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Rautajoki T, Rantala HA, Sutinen E, Saarto T, Rajala K, Pesonen I, Hollmen M, Myllärniemi M, Lehto JT. Health-related quality of life measured with K-BILD is associated with survival in patients with idiopathic pulmonary fibrosis. BMC Pulm Med 2024; 24:480. [PMID: 39350048 PMCID: PMC11443770 DOI: 10.1186/s12890-024-03303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) assessments and estimates of prognosis are needed for comprehensive care and planning of subsequent treatment in patients with idiopathic pulmonary fibrosis (IPF). We investigated HRQoL and its association with survival using a disease-specific tool in patients with IPF. METHODS The patients were recruited from the real-life FinnishIPF study in 2015. HRQoL was assessed with the King's Brief Interstitial Lung Disease (K-BILD) questionnaire every six months for 2.5 years. Dyspnoea was assessed with the modified Medical Research Council (mMRC) dyspnoea scale. Survival was registered until 31 December 2022. Patient survival according to the K-BILD total score was evaluated using the Kaplan‒Meier method. The Friedman test was used to compare the K-BILD total scores longitudinally, and the Mann‒Whitney U test was used to compare the mMRC groups. P values < 0.05 were considered statistically significant. RESULTS The median K-BILD total score (n = 245) was 51.6. At baseline, patients in the highest HRQoL quartile (K-BILD scores 58.9-100) had a longer median survival time (5.3 years) than did those with scores of 51.7-58.8 (3.1 years), 45.7-51.6 (2.3 years), and 0.0-45.6 (1.8 years). A decrease in the K-BILD total score of ≥ 5 units in the preceding 12 or 24 months showed a trend towards poorer survival, although statistical significance was not reached. Ninety-four patients survived more than 2.5 years and had available K-BILD data at all time points. The K-BILD total score remained higher in patients with a baseline mMRC of 0-1 than in those with a mMRC of 2-4, and the total score decreased only modestly in both groups (median of 3.3 and 4.8 units in patients with mMRC scores of 0-1 and 2-4, respectively). CONCLUSIONS In IPF, a reduced HRQoL is associated with impaired survival. A K-BILD total score less than approximately 50 units is associated with a median survival of approximately two years. In addition to assessing the treatment needs of patients with IPF using K-BILD, a decreased score may be useful for facilitating advance care planning and transplantation assessment.
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Affiliation(s)
- Tuuli Rautajoki
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Heidi A Rantala
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Eva Sutinen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Saarto
- University of Helsinki, Helsinki, Finland
- Palliative Care Center, HUS Comprehensive Cancer Centre, Helsinki, Finland
| | - Kaisa Rajala
- Wellbeing Services of Vantaa and Kerava, Vantaa, Finland
| | - Ida Pesonen
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Hollmen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marjukka Myllärniemi
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Tampere, Finland
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Bartold K, Iskierko Z, Sharma PS, Lin HY, Kutner W. Idiopathic pulmonary fibrosis (IPF): Diagnostic routes using novel biomarkers. Biomed J 2024; 47:100729. [PMID: 38657859 PMCID: PMC11340561 DOI: 10.1016/j.bj.2024.100729] [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: 11/28/2023] [Revised: 03/19/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) diagnosis is still the diagnosis of exclusion. Differentiating from other forms of interstitial lung diseases (ILDs) is essential, given the various therapeutic approaches. The IPF course is now unpredictable for individual patients, although some genetic factors and several biomarkers have already been associated with various IPF prognoses. Since its early stages, IPF may be asymptomatic, leading to a delayed diagnosis. The present review critically examines the recent literature on molecular biomarkers potentially useful in IPF diagnostics. The examined biomarkers are grouped into breath and sputum biomarkers, serologically assessed extracellular matrix neoepitope markers, and oxidative stress biomarkers in lung tissue. Fibroblasts and complete blood count have also gained recent interest in that respect. Although several biomarker candidates have been profiled, there has yet to be a single biomarker that proved specific to the IPF disease. Nevertheless, various IPF biomarkers have been used in preclinical and clinical trials to verify their predictive and monitoring potential.
