patients with IPF and shorter than the median TL (0-0.72) showed reduced overall survival (p = 0.004). T/S < 0.72 was associated with increased risk for IPF-AE (OR = 30.787, 95% CI: 2.153, 440.183, p = 0.012) independent of age, gender, smoking and lung function impairment. A protective effect of TL was observed, as it was inversely associated with risk of death both in UIP-f-ILDs (HR = 0.174, 95%CI: 0.036, 0.846, p = 0.030) and IPF patients (HR = 0.096, 95%CI: 0.011, 0.849, p = 0.035). CONCLUSIONS Shorter TL characterizes different UIP f-ILDs. Although no difference was observed in TL among diverse UIP subgroups, IPF-AE presented shorter TL compared to stable IPF. Reduced overall survival and higher hazard ratio of death are associated with shorter TL in IPF.
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Affiliation(s)
- I Tomos
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - A Karakatsani
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - E D Manali
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - C Kottaridi
- 2nd Department of Cytopathology, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - A Spathis
- 2nd Department of Cytopathology, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - S Argentos
- 2nd Department of Radiology, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
| | - S A Papiris
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Greece.
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Mosher CL, Mentz RJ. Cardiovascular implications of idiopathic pulmonary fibrosis: A way forward together? Am Heart J 2020; 226:69-74. [PMID: 32521292 DOI: 10.1016/j.ahj.2020.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease has an increased prevalence among patients with idiopathic pulmonary fibrosis (IPF). Cardiovascular disease and IPF share similar symptoms with overlapping demographics and risk factors for disease development. Common cellular mediators leading to disease development and progression have been identified in both the cardiovascular and pulmonary organ systems. In this context, discovery of new therapeutic targets and medical therapies could be mutually beneficial across cardiopulmonary diseases. Here we present (1) a clinical review of IPF for the cardiovascular clinician and (2) common cellular mechanisms responsible for fibrosis in the heart and lungs and (3) highlight future research considerations and the potential role of novel therapeutic agents which may be mutually beneficial in cardiac and pulmonary fibrosis.
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Sotgia S, Fois AG, Sotgiu E, Zinellu A, Paliogiannis P, Mangoni AA, Carru C. Micellar electrokinetic capillary chromatographic determination of pirfenidone and 5-carboxy-pirfenidone by direct injection of plasma from patients receiving treatment for idiopathic pulmonary fibrosis (IPF). Microchem J 2020. [DOI: 10.1016/j.microc.2019.104536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhu C, Wu Y, Liu H, Ban Y, Ma X, Zhang Z. Early pulmonary rehabilitation for SARS-CoV-2 pneumonia: Experience from an intensive care unit outside of the Hubei province in China. Heart Lung 2020; 49:449-450. [PMID: 32312554 PMCID: PMC7161510 DOI: 10.1016/j.hrtlng.2020.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Chengrui Zhu
- Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, North Nanjing Street 155, Shenyang 110001, Liaoning Province, China
| | - Yunhai Wu
- Department of Critical Care Medicine, The Sixth People' s Hospital of Shenyang, South Heping Street 85,Shenyang, Liaoning Province, China
| | - Hongyan Liu
- Department of infection, The Sixth People' s Hospital of Shenyang, South Heping Street 85,Shenyang, Liaoning Province, China
| | - Yuan Ban
- Department of Critical Care Medicine, The Sixth People' s Hospital of Shenyang, South Heping Street 85,Shenyang, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, North Nanjing Street 155, Shenyang 110001, Liaoning Province, China.
| | - Zhidan Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, North Nanjing Street 155, Shenyang 110001, Liaoning Province, China.
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Spagnolo P, Molyneaux PL, Bernardinello N, Cocconcelli E, Biondini D, Fracasso F, Tiné M, Saetta M, Maher TM, Balestro E. The Role of the Lung's Microbiome in the Pathogenesis and Progression of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2019; 20:E5618. [PMID: 31717661 PMCID: PMC6888416 DOI: 10.3390/ijms20225618] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease that commonly affects older adults and is associated with the histopathological and/or radiological patterns of usual interstitial pneumonia (UIP). Despite significant advances in our understanding of disease pathobiology and natural history, what causes IPF remains unknown. A potential role for infection in the disease's pathogenesis and progression or as a trigger of acute exacerbation has long been postulated, but initial studies based on traditional culture methods have yielded inconsistent results. The recent application to IPF of culture-independent techniques for microbiological analysis has revealed previously unappreciated alterations of the lung microbiome, as well as an increased bacterial burden in the bronchoalveolar lavage (BAL) of IPF patients, although correlation does not necessarily entail causation. In addition, the lung microbiome remains only partially characterized and further research should investigate organisms other than bacteria and viruses, including fungi. The clarification of the role of the microbiome in the pathogenesis and progression of IPF may potentially allow its manipulation, providing an opportunity for targeted therapeutic intervention.
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Affiliation(s)
- Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Philip L. Molyneaux
- NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London SW3 6LR, UK; (P.L.M.); (T.M.M.)
- National Heart and Lung Institute, Imperial College, Sir Alexander Fleming Building, London SW7 2AZ, UK
| | - Nicol Bernardinello
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Davide Biondini
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Federico Fracasso
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Mariaenrica Tiné
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Marina Saetta
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
| | - Toby M. Maher
- NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London SW3 6LR, UK; (P.L.M.); (T.M.M.)
- National Heart and Lung Institute, Imperial College, Sir Alexander Fleming Building, London SW7 2AZ, UK
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Paolo, Italy; (E.C.); (D.B.); (F.F.); (M.T.); (M.S.); (E.B.)
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Papiris SA, Tsirigotis P, Kannengiesser C, Kolilekas L, Gkirkas K, Papaioannou AI, Revy P, Giouleka P, Papadaki G, Kagouridis K, Pappa V, Borie R, Boileau C, Bouros D, Crestani B, Manali ED. Myelodysplastic syndromes and idiopathic pulmonary fibrosis: a dangerous liaison. Respir Res 2019; 20:182. [PMID: 31409344 PMCID: PMC6693222 DOI: 10.1186/s12931-019-1151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/05/2019] [Indexed: 01/13/2023] Open
Abstract
Previous studies have shown that the co-existence of bone marrow failure and pulmonary fibrosis in a single patient or in a family is suggestive of telomere related genes (TRG) germline mutations. This study presents the genetic background, clinical characteristics, and outcome of a group of five Greek patients co-affected with IPF and MDS. Four out of five patients developed an IPF acute exacerbation that was not reversible. We failed to detect any mutation in the TERT, TERC, DKC1, TINF2, RTEL1, PARN, NAF1, ACD, NHP2 and NOP10 genes in any patient. Moreover, telomere length was normal in the two patients tested. This could suggest that although the co-occurence of IPF and MDS are suggestive of TRG mutation in patients < 65 years old, in the elderly it may occur without germline mutations and could negatively affect prognosis. Physicians should be aware for possible IPF deterioration and therapeutic options for MDS should be wisely considered.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Hematology Unit, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Caroline Kannengiesser
- APHP Service de Génétique, Hôpital Bichat, Paris, France.,Université de Paris, Paris, France.,Inserm U1152, Paris, France
| | | | - Konstantinos Gkirkas
- 2nd Department of Internal Medicine, Hematology Unit, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece
| | - Patrick Revy
- Université de Paris, Paris, France.,INSERM UMR 1163, Laboratory of GenomeDynamics in the Immune System, Imagine Institute, labéllisé Ligue contre le cancer, Paris, France
| | - Paschalina Giouleka
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece
| | - Georgia Papadaki
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece
| | - Vassiliki Pappa
- 2nd Department of Internal Medicine, Hematology Unit, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Raphael Borie
- APHP, Hôpital Bichat, Service de Pneumologie A, DHU FIRE Centre de référence des maladies pulmonaires rares, Paris, France.,Inserm U1152, Paris, France
| | - Catherine Boileau
- APHP Service de Génétique, Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Demosthenes Bouros
- 1st Department of Pneumonology, Athens Chest Hospital "Sotiria", Athens, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Bruno Crestani
- Université de Paris, Paris, France.,APHP, Hôpital Bichat, Service de Pneumologie A, DHU FIRE Centre de référence des maladies pulmonaires rares, Paris, France.,Inserm U1152, Paris, France
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens, Greece.
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12
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Diaz de Teran T, Barbagelata E, Cilloniz C, Nicolini A, Perazzo T, Perren A, Ocak Serin S, Scharffenberg M, Fiorentino G, Zaccagnini M, Khatib MI, Papadakos P, Rezaul Karim HM, Solidoro P, Esquinas A. Non-invasive ventilation in palliative care: a systematic review. Minerva Med 2019; 110:555-563. [PMID: 31359741 DOI: 10.23736/s0026-4806.19.06273-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologies. For patients with end-stage chronic respiratory diseases, the use of NIV following the onset of acute or severe chronic respiratory failure is a valid option when intubation has been excluded. EVIDENCE ACQUISITION The following electronic databases were searched from their inception to January 2000 to December 2017: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), the Cochrane Database of Systematic Reviews, ACP Journal Club database. EVIDENCE SYNTHESIS The available evidence strongly supports the use of NIV in patients presenting with an exacerbation of chronic obstructive pulmonary disease, as well end-stage neuromuscular disease. Few studies support the use of NIV in end-stage interstitial lung disease and in morbid obesity patients. In patients with cancer has been recommend offering NIV as palliative care to improve dyspnea. CONCLUSIONS The decision regarding the treatment should be made by the patient, ideally before reaching the terminal stage and after having a frank dialogue with healthcare professionals and family members.