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Affiliation(s)
- Katarzyna Bartold
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - Zofia Iskierko
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | | | - Hung-Yin Lin
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Taiwan
| | - Wlodzimierz Kutner
- Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland; Faculty of Mathematics and Natural Sciences, School of Sciences, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland.
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Aburto M, Rodríguez-Portal JA, Fernandez-Fabrellas E, García Sevila R, Herrera Lara S, Bollo de Miguel E, González Ruiz JM, Molina-Molina M, Safont Muñoz B, Godoy Mayoral R, Romero Ortiz AD, Soler Sempere MJ, Castillo Villegas D, Gaudó Navarro J, Tomás López L, Nuñez Sanchez B, Palacios Hidalgo Z, Sellares Torres J, Sacristán Bou L, Nieto Barbero MA, Casanova Espinosa A, Portillo-Carroz K, Cano-Jimenez E, Acosta Fernández O, Legarreta MJ, Valenzuela C. [Influence of Clinical Practice Guidelines on the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis. Data from the Registry of the Spanish Society of Pulmonology and Thoracic Surgery]. OPEN RESPIRATORY ARCHIVES 2024; 6:100334. [PMID: 39021619 PMCID: PMC11253673 DOI: 10.1016/j.opresp.2024.100334] [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: 02/27/2024] [Accepted: 04/26/2024] [Indexed: 07/20/2024] Open
Abstract
Objective The objective of the study was to analyze the diagnostic process and the time until the start of treatment of patients with idiopathic pulmonary fibrosis in relation to the publication of successive clinical practice guide. Material and methods Multicenter, observational, ambispective study, in which patients includes in the idiopathic pulmonary fibrosis registry of the Spanish Society of Pulmonologist and Thoracic Surgery were analyzed. An electronic data collection notebook was enabled on the society's website. Sociodemographic and clinical variables were collected at diagnosis and follow-up of the patients. Results From January 2012 to december 2019, 1064 patients were included in the registry, with 929 finally analyzed. The diagnosis process varied depending on the year in which it was performed, and the radiological pattern observed in the high-resolution computed tomography. Up to 26.3% of the cases (244) were diagnosed with chest high-resolution computed tomography and clinical evaluation. Surgical biopsy was used up to 50.2% of cases diagnosed before 2011, while it has been used in 14.2% since 2018. The median time from the onset of symptoms to diagnosis was 360 days (IQR 120-720), taking more than 2 years in the 21.0% of patients. A percentage of 79.4 of patients received antifibrotic treatment. The average time from diagnosis to the antifibrotic treatment has been 309 ± 596.5 days, with a median of 49 (IQR 0-307). Conclusions The diagnostic process, including the time until diagnosis and the type of test used, has changed from 2011 to 2019, probably due to advances in clinical research and the publication of diagnostic-therapeutic consensus guidelines.
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Affiliation(s)
- Myriam Aburto
- Servicio de Neumología, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, España
- Departamento de Medicina, Universidad del País Vasco- Euskal Herriko Unibertsitatea, País Vasco, España
- Biobizkaia, Barakaldo, Bizkaia, España
| | | | - Estrella Fernandez-Fabrellas
- Servicio de Neumología, Consorci Hospital General Universitari de Valencia, Valencia, España
- Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - Raquel García Sevila
- Servicio de Neumología, Hospital General Universitario de Dr. Balmis, Alicante, España
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Susana Herrera Lara
- Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, España
| | | | | | - María Molina-Molina
- Unidad de EPID, Servicio de Neumología, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Belén Safont Muñoz
- Servicio de Neumología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Raul Godoy Mayoral
- Servicio de Neumología, Hospital Universitario de Albacete, Albacete, España
| | | | | | | | | | - Laura Tomás López
- Departamento de Medicina, Universidad del País Vasco- Euskal Herriko Unibertsitatea, País Vasco, España
- Servicio de Neumología, Hospital Universitario de Araba, Vitoria-Gazteiz, Araba, Vitoria-Gazteiz, Araba, España
| | - Belén Nuñez Sanchez
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | | | | | - Lirios Sacristán Bou
- Servicio de Neumología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | | | - Karina Portillo-Carroz
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Orlando Acosta Fernández
- Servicio de Neumología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - María José Legarreta
- Research Unit, Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, España
- Biosistemak Kronikgune Institute for Health Services Research, Galdakao, Bizkaia, España
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Galdakao, Bizkaia, España
| | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
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Rautajoki T, Lehto JT, Sutinen E, Bergman P, Sintonen H, Rajala K, Mäkelä K, Hollmen M, Saarto T, Myllärniemi M. Dyspnea Associates With a Widely Impaired Quality of Life in Idiopathic Pulmonary Fibrosis Patients: A Longitudinal Study Using 15D. J Palliat Med 2023; 26:1357-1364. [PMID: 37366772 DOI: 10.1089/jpm.2022.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background: Research on health-related quality of life (HRQoL) is crucial for developing comprehensive palliative care in idiopathic pulmonary fibrosis (IPF). Objectives: To study IPF patients' HRQoL compared with general population and its association with dyspnea in a longitudinal follow-up. Design: Assessment of IPF patients' HRQoL by a generic tool. Comparison of baseline data with the general population and a 30-month follow-up with 6 months intervals. Setting/Subjects: In total, 246 IPF patients were recruited from the Finnish nationwide real-life study, FinnishIPF. Measurements: Modified Medical Research Council (MMRC) dyspnea scale for dyspnea and the generic HRQoL tool 15D for the total and dimensional HRQoL were used. Results: At baseline, the mean 15D total score was lower (0.786, standard deviation [SD] 0.116) in IPF patients than in the general population (0.871, SD 0.043) (p < 0.001) and among the IPF patients with MMRC ≥2 compared with those with MMRC <2 (p < 0.001). In patients with MMRC ≥2, significant impairment compared with general population existed in 11 dimensions of HRQoL, such as breathing, usual activities, and sexual activity, whereas this was true in only 4 dimensions in MMRC <2 category. Mental function was not impaired in either group. During the follow-up, 15D total score decreased in both MMRC categories (p < 0.001) but stayed constantly worse in the MMRC ≥2 group. Seven and two dimensions of HRQoL significantly declined in the categories of MMRC <2 and MMRC ≥2, respectively. Conclusions: Patients with IPF, especially if dyspnea limits everyday life, suffer from widely impaired HRQoL, although self-assessed mental capability is preserved. Integrated palliative care is supported to face the multiple needs of IPF patients.
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Affiliation(s)
- Tuuli Rautajoki
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Juho T Lehto
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Eva Sutinen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Paula Bergman
- University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Kati Mäkelä
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Maria Hollmen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Saarto
- University of Helsinki, Helsinki, Finland
- Palliative Care Center, HUS Comprehensive Cancer Centre, Helsinki, Finland
| | - Marjukka Myllärniemi
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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5
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Hollmén M, Laaka A, Partanen JJ, Koskela J, Sutinen E, Kaarteenaho R, Ainola M, Myllärniemi M. KIF15 missense variant is associated with the early onset of idiopathic pulmonary fibrosis. Respir Res 2023; 24:240. [PMID: 37777755 PMCID: PMC10543873 DOI: 10.1186/s12931-023-02540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) has an unknown aetiology and limited treatment options. A recent meta-analysis identified three novel causal variants in the TERT, SPDL1, and KIF15 genes. This observational study aimed to investigate whether the aforementioned variants cause clinical phenotypes in a well-characterised IPF cohort. METHODS The study consisted of 138 patients with IPF who were diagnosed and treated at the Helsinki University Hospital and genotyped in the FinnGen FinnIPF study. Data on > 25 clinical parameters were collected by two pulmonologists who were blinded to the genetic data for patients with TERT loss of function and missense variants, SPDL1 and KIF15 missense variants, and a MUC5B variant commonly present in patients with IPF, or no variants were separately analysed. RESULTS The KIF15 missense variant is associated with the early onset of the disease, leading to progression to early-age transplantation or death. In patients with the KIF15 variant, the median age at diagnosis was 54.0 years (36.5-69.5 years) compared with 72.0 years (65.8-75.3 years) in the other patients (P = 0.023). The proportion of KIF15 variant carriers was 9- or 3.6-fold higher in patients aged < 55 or 65 years, respectively. The variants for TERT and MUC5B had similar effects on the patient's clinical course, as previously described. No distinct phenotypes were observed in patients with the SPDL1 variant. CONCLUSIONS Our study indicated the potential of KIF15 to be used in the genetic diagnostics of IPF. Further studies are needed to elucidate the biological mechanisms of KIF15 in IPF.