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Affiliation(s)
- Teresa Diaz de Teran
- Unit of Sleep and Non-Invasive Ventilation, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Elena Barbagelata
- Department of Internal Medicine, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Catia Cilloniz
- Department of Pneumology, Clinical Institute of Thoracic Surgery, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clínic, Barcelona, University of Barcelona (UB), Barcelona, Spain.,Unit SGR 911, Center for Biomedical Network Research for Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antonello Nicolini
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
| | - Tommaso Perazzo
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Andreas Perren
- Department of Intensive Care, Regional Hospital of Bellinzona, Bellinzona, Switzerland
| | - Sibel Ocak Serin
- University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Martin Scharffenberg
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Diseases, and Rehabilitation, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Marco Zaccagnini
- Department of Anesthesia and Critical Care, McGill University Health Center, Montreal, QC, Canada
| | - Mohamad I Khatib
- Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Peter Papadakos
- Department of Anesthesiology, University of Rochester, Rochester, NY, USA
| | - Habib M Rezaul Karim
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Paolo Solidoro
- Unit of Pneumology U, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Esquinas
- Unit of Intensive Care, Morales Meseguer Hospital, Murcia, Spain
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13
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Gui X, Qiu X, Tian Y, Xie M, Li H, Gao Y, Zhuang Y, Cao M, Ding H, Ding J, Zhang Y, Cai H. Prognostic value of IFN-γ, sCD163, CCL2 and CXCL10 involved in acute exacerbation of idiopathic pulmonary fibrosis. Int Immunopharmacol 2019; 70:208-215. [PMID: 30851700 DOI: 10.1016/j.intimp.2019.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is of concern because of its propensity for rapid deterioration and high mortality. Its aetiology and mechanism are still unclear. The aims of this study were to clarify the pathophysiology differences between AE-IPF and stable IPF (S-IPF) by comparing the serum levels of various cytokines and chemokines in the two groups and to identify those involvement in the occurrence of acute exacerbation and associated with mortality. METHODS The study included 28 patients with AE-IPF, 32 patients with S-IPF, and 18 healthy control subjects. We measured the serum cytokine and chemokine levels in all cases by multiplex assay. Serum levels of cytokines and chemokines were compared between AE-IPF and S-IPF subjects. Logistic regression analysis was applied to identify the ability of these variables to predict acute exacerbation. Kaplan-Meier curves were used to analyse survival and Cox proportional hazard regression was used to identify predictors of survival. RESULTS Levels of several cytokines and chemokines were significantly higher in both patient groups with IPF (with the exception of interleukin-2 [IL-2], chemokine cc-motif ligand 3, and RANTES [regulation upon activation normal T-cell express sequence]) than in healthy controls. Serum IL-1β (p = 0.008) and interferon (IFN)-γ (p = 0.007) levels tended to be higher in patients with AE-IPF than in those with S-IPF. The concentration of chemokine cc-motif ligand (CCL) 2 was significantly higher in bronchoalveolar lavage fluid than in serum (p = 0.001). Higher C-reactive protein, lactate dehydrogenase, percent forced vital capacity, percent diffusing capacity of the lung for carbon monoxide, and IFN-γ values in the patients with IPF were correlated with acute exacerbation status, with respective odds ratios of 1.241 (p = 0.011), 1.050 (p = 0.004), 1.043 (p = 0.001), 0.927 (p = 0.014), and 0.929 (p = 0.020). Acute exacerbation status was associated with an increased risk of mortality (hazard ratio 0.107, 95% confidence interval 0.036-0.314; p < 0.001). Univariate Cox regression demonstrated an association of IFN-γ, CCL2, C-X-C motif chemokine 10 (CXCL10) and sCD163 levels with an increased mortality risk (p = 0.015, p = 0.002, p = 0.001, and p = 0.030, respectively). CONCLUSIONS Our data demonstrate that serum levels of some pro-inflammatory cytokines and macrophage chemokines are upregulated during acute exacerbations of IPF and that these exacerbations are associated with the serum IFN-γ level. Chemokines and protein such as sCD163, CCL2, and CXCL10 are associated with activation of macrophages and may have a serious impact on overall survival in patients with IPF.
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Affiliation(s)
- Xianhua Gui
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Xiaohua Qiu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Yaqiong Tian
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Miaomiao Xie
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Hui Li
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Yujuan Gao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Yi Zhuang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Mengshu Cao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China
| | - Hui Ding
- Department of Respiratory Medicine, Yixing People Hospital, Affiliated Jiangsu University, No. 75 Tongzhenguan Road, Yixing 214200, Jiangsu, PR China
| | - Jingjing Ding
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China.
| | - Yingwei Zhang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China.
| | - Hourong Cai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, PR China.
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14
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Ito J, Nagata K, Morimoto T, Kogo M, Fujimoto D, Nakagawa A, Otsuka K, Tomii K. Respiratory management of acute exacerbation of interstitial pneumonia using high-flow nasal cannula oxygen therapy: a single center cohort study. J Thorac Dis 2019; 11:103-112. [PMID: 30863578 DOI: 10.21037/jtd.2018.12.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The role of high-flow nasal cannula oxygen therapy (HFNC) in respiratory management of acute exacerbation of interstitial pneumonia (AE-IP) is unknown. Methods We retrospectively reviewed patients with AE-IP who were admitted to our hospital from June 2009 - May 2015 and compared mortality, complications, sedatives and analgesia use, and oral intake between cohorts before (pre-HFNC: June 2009 - May 2012) and after (post-HFNC: June 2012 - May 2015) the introduction of HFNC. In the pre-HFNC cohort, standard oxygen therapy, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) were used for respiratory management of AE-IP. In the post-HFNC cohort, HFNC was also used as an alternative to NIV in patients (I) who had refused NIV; (II) unable to cooperate, (III) intolerant to NIV, or (IV) who improved in respiratory parameters after NIV treatment for weaning. Results Fifty-three pre-HFNC patients and 43 post-HFNC patients were enrolled. Neither the baseline characteristics at admission nor the major pharmacotherapy for AE-IP differed between the two cohorts. Twenty-eight (52.8%) patients and 19 (44.2%) patients required any respiratory support, in pre- and post-HFNC cohort, respectively (P=0.40). After introduction of HFNC, it was used in 40% of the patients who required respiratory support and NIV use was significantly reduced from 49.1% to 16.3% (P<0.001). The post-HFNC cohort had significantly lower in-hospital mortality than the pre-HFNC cohort (27.9% vs. 49.1%, P=0.04). The incidence of complications was not significantly different between the two cohorts. The use of sedoanalgesia during respiratory support and the number of patients who discontinued oral intake for >24 hours were decreased after the introduction of HFNC (78.6% vs. 31.6%, P<0.001; 52.8% vs. 23.3%, P=0.003). Conclusions HFNC might be a feasible option in respiratory management of AE-IP.
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Affiliation(s)
- Jiro Ito
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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15
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Jeon CS, Yoon DW, Moon SM, Shin S, Cho JH, Lee SM, Ahn HJ, Kim JA, Yang M. Non-intubated video-assisted thoracoscopic lung biopsy for interstitial lung disease: a single-center experience. J Thorac Dis 2018; 10:3262-3268. [PMID: 30069322 DOI: 10.21037/jtd.2018.05.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The mortality and morbidity associated with video-assisted thoracoscopic (VATS) lung biopsy for interstitial lung disease (ILD) are not negligible. We evaluated whether non-intubated VATS lung biopsy, which avoids intubation and general anesthesia, can be safely performed in ILD subjects. Methods This retrospective study compared the incidence of complications and surgical mortality between 25 consecutive intubated subjects and 10 non-intubated subjects (a total of 35 consecutive subjects) at a single institution. Results No major surgical complications or deaths were reported in either group, and non-intubated VATS biopsies were safely performed in subjects with relatively low carbon monoxide diffusing capacity (P=0.08) or poor American Society of Anesthesiologists physical status scores (ASA) (P=0.02). Conclusions These preliminary results suggest that non-intubated VATS lung biopsy is a safe and feasible option in patients with ILD.