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Affiliation(s)
- Maria Hollmén
- Individrug, Heart and Lung Centre, The University of Helsinki and Helsinki University Hospital, Research Programs Unit, Helsinki, Finland
| | - Atte Laaka
- Individrug, Heart and Lung Centre, The University of Helsinki and Helsinki University Hospital, Research Programs Unit, Helsinki, Finland
| | - Juulia J. Partanen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Jukka Koskela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Eva Sutinen
- Individrug, Heart and Lung Centre, The University of Helsinki and Helsinki University Hospital, Research Programs Unit, Helsinki, Finland
| | - Riitta Kaarteenaho
- Research Unit of Biomedicine and Internal Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mari Ainola
- Individrug, Heart and Lung Centre, The University of Helsinki and Helsinki University Hospital, Research Programs Unit, Helsinki, Finland
| | - Marjukka Myllärniemi
- Individrug, Heart and Lung Centre, The University of Helsinki and Helsinki University Hospital, Research Programs Unit, Helsinki, Finland
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Shah Gupta R, Koteci A, Morgan A, George PM, Quint JK. Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review. BMJ Open Respir Res 2023; 10:10/1/e001291. [PMID: 37308252 DOI: 10.1136/bmjresp-2022-001291] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/06/2023] [Indexed: 06/14/2023] Open
Abstract
Interstitial lung disease (ILD) is a collective term representing a diverse group of pulmonary fibrotic and inflammatory conditions. Due to the diversity of ILD conditions, paucity of guidance and updates to diagnostic criteria over time, it has been challenging to precisely determine ILD incidence and prevalence. This systematic review provides a synthesis of published data at a global level and highlights gaps in the current knowledge base. Medline and Embase databases were searched systematically for studies reporting incidence and prevalence of various ILDs. Randomised controlled trials, case reports and conference abstracts were excluded. 80 studies were included, the most described subgroup was autoimmune-related ILD, and the most studied conditions were rheumatoid arthritis (RA)-associated ILD, systemic sclerosis associated (SSc) ILD and idiopathic pulmonary fibrosis (IPF). The prevalence of IPF was mostly established using healthcare datasets, whereas the prevalence of autoimmune ILD tended to be reported in smaller autoimmune cohorts. The prevalence of IPF ranged from 7 to 1650 per 100 000 persons. Prevalence of SSc ILD and RA ILD ranged from 26.1% to 88.1% and 0.6% to 63.7%, respectively. Significant heterogeneity was observed in the reported incidence of various ILD subtypes. This review demonstrates the challenges in establishing trends over time across regions and highlights a need to standardise ILD diagnostic criteria.PROSPERO registration number: CRD42020203035.
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Affiliation(s)
- Rikisha Shah Gupta
- National Heart and Lung Institute, Imperial College London, London, UK
- Real-World Evidence, Gilead Sciences, Foster City, CA, USA
| | - Ardita Koteci
- Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Ann Morgan
- Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Peter M George
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College London, London, UK
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Salonen J, Nurmi H, Hodgson U, Hasala H, Kilpeläinen M, Hollmen M, Purokivi M, Kaarteenaho R. Virtual communication is commonly used in Finnish interstitial lung disease multidisciplinary meetings. Eur Clin Respir J 2023; 10:2190210. [PMID: 36950471 PMCID: PMC10026813 DOI: 10.1080/20018525.2023.2190210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Multidisciplinary meeting (MDM) is a core element in the diagnosis of interstitial lung diseases (ILD). The aim of the study was to investigate the implementation and key elements related to ILD MDMs in Finnish specialized care, which is characterized by long travel distances and a large number of small centers treating patients suffering from ILDs. An electronic questionnaire was sent to ILD experts working at five academic centers of Finland regarding the implementation of ILD MDMs with the focus on utilization of virtual communication. Responses were received from all academic centers of Finland (n = 5) whose catchment areas cover all of Finland. ILD MDMs were organized in each center approximately every two weeks and the core participants included a radiologist, respiratory physicians, junior staff, pathologist and a rheumatologist. All non-academic centers could refer their patients to be evaluated in ILD MDM of an academic center. Virtual communication was utilized by all academic centers in the implementation of ILD MDMs, being most common among small centers located in Eastern and Northern Finland. Virtual access to ILD MDM of an academic center was available in most parts of Finland, enabling small centers to benefit from the ILD expertise of academic centers.
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Affiliation(s)
- Johanna Salonen
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Center of Internal and Respiratory Medicine and Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Hanna Nurmi
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulla Hodgson
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Social Insurance Institution of Finland, Helsinki, Finland
| | - Hannele Hasala
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Maritta Kilpeläinen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Maria Hollmen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Minna Purokivi
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Riitta Kaarteenaho
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Center of Internal and Respiratory Medicine and Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
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Salonen J, Purokivi M, Hodgson U, Kaarteenaho R. National data on prevalence of idiopathic pulmonary fibrosis and antifibrotic drug use in Finnish specialised care. BMJ Open Respir Res 2022; 9:9/1/e001363. [PMID: 36571594 PMCID: PMC9462099 DOI: 10.1136/bmjresp-2022-001363] [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: 07/09/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The previous data concerning the prevalence of idiopathic pulmonary fibrosis (IPF) and the frequency of antifibrotic drug use in Finland were based on research registries and medical records whereas nationwide data on the number of patients with IPF in specialised care and those on antifibrotic treatment have not been published. METHODS We made an information request to the Finnish National Hospital Discharge Register (Hilmo) covering the whole population of Finland to find out the annual numbers of patients with IPF treated in specialised care in 2016-2021. The numbers of the patients initiating and using pirfenidone and nintedanib were requested from the Social Insurance Institution of Finland (Kela) for the same time period. RESULTS The estimated prevalence of IPF in specialised care was 36.0 per 100 000 in 2021, having increased since 2016. The number of antifibrotic drug users and their proportion of outpatients with IPF had also risen during the follow-up period. In 2021, 35% of the patients with IPF used pirfenidone or nintedanib. The number of inpatients treated in specialised care because of IPF had declined during 2016-2021. CONCLUSIONS The prevalence of IPF was higher than expected in Finnish specialised care and had increased during the 6-year follow-up time. The increase in the number of patients with IPF using antifibrotic drugs might have diminished the need for IPF-related hospitalisations.
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Affiliation(s)
- Johanna Salonen
- Respiratory Medicine, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland,Center of Internal and Respiratory Medicine, Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Minna Purokivi
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ulla Hodgson
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland,Social Insurance Institution of Finland, Helsinki, Finland
| | - Riitta Kaarteenaho
- Respiratory Medicine, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland,Center of Internal and Respiratory Medicine, Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
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Maher TM, Bendstrup E, Dron L, Langley J, Smith G, Khalid JM, Patel H, Kreuter M. Global incidence and prevalence of idiopathic pulmonary fibrosis. Respir Res 2021; 22:197. [PMID: 34233665 PMCID: PMC8261998 DOI: 10.1186/s12931-021-01791-z] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive debilitating lung disease with considerable morbidity. Heterogeneity in epidemiologic studies means the full impact of the disease is unclear. METHODS A targeted literature search for population-based, observational studies reporting incidence and/or prevalence of IPF from January 2009 to April 2020 was conducted. Identified studies were aggregated by country. For countries with multiple publications, a weighted average was determined. Incidence and prevalence data were adjusted for between-study differences where possible. The final model included adjusted estimates of incidence and prevalence per 10,000 of the population with 95% confidence intervals. As prevalence estimates vary depending on the definitions used, estimates were based on a specific case definition of IPF. RESULTS Overall, 22 studies covering 12 countries met the inclusion criteria, with 15 reporting incidence and 18 reporting prevalence estimates. The adjusted incidence estimates (per 10,000 of the population) ranged from 0.35 to 1.30 in Asia-Pacific countries, 0.09 to 0.49 in Europe, and 0.75 to 0.93 in North America. Unadjusted and adjusted incidence estimates were consistent. The adjusted prevalence estimates ranged from 0.57 to 4.51 in Asia-Pacific countries, 0.33 to 2.51 in Europe, and 2.40 to 2.98 in North America. South Korea had the highest incidence and prevalence estimates. When prevalence estimates were compared to country-specific rare disease thresholds, IPF met the definition of a rare disease in all countries except South Korea. There were notable geographic gaps for IPF epidemiologic data. CONCLUSIONS Due to differences in study methodologies, there is worldwide variability in the reported incidence and prevalence of IPF. Based on the countries included in our analysis, we estimated the adjusted incidence and prevalence of IPF to be in the range of 0.09-1.30 and 0.33-4.51 per 10,000 persons, respectively. According to these prevalence estimates, IPF remains a rare disease. For consistency, future epidemiologic studies of IPF should take age, sex, smoking status, and the specificity of case definitions into consideration.