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Affiliation(s)
- Chang-Seok Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin M Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Stravinskas Durigon T, MacKenzie B, Carneiro Oliveira-Junior M, Santos-Dias A, De Angelis K, Malfitano C, Kelly da Palma R, Moreno Guerra J, Damaceno-Rodrigues NR, Garcia Caldini E, de Almeida FM, Aquino-Santos HC, Rigonato-Oliveira NC, Leal de Oliveira DB, Aimbire F, Ligeiro de Oliveira AP, Franco de Oliveira LV, Durigon EL, Hiemstra PS, Vieira RP. Aerobic Exercise Protects from Pseudomonas aeruginosa-Induced Pneumonia in Elderly Mice. J Innate Immun 2018; 10:279-290. [PMID: 29843140 DOI: 10.1159/000488953] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/04/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (PS) infection results in severe morbidity and mortality, especially in immune-deficient populations. Aerobic exercise (AE) modulates the immune system, but its effects on the outcomes of pulmonary PS infection in elderly mice are unknown. METHODS BALB/c mice (24 weeks old) were randomized to sedentary, exercise (EX), PS, and PS + EX groups for the acute experimental setting, and PS and PS + EX groups for the chronic setting. Low-intensity AE was performed for 5 weeks, 60 min/day; 24 h after the final AE session, mice were inoculated with 5 × 104 colony-forming units (CFU) of PS, and 24 h and 14 days after PS inoculation, mice were studied. RESULTS AE inhibited PS colonization (p < 0.001) and lung inflammation (total cells, neutrophils, lymphocytes [p < 0.01] in bronchoalveolar lavage [BAL]), with significant differences in BAL levels of IL-1β (p < 0.001), IL-6 (p < 0.01), CXCL1 (p < 0.001), and TNF-α (p < 0.001), as well as parenchymal neutrophils (p < 0.001). AE increased BAL levels of IL-10 and parenchymal (p < 0.001) and epithelial (p < 0.001) IL-10 expression, while epithelial (p < 0.001) and parenchymal (p < 0.001) NF-κB expression was decreased. AE diminished pulmonary lipid peroxidation (p < 0.001) and increased glutathione peroxidase (p < 0.01). Pre-incubation of BEAS-2B with IL-10 inhibited PS-induced epithelial cell expression of TNF-α (p < 0.05), CD40 (p < 0.01), and dichlorodihydrofluorescein diacetate (p < 0.05). CONCLUSIONS AE inhibits PS-induced lung inflammation and bacterial colonization in elderly mice, involving IL-10/NF-κB, and redox signaling.
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Affiliation(s)
- Thomas Stravinskas Durigon
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | - BreAnne MacKenzie
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | | | - Alana Santos-Dias
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | - Kátia De Angelis
- Department of Physiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Christiano Malfitano
- Science Department of Health, Federal University of Lavras (UFLA), Lavras, Brazil
| | - Renata Kelly da Palma
- Department of Health Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | - Juliana Moreno Guerra
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | | | - Elia Garcia Caldini
- Department of Pathology (LIM 59), University of São Paulo, São Paulo, Brazil
| | - Francine Maria de Almeida
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | | | | | - Danielle Bruna Leal de Oliveira
- Laboratory of Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Flavio Aimbire
- Institute of Science and Technology, Federal University of São Paulo (UNIFESP), São José dos Campos, Brazil
| | | | | | - Edison Luiz Durigon
- Laboratory of Virology, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodolfo P Vieira
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil.,Postgraduation Program in Bioengineering, Universidade Brasil, São Paulo, Brazil.,Postgraduation Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, Brazil
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17
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Faverio P, De Giacomi F, Sardella L, Fiorentino G, Carone M, Salerno F, Ora J, Rogliani P, Pellegrino G, Sferrazza Papa GF, Bini F, Bodini BD, Messinesi G, Pesci A, Esquinas A. Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights. BMC Pulm Med 2018; 18:70. [PMID: 29764401 PMCID: PMC5952859 DOI: 10.1186/s12890-018-0643-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs. Methods A literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017). Results In managing ARF, it is important to establish an adequate diagnostic and therapeutic management depending on whether the patient has an underlying known chronic ILD or ARF is presenting in an unknown or de novo ILD. In the first case both primary causes, such as acute exacerbations of the disease, and secondary causes, including concomitant pulmonary infections, fluid overload and pulmonary embolism need to be investigated. In the second case, a diagnostic work-up that includes investigations in regards to ILD etiology, such as autoimmune screening and bronchoalveolar lavage, should be performed, and possible concomitant causes of ARF have to be ruled out. Oxygen supplementation and ventilatory support need to be titrated according to the severity of ARF and patients’ therapeutic options. High-Flow Nasal oxygen might potentially be an alternative to conventional oxygen therapy in patients requiring both high flows and high oxygen concentrations to correct hypoxemia and control dyspnea, however the evidence is still scarce. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associated to advanced stages of ILDs. However, in selected patients, such as those with less severe ARF, a NIV trial might help in the early recognition of NIV-responder patients, who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation, should be limited to patients listed for lung transplant or with reversible causes of ARF. Conclusions Despite the overall poor prognosis of ARF in ILDs, a personalized approach may positively influence patients’ management, possibly leading to improved outcomes. However, further studies are warranted.
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Affiliation(s)
- Paola Faverio
- Dipartimento Cardio-Toraco-Vascolare, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Federica De Giacomi
- Dipartimento Cardio-Toraco-Vascolare, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Sardella
- Dipartimento Cardio-Toraco-Vascolare, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Giuseppe Fiorentino
- UOC di Fisiopatologia e Riabilitazione Respiratoria, AO Ospedali dei Colli Monaldi, Naples, Italy
| | - Mauro Carone
- UOC Pulmonology and Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS di Cassano Murge (BA), Cassano delle Murge, Italy
| | - Francesco Salerno
- UOC Pulmonology and Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS di Cassano Murge (BA), Cassano delle Murge, Italy
| | - Jousel Ora
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Giulia Pellegrino
- Dipartimento di Scienze Neuroriabilitative, Casa di Cura del Policlinico, Milan, Italy
| | | | - Francesco Bini
- Department of Internal Medicine, UOC Pulmonology, Ospedale ASST-Rhodense, Garbagnate Milanese, Italy
| | - Bruno Dino Bodini
- Pulmonology Unit, Ospedale Maggiore della Carità, University of Piemonte Orientale, Novara, Italy
| | - Grazia Messinesi
- Dipartimento Cardio-Toraco-Vascolare, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Alberto Pesci
- Dipartimento Cardio-Toraco-Vascolare, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900, Monza, Italy
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18
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Marchioni A, Tonelli R, Ball L, Fantini R, Castaniere I, Cerri S, Luppi F, Malerba M, Pelosi P, Clini E. Acute exacerbation of idiopathic pulmonary fibrosis: lessons learned from acute respiratory distress syndrome? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:80. [PMID: 29566734 PMCID: PMC5865285 DOI: 10.1186/s13054-018-2002-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease characterized by progressive loss of lung function and poor prognosis. The so-called acute exacerbation of IPF (AE-IPF) may lead to severe hypoxemia requiring mechanical ventilation in the intensive care unit (ICU). AE-IPF shares several pathophysiological features with acute respiratory distress syndrome (ARDS), a very severe condition commonly treated in this setting.A review of the literature has been conducted to underline similarities and differences in the management of patients with AE-IPF and ARDS.During AE-IPF, diffuse alveolar damage and massive loss of aeration occurs, similar to what is observed in patients with ARDS. Differently from ARDS, no studies have yet concluded on the optimal ventilatory strategy and management in AE-IPF patients admitted to the ICU. Notwithstanding, a protective ventilation strategy with low tidal volume and low driving pressure could be recommended similarly to ARDS. The beneficial effect of high levels of positive end-expiratory pressure and prone positioning has still to be elucidated in AE-IPF patients, as well as the precise role of other types of respiratory assistance (e.g., extracorporeal membrane oxygenation) or innovative therapies (e.g., polymyxin-B direct hemoperfusion). The use of systemic drugs such as steroids or immunosuppressive agents in AE-IPF is controversial and potentially associated with an increased risk of serious adverse reactions.Common pathophysiological abnormalities and similar clinical needs suggest translating to AE-IPF the lessons learned from the management of ARDS patients. Studies focused on specific therapeutic strategies during AE-IPF are warranted.
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Affiliation(s)
- Alessandro Marchioni
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Lorenzo Ball
- San Martino Policlinico Hospital, IRCCS for Oncology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Riccardo Fantini
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Stefania Cerri
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Fabrizio Luppi
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Mario Malerba
- San Andrea Hospital-ASL Vercelli, Pneumology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Enrico Clini
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
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19
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Schuliga M, Grainge C, Westall G, Knight D. The fibrogenic actions of the coagulant and plasminogen activation systems in pulmonary fibrosis. Int J Biochem Cell Biol 2018; 97:108-117. [PMID: 29474926 DOI: 10.1016/j.biocel.2018.02.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 12/27/2022]
Abstract
Fibrosis causes irreversible damage to lung structure and function in restrictive lung diseases such as idiopathic pulmonary fibrosis (IPF). Extravascular coagulation involving fibrin formation in the intra-alveolar compartment is postulated to have a pivotal role in the development of pulmonary fibrosis, serving as a provisional matrix for migrating fibroblasts. Furthermore, proteases of the coagulation and plasminogen activation (plasminergic) systems that form and breakdown fibrin respectively directly contribute to pulmonary fibrosis. The coagulants, thrombin and factor Xa (FXa) evoke fibrogenic effects via cleavage of the N-terminus of protease-activated receptors (PARs). Whilst the formation and activity of plasmin, the principle plasminergic mediator is suppressed in the airspaces of patients with IPF, localized increases are likely to occur in the lung interstitium. Plasmin-evoked proteolytic activation of factor XII (FXII), matrix metalloproteases (MMPs) and latent, matrix-bound growth factors such as epidermal growth factor (EGF) indirectly implicate plasmin in pulmonary fibrosis. Another plasminergic protease, urokinase plasminogen activator (uPA) is associated with regions of fibrosis in the remodelled lung of IPF patients and elicits fibrogenic activity via binding its receptor (uPAR). Plasminogen activator inhibitor-1 (PAI-1) formed in the injured alveolar epithelium also contributes to pulmonary fibrosis in a manner that involves vitronectin binding. This review describes the mechanisms by which components of the two systems primarily involved in fibrin homeostasis contribute to interstitial fibrosis, with a particular focus on IPF. Selectively targeting the receptor-mediated mechanisms of coagulant and plasminergic proteases may limit pulmonary fibrosis, without the bleeding complications associated with conventional anti-coagulant and thrombolytic therapies.
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Affiliation(s)
- Michael Schuliga
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Christopher Grainge
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Glen Westall
- Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Prahran, Victoria, Australia
| | - Darryl Knight
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
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20
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Papiris SA, Kagouridis K, Kolilekas L, Karakatsani A, Korbila I, Giouleka P, Papadaki G, Maniati M, Bouros D, Manali ED. The New Idiopathic Pulmonary Fibrosis Acute Exacerbations Document: One Step Ahead but Still Suspended in the Air. Am J Respir Crit Care Med 2017; 195:267-269. [PMID: 28084826 DOI: 10.1164/rccm.201607-1426le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | - Ioanna Korbila
- 1 National and Kapodistrian University of Athens Athens, Greece
| | | | | | - Maria Maniati
- 1 National and Kapodistrian University of Athens Athens, Greece
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21
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Murtha LA, Schuliga MJ, Mabotuwana NS, Hardy SA, Waters DW, Burgess JK, Knight DA, Boyle AJ. The Processes and Mechanisms of Cardiac and Pulmonary Fibrosis. Front Physiol 2017; 8:777. [PMID: 29075197 PMCID: PMC5643461 DOI: 10.3389/fphys.2017.00777] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/22/2017] [Indexed: 02/06/2023] Open
Abstract
Fibrosis is the formation of fibrous connective tissue in response to injury. It is characterized by the accumulation of extracellular matrix components, particularly collagen, at the site of injury. Fibrosis is an adaptive response that is a vital component of wound healing and tissue repair. However, its continued activation is highly detrimental and a common final pathway of numerous disease states including cardiovascular and respiratory disease. Worldwide, fibrotic diseases cause over 800,000 deaths per year, accounting for ~45% of total deaths. With an aging population, the incidence of fibrotic disease and subsequently the number of fibrosis-related deaths will rise further. Although, fibrosis is a well-recognized cause of morbidity and mortality in a range of disease states, there are currently no viable therapies to reverse the effects of chronic fibrosis. Numerous predisposing factors contribute to the development of fibrosis. Biological aging in particular, interferes with repair of damaged tissue, accelerating the transition to pathological remodeling, rather than a process of resolution and regeneration. When fibrosis progresses in an uncontrolled manner, it results in the irreversible stiffening of the affected tissue, which can lead to organ malfunction and death. Further investigation into the mechanisms of fibrosis is necessary to elucidate novel, much needed, therapeutic targets. Fibrosis of the heart and lung make up a significant proportion of fibrosis-related deaths. It has long been established that the heart and lung are functionally and geographically linked when it comes to health and disease, and thus exploring the processes and mechanisms that contribute to fibrosis of each organ, the focus of this review, may help to highlight potential avenues of therapeutic investigation.
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Affiliation(s)
- Lucy A Murtha
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Michael J Schuliga
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Nishani S Mabotuwana
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sean A Hardy
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - David W Waters
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Janette K Burgess
- Department of Pathology and Medical Biology, Groningen Research Institute for Asthma and COPD, W. J. Kolff Research Institute, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Respiratory Cellular and Molecular Biology Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia.,Discipline of Pharmacology, University of Sydney, Sydney, NSW, Australia
| | - Darryl A Knight
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BS, Canada.,Department of Medicine, University of Western Australia, Perth, WA, Australia.,Research and Innovation Conjoint, Hunter New England Health, Newcastle, NSW, Australia
| | - Andrew J Boyle
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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22
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Papiris SA, Tomos IP, Karakatsani A, Spathis A, Korbila I, Analitis A, Kolilekas L, Kagouridis K, Loukides S, Karakitsos P, Manali ED. High levels of IL-6 and IL-8 characterize early-on idiopathic pulmonary fibrosis acute exacerbations. Cytokine 2017; 102:168-172. [PMID: 28847533 DOI: 10.1016/j.cyto.2017.08.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Controversy exists about the pathogenesis of idiopathic pulmonary fibrosis acute exacerbations (IPF-AEs). According to one hypothesis IPF-AEs represent the development of any etiology diffuse alveolar damage (DAD) upon usual interstitial pneumonia (UIP), whilst other researchers argue that an accelerated phase of the intrinsic fibrotic process of unknown etiology prevails, leading to ARDS. Different cytokines might be involved in both processes. The aim of this study was to assess pro-inflammatory and pro-fibrotic cytokines in the peripheral blood from stable and exacerbated IPF patients. METHODS Consecutive IPF patients referred to our department were included. Diagnoses of IPF and IPF-AE were based on international guidelines and consensus criteria. The interleukins (IL)-4, IL-6, IL-8, IL-10, and IL-13 as well asactive transforming growth factor-beta (TGF-β) were measured in blood from both stable and exacerbated patients on the day of hospital admission for deterioration. Subjects were followed for 12months. Mann-Whitney test as well as Tobit and logistic regression analyses were applied. RESULTS Among the 41 patients studied, 23 were stable, and 18 under exacerbation; of the latter, 12 patients survived. The IL-6 and IL-8 levels were significantly higher in exacerbated patients (p=0.002 and p=0.046, respectively). An increase in either IL-6 or IL-8 by 1pg/ml increases the odds of death by 5.6% (p=0.021) and 6.7% (p=0.013), respectively, in all patients. No differences were detected for the other cytokines. CONCLUSION High levels of IL-6 and IL-8 characterize early-on IPF-AEs and an increase in the levels of IL-6 and IL-8 associates with worse outcome in all patients. However, as the most representative pro-fibrotic cytokines, TGF-β, IL-10, IL-4 and IL-13 were not increased and given the dualistic nature, both pro-inflammatory and pro-fibrotic of IL-6 further studies are necessary to clarify the enigma of IPF-AEs etiopathogenesis.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Aris Spathis
- Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Ioanna Korbila
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Antonis Analitis
- Department of Hygiene, School of Medicine, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece.
| | - Likurgos Kolilekas
- 7th Pulmonary Department and Asthma Center, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Petros Karakitsos
- Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
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23
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Marashi SM, Nasri-Nasrabadi Z. Is there a role for sildenafil in the management of paraquat-induced lung fibrosis? Arh Hig Rada Toksikol 2017; 67:167-8. [PMID: 27331304 DOI: 10.1515/aiht-2016-67-2804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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24
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Andrade-Sousa AS, Rogério Pereira P, MacKenzie B, Oliveira-Junior MC, Assumpção-Neto E, Brandão-Rangel MAR, Damaceno-Rodrigues NR, Garcia Caldini E, Velosa APP, Teodoro WR, Ligeiro de Oliveira AP, Dolhnikoff M, Eickelberg O, Vieira RP. Aerobic Exercise Attenuated Bleomycin-Induced Lung Fibrosis in Th2-Dominant Mice. PLoS One 2016; 11:e0163420. [PMID: 27677175 PMCID: PMC5038953 DOI: 10.1371/journal.pone.0163420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/08/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the effect of aerobic exercise (AE) in reducing bleomycin-induced fibrosis in mice of a Th2-dominant immune background (BALB/c). METHODS BALB/c mice were distributed into: sedentary, control (CON), Exercise-only (EX), sedentary, bleomycin-treated (BLEO) and bleomycin-treated+exercised (BLEO+EX); (n = 8/group). Following treadmill adaptation, 15 days following a single, oro-tracheal administration of bleomycin (1.5U/kg), AE was performed 5 days/week, 60min/day for 4 weeks at moderate intensity (60% of maximum velocity reached during a physical test) and assessed for pulmonary inflammation and remodeling, and cytokine levels in bronchoalveolar lavage (BAL). RESULTS At 45 days post injury, compared to BLEO, BLEO+EX demonstrated reduced collagen deposition in the airways (p<0.001) and also in the lung parenchyma (p<0.001). In BAL, a decreased number of total leukocytes (p<0.01), eosinophils (p<0.001), lymphocytes (p<0.01), macrophages (p<0.01), and neutrophils (p<0.01), as well as reduced pro-inflammatory cytokines (CXCL-1; p<0.01), (IL-1β; p<0.001), (IL-5; p<0.01), (IL-6; p<0.001), (IL-13; p<0.01) and pro-fibrotic growth factor IGF-1 (p<0.001) were observed. Anti-inflammatory cytokine IL-10 was increased (p<0.001). CONCLUSION AE attenuated bleomycin-induced collagen deposition, inflammation and cytokines accumulation in the lungs of mice with a predominately Th2-background suggesting that therapeutic AE (15-44 days post injury) attenuates the pro-inflammatory, Th2 immune response and fibrosis in the bleomycin model.