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Affiliation(s)
- Toby M Maher
- Keck School of Medicine, The University of Southern California, Los Angeles, CA, USA. .,National Heart and Lung Institute, Imperial College, London, UK.
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Javaria Mona Khalid
- Evidence Generation and Epidemiology, Global Medical Affairs, Galapagos NV, Mechelen, Belgium
| | - Haridarshan Patel
- Evidence Generation and Epidemiology, Global Medical Affairs, Galapagos NV, Mechelen, Belgium
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, University of Heidelberg, Heidelberg, Germany.,German Center for Lung Research, Heidelberg, Germany
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10
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Alqalyoobi S, Fernández Pérez ER, Oldham JM. In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs. BMC Pulm Med 2020; 20:289. [PMID: 33160338 PMCID: PMC7648951 DOI: 10.1186/s12890-020-01328-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality. While early accurate diagnosis is essential for IPF treatment, data evaluating the impact of hospital academic status on IPF-related mortality remains limited. Here we examined in-hospital mortality trends for patients with IPF from 2013 to 2017. We hypothesized that in-hospital IPF mortality would be influenced by hospital academic setting. Methods Hospitalization data was extracted from the National Inpatient Sample (NIS) for subjects with an international classification of disease code for IPF. In-hospital mortality stratified by hospital setting (academic versus non-academic) was the primary outcome of interest, with secondary analyses performed for subgroups with and without respiratory failure and requiring mechanical ventilation. Predictors of mortality were then assessed. Results Among 93,680 patients with IPF requiring hospitalization, 58,450 (62.4%) were admitted to academic institutions. In-hospital mortality decreased significantly in those admitted to an academic hospital (p < 0.001) but remained unchanged in patients admitted to a non-academic hospital. A plateau in-hospital mortality was observed among all hospitalized patients (p = 0.12), with a significant decrease observed for patients with admitted respiratory failure (p < 0.001) and those placed on mechanic ventilation (p < 0.001). Conclusion In-hospital mortality decreased significantly for patients with IPF admitted to an academic hospital, suggesting that management strategies may differ by hospital setting. Mortality among those with respiratory failure and those requiring mechanical ventilation has dropped significantly. Our findings may underscore the importance of promoting early referral to an academic institution and adherence to international treatment guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-020-01328-y.
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Affiliation(s)
- Shehabaldin Alqalyoobi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, East Carolina University-Brody School of Medicine, Greenville, North Carolina, USA. .,Present address: Internal Medicine - Pulmonary, Critical Care, and Sleep Medicine, Brody School of Medicine, Mail Stop 628, 3E-149, Greenville, NC, 27834, USA.