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Affiliation(s)
- Adilson Santos Andrade-Sousa
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Paulo Rogério Pereira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - BreAnne MacKenzie
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Manoel Carneiro Oliveira-Junior
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Erasmo Assumpção-Neto
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Maysa Alves Rodrigues Brandão-Rangel
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Nilsa Regina Damaceno-Rodrigues
- Laboratory of Cellular Biology (LIM 59), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Elia Garcia Caldini
- Laboratory of Cellular Biology (LIM 59), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Ana Paula Pereira Velosa
- Laboratory of Medical Investigation (LIM 17), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Walcy Rosolia Teodoro
- Laboratory of Medical Investigation (LIM 17), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Ana Paula Ligeiro de Oliveira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Marisa Dolhnikoff
- Department of Pathology, School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Oliver Eickelberg
- Comprehensive Pneumology Center (CPC), Ludwig Maximilian Universität München and Helmholtz Zentrum München, Max-Lebsche-Platz 31, München, Germany
| | - Rodolfo Paula Vieira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
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25
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Nakamura Y, Suda T. Idiopathic Pulmonary Fibrosis: Diagnosis and Clinical Manifestations. Clin Med Insights Circ Respir Pulm Med 2016; 9:163-71. [PMID: 27625576 PMCID: PMC5013866 DOI: 10.4137/ccrpm.s39897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a parenchymal lung disease characterized by progressive interstitial fibrosis. The clinical course of IPF can be unpredictable and may be punctuated by acute exacerbations. Although much progress is being made in unraveling the mechanisms underlying IPF, effective therapy for improving survival remains elusive. Longitudinal disease profiling, especially in terms of clinical manifestations in a large cohort of patients, should lead to proper management of the patients and development of new treatments for IPF. Appropriate multidisciplinary assessment in ongoing registries is required to achieve this. This review summarizes the current status of the diagnosis and clinical manifestations of IPF.
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Affiliation(s)
- Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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26
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Callahan SJ, Xia M, Murray S, Flaherty KR. Clinical characteristics in patients with asymmetric idiopathic pulmonary fibrosis. Respir Med 2016; 119:96-101. [PMID: 27692155 DOI: 10.1016/j.rmed.2016.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/30/2016] [Accepted: 08/29/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND A group of patients with idiopathic pulmonary fibrosis (IPF) presents with disease affecting one lung markedly more than the other. At this time, it is unclear how this population differs from those who present with more symmetric disease. We sought to explain the characteristics of the asymmetric group and how their disease progresses. METHODS In this retrospective case-control study we accessed an interstitial lung disease (ILD) database and identified 14 asymmetric IPF cases via high-resolution computed tomography (HRCT) scoring of each lung lobe's disease severity. We identified 28 symmetric IPF controls from the same database using the same methods, and compared the clinical features of each group. RESULTS Patients with asymmetric disease exhibited similar demographics as those in the general IPF population; they were predominantly male (64%), elderly (69 years old), and used tobacco (57%). We found a trend toward significantly increased all-cause mortality in the case population two years following diagnosis (p = 0.089). Pulmonary function tests were significantly lower in the case group at the time of diagnosis, then both groups experienced gradual decline. We found no statistically significant differences in number of IPF exacerbations (cases 43%, controls 39%, p = 0.824) and gastro-esophageal reflux (both groups 50%). CONCLUSION Patients with asymmetric IPF resemble patients in the general IPF population but may have a lower overall survival rate. Further systemic factors may be studied to identify reasons for disease asymmetry and clinical decline in this population.
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Affiliation(s)
- Sean J Callahan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Virginia Health System, P.O. Box 800546, Charlottesville, VA 22908, USA.
| | - Meng Xia
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Susan Murray
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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27
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Papaioannou AI, Kostikas K, Manali ED, Papadaki G, Roussou A, Kolilekas L, Borie R, Bouros D, Papiris SA. Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract. Respir Med 2016; 117:14-26. [PMID: 27492509 DOI: 10.1016/j.rmed.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/20/2016] [Accepted: 05/05/2016] [Indexed: 12/12/2022]
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. Patients with this condition experience severe dyspnea and impaired gas exchange with preserved lung volumes. The diagnosis of the CPFE syndrome is based on HRCT imaging, showing the coexistence of emphysema and pulmonary fibrosis both in varying extent and locations within the lung parenchyma. Individual genetic background seem to predispose to the development of the disease. The risk of the development of pulmonary hypertension in patients with CPFE is high and related to poor prognosis. CPFE patients also present a high risk of lung cancer. Mortality is significant in patients with CPFE and median survival is reported between 2.1 and 8.5 years. Currently, no specific recommendations are available regarding the management of patients with CPFE. In this review we provide information on the existing knowledge on CPFE regarding the pathophysiology, clinical manifestations, imaging, complications, possible therapeutic interventions and prognosis of the disease.
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Affiliation(s)
- Andriana I Papaioannou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Konstantinos Kostikas
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Effrosyni D Manali
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Georgia Papadaki
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Aneza Roussou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Likurgos Kolilekas
- 7th Department of Pneumonology, "Sotiria" Chest Diseases Hospital, Athens, Greece.
| | - Raphaël Borie
- APHP, Hôpital Bichat, DHU FIRE Service de Pneumologie A, Centre de compétence des maladies pulmonaires rares, INSERM, Unité 1152, Université Paris Diderot, Paris, France.
| | - Demosthenis Bouros
- 1st Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Medical School, National and Kapodistrian University of Athens, Greece.
| | - Spyridon A Papiris
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
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28
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Papiris SA, Manali ED, Kolilekas L, Kagouridis K, Maniati M, Filippatos G, Bouros D. Acute Respiratory Events in Connective Tissue Disorders. Respiration 2016; 91:181-201. [PMID: 26938462 DOI: 10.1159/000444535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the 'mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the 'vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.
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Affiliation(s)
- Spyros A Papiris
- 2nd Department of Pneumonology, x2018;Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Yount SE, Beaumont JL, Chen SY, Kaiser K, Wortman K, Van Brunt DL, Swigris J, Cella D. Health-Related Quality of Life in Patients with Idiopathic Pulmonary Fibrosis. Lung 2016; 194:227-34. [PMID: 26861885 DOI: 10.1007/s00408-016-9850-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Idiopathic pulmonary fibrosis (IPF) produces symptoms and activity limitations that impair health-related quality of life (HRQOL). The Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)) includes measures of self-reported health and HRQOL for a range of conditions. This study evaluated the HRQOL of individuals with IPF using PROMIS measures and examined associations between HRQOL and key symptoms or supplemental oxygen need. METHODS Individuals who reported being told by a doctor that they have IPF completed an online battery of measures at baseline and 7-10 days later (for test-retest reliability). Measures included a brief survey of demographic and health-related questions, the PROMIS-29 profile, the Modified Medical Research Council Dyspnea Scale (MMRC), PROMIS dyspnea severity short form, A Tool to Assess Quality of life in IPF (ATAQ-IPF) and one cough item from the Functional Assessment of Chronic Illness Therapy (FACIT). RESULTS 220 individuals were included in the final sample. Except for sleep disturbance, all PROMIS domain scores significantly (p < .01) differed by MMRC level. Supplemental oxygen users were more impaired than non-users in fatigue, physical function, and social role participation (p < 0.01). The test-retest reliability was acceptable to excellent (>0.7) for all scales, but was lower for sleep disturbance (0.64). CONCLUSIONS People with IPF report substantial deficits in HRQOL across a range of PROMIS domains, and deficits vary by dyspnea and cough severity. These deficits warrant monitoring in clinical practice and consideration when investigating new therapies. Further research is required to further evaluate the psychometric performance of the PROMIS-29 in IPF.
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Affiliation(s)
- Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL, 60611, USA.
| | - Jennifer L Beaumont
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL, 60611, USA
| | - Shih-Yin Chen
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL, 60611, USA
| | - Katy Wortman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL, 60611, USA
| | | | - Jeffrey Swigris
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL, 60611, USA
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Papiris SA, Kagouridis K, Kolilekas L, Papaioannou AI, Roussou A, Triantafillidou C, Baou K, Malagari K, Argentos S, Kotanidou A, Karakatsani A, Manali ED. Survival in Idiopathic pulmonary fibrosis acute exacerbations: the non-steroid approach. BMC Pulm Med 2015; 15:162. [PMID: 26666385 PMCID: PMC4678631 DOI: 10.1186/s12890-015-0146-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/18/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis acute exacerbation (IPF-AE) constitutes IPF's most devastating event, representing the unexpected superimposition of diffuse alveolar damage of unknown etiology. Guidelines recommend high-dose steroids treatment despite unproven benefit. We hypothesized that previous immunosuppression and the administration of high-dose steroids adversely affect IPF-AE outcome. METHODS We studied all consecutive patients hospitalized in our department for IPF deterioration from 2007 to June 2013. Our protocol consisted of immediate cessation of immunosuppression (if any), best supportive care, broad-spectrum antimicrobials and thorough evaluation to detect reversible causes of deterioration. Patients were followed-up for survival; post-discharge none received immunosuppression. RESULTS Twenty-four out of 85 admissions (28%) fulfilled IPF-AE criteria. IPF-AE were analyzed both as unique events and as unique patients. As unique events 50% survived; 3 out of 12 (25%) in the group previously treated with immunosuppression whereas nine out of 12 (75%) in the group not receiving immunosuppression (p = 0.041). As unique patients 35.3% survived; 3 out of 6 (50%) in the never treated group whereas three out of 11 (27.3%) in the group receiving immunosuppression (p = 0.685). The history of immunosuppression significantly and adversely influenced survival (p = 0.035). Survival was greater in the never treated group compared to the immunosuppressed patients (p = 0.022). Post-discharge, our IPF-AE survivors had an 83% 1-year survival. CONCLUSIONS By applying the above mentioned protocol half of our patients survived. The history of immunosuppression before IPF-AE adversely influences survival. Avoiding steroids in IPF patients may favor the natural history of the disease even at the moment of its most devastating event.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Likurgos Kolilekas
- 7th Pulmonary Department and Asthma Center, Sotiria Chest Diseases Hospital, Athens, Greece.
| | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Aneza Roussou
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Katerina Baou
- 4th Pulmonary Department, Sotiria Chest Diseases Hospital, Athens, Greece.
| | - Katerina Malagari
- Imaging and Research Unit, Evgenidion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Stylianos Argentos
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Anastasia Kotanidou
- 1st Department of Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Juarez MM, Chan AL, Norris AG, Morrissey BM, Albertson TE. Acute exacerbation of idiopathic pulmonary fibrosis-a review of current and novel pharmacotherapies. J Thorac Dis 2015; 7:499-519. [PMID: 25922733 DOI: 10.3978/j.issn.2072-1439.2015.01.17] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/26/2014] [Indexed: 12/19/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive form of lung disease of unknown etiology for which a paucity of therapies suggest benefit, and for which none have demonstrated improved survival. Acute exacerbation of IPF (AE-IPF) is defined as a sudden acceleration of the disease or an idiopathic acute injury superimposed on diseased lung that leads to a significant decline in lung function. An AE-IPF is associated with a mortality rate as high as 85% with mean survival periods of between 3 to 13 days. Under these circumstances, mechanical ventilation (MV) is controversial, unless used a as a bridge to lung transplantation. Judicious fluid management may be helpful. Pharmaceutical treatment regimens for AE-IPF include the use of high dose corticosteroids with or without immunosuppressive agents such as cyclosporine A (CsA), and broad spectrum antibiotics, despite the lack of convincing evidence demonstrating benefit. Newer research focuses on abnormal wound healing as a cause of fibrosis and preventing fibrosis itself through blocking growth factors and their downstream intra-cellular signaling pathways. Several novel pharmaceutical approaches are discussed.
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Affiliation(s)
- Maya M Juarez
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, CA 95817, USA
| | - Andrew L Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, CA 95817, USA
| | - Andrew G Norris
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, CA 95817, USA
| | - Brian M Morrissey
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, CA 95817, USA
| | - Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, CA 95817, USA
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Schupp JC, Binder H, Jäger B, Cillis G, Zissel G, Müller-Quernheim J, Prasse A. Macrophage activation in acute exacerbation of idiopathic pulmonary fibrosis. PLoS One 2015; 10:e0116775. [PMID: 25590613 PMCID: PMC4295887 DOI: 10.1371/journal.pone.0116775] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/02/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a common cause of disease acceleration in IPF and has a major impact on mortality. The role of macrophage activation in AE of IPF has never been addressed before. METHODS We evaluated BAL cell cytokine profiles and BAL differential cell counts in 71 IPF patients w/wo AE and in 20 healthy volunteers. Twelve patients suffered from AE at initial diagnosis while sixteen patients developed AE in the 24 months of follow-up. The levels of IL-1ra, CCL2, CCL17, CCL18, CCL22, TNF-α, IL-1β, CXCL1 and IL-8 spontaneously produced by BAL-cells were analysed by ELISA. RESULTS In patients with AE, the percentage of BAL neutrophils was significantly increased compared to stable patients. We found an increase in the production rate of the pro-inflammatory cytokines CXCL1 and IL-8 combined with an increase in all tested M2 cytokines by BAL-cells. An increase in CCL18 levels and neutrophil counts during AE was observed in BAL cells from patients from whom serial lavages were obtained. Furthermore, high baseline levels of CCL18 production by BAL cells were significantly predictive for the development of future AE. CONCLUSIONS BAL cell cytokine production levels at acute exacerbation show up-regulation of pro-inflammatory as well as anti-inflammatory/ M2 cytokines. Our data suggest that AE in IPF is not an incidental event but rather driven by cellular mechanisms including M2 macrophage activation.
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Affiliation(s)
| | - Harald Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Benedikt Jäger
- Department of Pneumology, University Medical Centre, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Giuseppe Cillis
- Respiratory Diseases Section, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - Gernot Zissel
- Department of Pneumology, University Medical Centre, Freiburg, Germany
| | | | - Antje Prasse
- Department of Pneumology, University Medical Centre, Freiburg, Germany
- * E-mail:
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34
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Vianello A, Pipitone E. Noninvasive ventilation in patients with idiopathic pulmonary fibrosis is not a futile intervention! J Crit Care 2014; 29:1129. [PMID: 25212494 DOI: 10.1016/j.jcrc.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Vianello
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
| | - Emanuela Pipitone
- Department of Formative Sciences, University of Modena and Reggio Emilia, Modena, Italy
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35
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Zhou Y, Peng H, Sun H, Peng X, Tang C, Gan Y, Chen X, Mathur A, Hu B, Slade MD, Montgomery RR, Shaw AC, Homer RJ, White ES, Lee CM, Moore MW, Gulati M, Lee CG, Elias JA, Herzog EL. Chitinase 3-like 1 suppresses injury and promotes fibroproliferative responses in Mammalian lung fibrosis. Sci Transl Med 2014; 6:240ra76. [PMID: 24920662 PMCID: PMC4340473 DOI: 10.1126/scitranslmed.3007096] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Epithelial injury, alternative macrophage accumulation, and fibroproliferation coexist in the lungs of patients with idiopathic pulmonary fibrosis (IPF). Chitinase 3-like 1 (CHI3L1) is a prototypic chitinase-like protein that has been retained over species and evolutionary time. However, the regulation of CHI3L1 in IPF and its ability to regulate injury and/or fibroproliferative repair have not been fully defined. We demonstrated that CHI3L1 levels were elevated in patients with IPF. High levels of CHI3L1 are associated with progression--as defined by lung transplantation or death--and with scavenger receptor-expressing circulating monocytes in an ambulatory IPF population. In preterminal acute exacerbations of IPF, CHI3L1 levels were reduced and associated with increased levels of apoptosis. We also demonstrated that in bleomycin-treated mice, CHI3L1 expression was acutely and transiently decreased during the injury phase and returned toward and eventually exceeded baseline levels during the fibrotic phase. In this model, CHI3L1 played a protective role in injury by ameliorating inflammation and cell death, and a profibrotic role in the repair phase by augmenting alternative macrophage activation, fibroblast proliferation, and matrix deposition. Using three-dimensional culture system of a human fibroblast cell line, we found that CHI3L1 is sufficient to induce low grade myofibroblast transformation. In combination, these studies demonstrate that CHI3L1 is stimulated in IPF, where it represents an attempt to diminish injury and induce repair. They also demonstrate that high levels of CHI3L1 are associated with disease progression in ambulatory patients and that a failure of the CHI3L1 antiapoptotic response might contribute to preterminal disease exacerbations.
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Affiliation(s)
- Yang Zhou
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Hong Peng
- Department of Respiratory Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, PR China
| | - Huanxing Sun
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Xueyan Peng
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Chuyan Tang
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Ye Gan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Xiaosong Chen
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Aditi Mathur
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Buqu Hu
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Martin D. Slade
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | | | - Albert C. Shaw
- Program on Aging, Yale School of Medicine, New Haven, CT 06520, USA
| | - Robert J. Homer
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Eric S. White
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Chang-Min Lee
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Meagan W. Moore
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Mridu Gulati
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Chun Geun Lee
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jack A. Elias
- Division of Biology and Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI 02912, USA
| | - Erica L. Herzog
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
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Papiris SA, Kagouridis K, Kolilekas L, Bouros D, Manali ED. Idiopathic pulmonary fibrosis acute exacerbations: where are we now? Expert Rev Respir Med 2014; 8:271-3. [PMID: 24655104 DOI: 10.1586/17476348.2014.896206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Considerable controversy is haunting the treatment of IPF 'acute exacerbation', its most devastating complication. The consensus coined term 'acute exacerbation' implies that on an unknown etiology disease such as IPF, an unknown etiology superimposed acute lung injury/acute respiratory distress syndrome (ALI/ARDS) represents the end-life event in a consistent proportion of patients and are treated by high dose steroids despite unproven benefit. Inversely, ALI/ARDS treatment recommendations are based on the provision of excellent supportive care plus an extensive search and appropriate treatment of the etiologic precipitant and all intensive care clinicians in the absence of an obvious etiology, considering that occult infection is the most probable and also the most treatable underlying condition, universally administer extensive spectrum antimicrobials. Viewing the persistent high mortality in IPF 'acute exacerbations' treated with steroids we strongly believe that a study comparing the two arms of the steroid and non-steroid approach is greatly awaited by scientists and owed to the patients.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dual targeting of MEK and PI3K pathways attenuates established and progressive pulmonary fibrosis. PLoS One 2014; 9:e86536. [PMID: 24475138 PMCID: PMC3903543 DOI: 10.1371/journal.pone.0086536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/10/2013] [Indexed: 01/07/2023] Open
Abstract
Pulmonary fibrosis is often triggered by an epithelial injury resulting in the formation of fibrotic lesions in the lung, which progress to impair gas exchange and ultimately cause death. Recent clinical trials using drugs that target either inflammation or a specific molecule have failed, suggesting that multiple pathways and cellular processes need to be attenuated for effective reversal of established and progressive fibrosis. Although activation of MAPK and PI3K pathways have been detected in human fibrotic lung samples, the therapeutic benefits of in vivo modulation of the MAPK and PI3K pathways in combination are unknown. Overexpression of TGFα in the lung epithelium of transgenic mice results in the formation of fibrotic lesions similar to those found in human pulmonary fibrosis, and previous work from our group shows that inhibitors of either the MAPK or PI3K pathway can alter the progression of fibrosis. In this study, we sought to determine whether simultaneous inhibition of the MAPK and PI3K signaling pathways is a more effective therapeutic strategy for established and progressive pulmonary fibrosis. Our results showed that inhibiting both pathways had additive effects compared to inhibiting either pathway alone in reducing fibrotic burden, including reducing lung weight, pleural thickness, and total collagen in the lungs of TGFα mice. This study demonstrates that inhibiting MEK and PI3K in combination abolishes proliferative changes associated with fibrosis and myfibroblast accumulation and thus may serve as a therapeutic option in the treatment of human fibrotic lung disease where these pathways play a role.
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38
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Papiris SA, Kagouridis K, Papadaki G, Kolilekas L, Manali ED. Treating CTDs related fibrotic ILDs by immunosuppressants: "facts and faults". Lung 2013; 192:221-3. [PMID: 24217988 DOI: 10.1007/s00408-013-9532-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/22/2013] [Indexed: 12/24/2022]
Abstract
Fibrotic interstitial lung diseases (ILDs) are commonly encountered in scleroderma where they significantly influence prognosis. The mainstay of treatment in idiopathic fibrotic ILDs for the past 30 years was based on the combined administration of prednisone and cyclophosphamide (CYC) or prednisone, azathioprine plus N-acetyl cysteine, recently proved ineffective and harmful. Rheumatologists also despite "facts" showing that CYC treatment has no beneficial impact on fibrotic ILDs in scleroderma continue to commit the same, in a manner of speaking, "faults" by "treating their fibrotic ILDs by immunosuppressants." In this issue of the journal, Panopoulos et al. (Lung, 191, 483-489, 2013) recognizing the minimal effect of CYC on fibrotic ILDs in scleroderma patients and the increased use in clinical practice of mycophenolate mofetil (MMF) as an alternative, report that MMF use to replace CYC in this setting is not supported, confirming that restoration of purely fibrotic damage in the lungs remains one of the most challenging fields in medicine.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12461, Haidari, Greece,
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Antoniou KM, Wells AU. Acute exacerbations of idiopathic pulmonary fibrosis. ACTA ACUST UNITED AC 2013; 86:265-74. [PMID: 24157720 DOI: 10.1159/000355485] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and ultimately fatal disease, with a highly variable course in individual patients. Episodes of rapid deterioration are not uncommon, often following a period of stability. In cases of uncertain etiology, with typical clinical and high-resolution computed tomography (HRCT) features, the term 'acute exacerbation of IPF' (AE-IPF) has been coined to describe a combination of diffuse alveolar damage and preexisting usual interstitial pneumonia. In 2007, a consensus definition and diagnostic criteria were proposed. Although the presence of overt infection is currently an exclusion criterion, it appears likely that occult infection, reflux and thoracic surgical procedures are all trigger factors for AE-IPF. The development of new, usually bilateral infiltrates (ground-glass attenuation with variable admixed consolidation) is a defining HRCT feature. The outcome is poor with a short-term mortality in excess of 50% despite therapy. A number of pathophysiologic pathways are activated, with immunologic dysregulation, epithelial damage and circulating fibrocytes all believed to play a pathogenetic role. Acute exacerbations are less prevalent in other fibrotic lung diseases than in IPF and may have a better outcome, with the exception of acute exacerbations of rheumatoid lung. In AE-IPF, the exclusion of alternative causes of rapid deterioration, including heart failure and infection, is the main goal of investigation. Empirical high-dose corticosteroid steroid therapy is generally used in AE-IPF, without proven benefit.
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Affiliation(s)
- Katerina M Antoniou
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pulmonary Medicine, Medical School, University of Crete, Heraklion, Greece
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Panopoulos ST, Bournia VK, Trakada G, Giavri I, Kostopoulos C, Sfikakis PP. Mycophenolate versus cyclophosphamide for progressive interstitial lung disease associated with systemic sclerosis: a 2-year case control study. Lung 2013; 191:483-9. [PMID: 23925736 DOI: 10.1007/s00408-013-9499-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/20/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Cyclophosphamide is considered the treatment of choice for interstitial lung disease (ILD) secondary to systemic sclerosis (SSc), albeit having a minimal effect. Although controlled evidence does not exist, mycophenolate is used increasingly in clinical practice as an alternative. We aimed to compare the long-term efficacy of these drugs. METHODS Patients from our SSc cohort who received mycophenolate for over 1 year for progressive ILD were 1:1 matched for age, gender, and baseline forced vital capacity (FVC ±3 %) with cyclophosphamide-treated patients. Changes in FVC, total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO), and high-resolution computed tomography (HRCT) scans were compared between groups. Changes in pulmonary function tests (PFTs) over at least 1 year in six unmatched control patients, who had denied mycophenolate or cyclophosphamide, also were examined. RESULTS FVC, TLC, and DLCO did not change significantly in either mycophenolate (from 79.0 ± 12.5 to 80.2 ± 8.1 to 81.2 ± 11.4, from 71.5 ± 16.1 to 74.3 ± 10.8 to 71.8 ± 13.0, from 56.8 ± 12.0 to 55.2 ± 9.9 to 50.6 ± 8.5, respectively) or cyclophosphamide group (from 77.3 ± 12.5 to 79.7 ± 10.3 to 82.5 ± 12.9, from 64.7 ± 14.9 to 68.6 ± 16.0 to 66.1 ± 15.5, from 53.1 ± 14.3 to 56.4 ± 13.5 to 56.3 ± 6.7, respectively), after 1 or 2 years of treatment. PFTs also remained stable in the control group. In either the mycophenolate or cyclophosphamide groups, six patients remained stable, three improved, and one deteriorated according to the definitions of the American Thoracic Society. However, and despite the fact that patients in the cyclophosphamide group had more extended ILD at baseline, a deterioration of lung HRCT findings at 2 years was noticed after mycophenolate (from 10.0 ± 8.9 to 12.7 ± 8.2, p = 0.039) but not after cyclophosphamide. CONCLUSIONS Although these results derive from patients selected for receiving at least 1 year of treatment and therefore they do not represent an intention-to-treat cohort, an eagerness to replace cyclophosphamide by mycophenolate in SSc-associated ILD treatment is not supported.
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Affiliation(s)
- Stylianos T Panopoulos
- First Department of Propedeutic and Internal Medicine, Athens University Medical School, Athens, Greece,
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Papiris SA, Triantafillidou C, Manali ED, Kolilekas L, Baou K, Kagouridis K, Bouros D. Combined pulmonary fibrosis and emphysema. Expert Rev Respir Med 2013; 7:19-31; quiz 32. [PMID: 23362797 DOI: 10.1586/ers.12.80] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The advent of computed tomography permitted recognition of the coexistence of pulmonary fibrosis and emphysema (CPFE). Emphysema is usually encountered in the upper lobes preceding fibrosis of the lower lobes, and patients are smokers, predominantly male, with distinct physiologic profile characterized by preserved lung volumes and markedly reduced diffusion capacity. Actually, the term CPFE is reserved for the coexistence of any type and grade of radiological pulmonary emphysema and the idiopathic usual interstitial pneumonia computed tomography pattern as well as any pathologically confirmed case. CPFE is complicated by pulmonary hypertension, lung cancer and acute lung injury and may present different outcome than that of its components.
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Affiliation(s)
- Spyros A Papiris
- Second Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
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Bhatti H, Girdhar A, Usman F, Cury J, Bajwa A. Approach to acute exacerbation of idiopathic pulmonary fibrosis. Ann Thorac Med 2013; 8:71-7. [PMID: 23741267 PMCID: PMC3667448 DOI: 10.4103/1817-1737.109815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/12/2012] [Indexed: 01/21/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial pneumonia with a median survival of 3 years after diagnosis. Acute exacerbation of IPF (AE-IPF) is now identified as a life-threatening complication. It presents as worsening dyspnea with new ground glass opacities superimposed upon a radiographic usual interstitial pneumonia (UIP) pattern. It is a diagnosis of exclusion. The prognosis of AE-IPF is poor and treatment strategies lack standardization. In order to rule out any reversible etiology for an acute decompensation of a previously stable IPF patient diagnostic modalities include computerized tomographic angiogram (CTA) coupled with high-resolution computerized tomography (HRCT) imaging of the chest, bronchoalveolar lavage (BAL) and echocardiogram with bubble study. Avoiding risk factors, identifying underlying causes and supportive care are the mainstays of treatment. Anti-inflammatory and immunosuppressant medications have not shown to improve survival in AE-IPF. Most of the patients are managed in a critical care setting with mechanical ventilation. Lung transplantation is a promising option but most institutions are not equipped and not every patient is a candidate.
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Affiliation(s)
- Hammad Bhatti
- Department of Pulmonary and Critical Care, UF College of Medicine at, Jacksonville, Florida, USA
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Abstract
PURPOSE OF REVIEW Diagnosis of idiopathic interstitial pneumonias (IIPs) requires the exclusion of, among others, concomitant connective tissue diseases (CTDs), which may present as interstitial lung disease (ILD). This review focuses on the evaluation required to separate these entities through serology, although not exclusively. RECENT FINDINGS Several recent data suggest that patients diagnosed with IIPs can show evidence of CTDs on follow-up. This is especially true for nonspecific interstitial pneumonia but may also be seen with other forms of ILD. SUMMARY ILDs may occur alone, IIPs, or in association with, among others, CTDs. In the latter case, they may present before, during or even several months or years after the fulfillment of undisputed criteria for CTDs. If present before, their presentation presupposes their occurrence in early undiagnosed, undefined or undifferentiated CTD, which occasionally indefinitely maintains this status of diagnostic uncertainty, especially if ILD is empirically treated by immunosuppressants. Serologic evaluation for autoantibodies assisted by serum inflammatory biomarkers, detailed search for clinical clues of CTDs and suggestive histopathologic features on lung specimens may provide a framework to build the correct diagnosis. Obtaining a diagnosis of ILD associated with CTD exceeds semantics as this subset of patients may present different natural history, pathobiology, treatment and prognosis.
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Diffuse alveolar hemorrhage in coumarin users: a fibrosing interstitial pneumonia trigger? Lung 2012; 191:53-9. [PMID: 23149804 DOI: 10.1007/s00408-012-9436-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/20/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fibrosing interstitial pneumonias (IPs) include idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP). It has been suggested that oxidative damage plays a role in the pathophysiology of idiopathic interstitial pneumonias. Diffuse alveolar hemorrhage (DAH) can cause oxidative stress. Accordingly, we hypothesized that episodes of DAH might trigger fibrosing IP development. METHODS Patients using coumarins with confirmed DAH were retrospectively gathered during a 9 year period and reviewed for the development of IPF or fibrosing NSIP. RESULTS A total of 65 patients with DAH could finally be included, 31 (48 %) of whom subsequently developed a fibrosing IP. The majority of these 31 patients developed the fibrosing IP within 3 years after DAH confirmation. A total of 41 (63 %) patients died within 3.0 ± 0.9 (range 1.3-4.7) years after the DAH diagnosis had been confirmed. Twenty-two of the deceased (54 %) had finally developed fibrosing IP. CONCLUSIONS Almost half of the patients with established episodes of DAH developed fibrosing IP; therefore it seems that DAH might be a trigger for the development of fibrosing IP. This observation warrants prospective studies to further evaluate the clinical impact of these findings.
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Papiris SA, Manali ED, Kolilekas L, Triantafillidou C, Tsangaris I, Kagouridis K. Steroids in idiopathic pulmonary fibrosis acute exacerbation: defenders or killers? Am J Respir Crit Care Med 2012; 185:587-8. [PMID: 22383571 DOI: 10.1164/ajrccm.185.5.587] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kanne JP. Idiopathic Interstitial Pneumonias. CLINICALLY ORIENTED PULMONARY IMAGING 2012. [PMCID: PMC7120217 DOI: 10.1007/978-1-61779-542-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The idiopathic interstitial pneumonias are a distinct group of clinicopathologic entities. High-resolution computed tomography (HRCT) plays a critical role in the evaluation and management of patients. In the appropriate clinical setting, characteristic HRCT findings may be diagnostic, obviating the need for open lung biopsy. In more challenging or complicated cases, consensus among the clinician, radiologist, and pathologist may be required. This chapter describes and depicts the characteristic HRCT features of usual interstitial pneumonia, nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, respiratory bronchiolitis, respiratory bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia.
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Affiliation(s)
- Jeffrey P. Kanne
- , Cardiothoracic Radiology, University of Wisconsin Hospital and Cli, 600 Highland Ave., Madison, 53792 USA
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Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma. Pulm Med 2011; 2011:872120. [PMID: 21660199 PMCID: PMC3109679 DOI: 10.1155/2011/872120] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 03/01/2011] [Accepted: 03/24/2011] [Indexed: 12/20/2022] Open
Abstract
Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Diagnosis can be challenging since patients are unlikely to report dyspnea due to an overall decrease in physical activity with advanced arthritic symptoms. Additionally, infections, drug toxicity, and environmental toxins can mimic ILD, creating significant diagnostic dilemmas for the clinician. In this paper we will explore an effective clinical algorithm for the diagnosis of RA-ILD. We will also discuss features of drug-related toxicities, infections, and environmental toxins that comprise the main entities in the differential diagnosis of RA-ILD. Finally, we will explore the known and experimental treatment options that may have some benefit in the treatment of RA-ILD.
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Triantafillidou C, Manali ED, Magkou C, Sotiropoulou C, Kolilekas LF, Kagouridis K, Rontogianni D, Papiris SA. Medical Research Council dyspnea scale does not relate to fibroblast foci profusion in IPF. Diagn Pathol 2011; 6:28. [PMID: 21466701 PMCID: PMC3083323 DOI: 10.1186/1746-1596-6-28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 04/05/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In Idiopathic pulmonary fibrosis (IPF) irreversibly progressive fibrosing parenchymal damage, leads to defects in mechanics and gas exchange, manifesting with disabling exertional dyspnea. Previous studies have shown a relationship between fibroblast foci (FF) profusion and severity and survival and a relationship between dyspnea grade and severity and outcome. We hypothesized a relationship between Medical Research Council (MRC) dyspnea scale with FF, and a relationship between FF and functional parameters and survival. METHODS We retrospectively reviewed 24 histologically documented IPF patients. Profusion of FF was semiquantitatively evaluated by two scores, Brompton and Michigan. Survival analysis was performed by fitting Cox regression models to examine the relationship of the two scores with survival and the non-parametric Spearman correlation coefficient was calculated to describe the relationships of FF scores with dyspnea scores and functional parameters. RESULTS No statistically significant correlation between FF scores and the MRC scores was observed (p = 0.96 and p = 0.508 respectively). No significant correlation between FF scores and survival (p = 0.438 and p = 0.861 respectively) or any functional parameter was observed. CONCLUSIONS The lack of relationship between the MRC dyspnea scale and the FF might relate to the fact that dyspnea in IPF better reflects the overall of lung damage and its related consequences on mechanics and gas exchange whereas FF, one of its histological hallmarks, may not reflect its entire histology derangement also constrained by the geographically limited sampled tissue. This might be also valid for the observed lack of association between FF and survival or functional parameters.
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Affiliation(s)
- Christina Triantafillidou
- 2nd Pulmonary Department, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
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