| | - Evans R Fernández Pérez
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Justin M Oldham
- Department of Internal Medicine; Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
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11
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Seppälä S, Rajala K, Lehto JT, Sutinen E, Mäkitalo L, Kautiainen H, Kankaanranta H, Ainola M, Saarto T, Myllärniemi M. Factor analysis identifies three separate symptom clusters in idiopathic pulmonary fibrosis. ERJ Open Res 2020; 6:00347-2020. [PMID: 33043051 PMCID: PMC7533377 DOI: 10.1183/23120541.00347-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and progressive lung disease with a poor prognosis. Patients with IPF suffer from a high symptom burden, which impairs their health-related quality of life (HRQoL). Lack of research on IPF symptoms and their clustering, however, makes symptom-centred care challenging. There are three distinct symptom factors (respiratory, emotional and pain) in IPF patients. The symptom factors are associated with impairment in different domains of quality of life, with the respiratory and emotional factors having a widespread impact.https://bit.ly/3inDezm
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Affiliation(s)
- Severi Seppälä
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Päijät-Häme Central Hospital, Dept of Respiratory Medicine, Lahti, Finland
| | - Kaisa Rajala
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Uusimaa, Finland
| | - Juho Tuomas Lehto
- Palliative Care Centre and Dept of Oncology, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Eva Sutinen
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Laura Mäkitalo
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.,Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Ainola
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Tiina Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, Dept of Palliative Care and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjukka Myllärniemi
- INDIVIDRUG Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
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12
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Rozenberg D, Sitzer N, Porter S, Weiss A, Colman R, Reid WD, Shapera S, Fisher J, Wentlandt K. Idiopathic Pulmonary Fibrosis: A Review of Disease, Pharmacological, and Nonpharmacological Strategies With a Focus on Symptoms, Function, and Health-Related Quality of Life. J Pain Symptom Manage 2020; 59:1362-1378. [PMID: 31887400 DOI: 10.1016/j.jpainsymman.2019.12.364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
Despite several advances in treatment, idiopathic pulmonary fibrosis (IPF) remains a progressive, symptomatic, and terminal disease in patients not suitable for lung transplantation. With disease progression, IPF often leads to a constellation of symptoms, including dyspnea, cough, anxiety, and depression. Palliative care is appropriate to support these patients. However, traditional curriculum in palliative care has often focused on supporting patients with malignant disease, and clinicians are not universally trained to manage patients with progressive nonmalignant diseases such as IPF. Current antifibrotic therapies aim to slow disease progression but are not able to reduce symptoms or improve daily function and health-related quality of life (HRQL). Palliative care in this patient group requires an understanding of the clinical characteristics of IPF, comorbidities, common medications used, and nonpharmacological strategies that can be undertaken to improve daily function and HRQL. This review focuses on IPF management strategies and their effects on symptoms, exercise tolerance, HRQL, and survival. Pharmacological interactions and considerations related to commonly used palliative care medications are also reviewed. This review highlights the needs of patients with IPF and caregivers, psychosocial function, patient-reported assessment tools, and topics related to advance care planning.
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Affiliation(s)
- Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Nicole Sitzer
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Porter
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Colman
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - W Darlene Reid
- Interdepartmental Division of Critical Care, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shane Shapera
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Jolene Fisher
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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13
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Label-free plasma proteomics identifies haptoglobin-related protein as candidate marker of idiopathic pulmonary fibrosis and dysregulation of complement and oxidative pathways. Sci Rep 2020; 10:7787. [PMID: 32385381 PMCID: PMC7211010 DOI: 10.1038/s41598-020-64759-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/19/2020] [Indexed: 02/06/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a lung parenchymal disease of unknown cause usually occurring in older adults. It is a chronic and progressive condition with poor prognosis and diagnosis is largely clinical. Currently, there exist few biomarkers that can predict patient outcome or response to therapies. Together with lack of markers, the need for novel markers for the detection and monitoring of IPF, is paramount. We have performed label-free plasma proteomics of thirty six individuals, 17 of which had confirmed IPF. Proteomics data was analyzed by volcano plot, hierarchical clustering, Partial-least square discriminant analysis (PLS-DA) and Ingenuity pathway analysis. Univariate and multivariate statistical analysis overlap identified haptoglobin-related protein as a possible marker of IPF when compared to control samples (Area under the curve 0.851, ROC-analysis). LXR/RXR activation and complement activation pathways were enriched in t-test significant proteins and oxidative regulators, complement proteins and protease inhibitors were enriched in PLS-DA significant proteins. Our pilot study points towards aberrations in complement activation and oxidative damage in IPF patients and provides haptoglobin-related protein as a new candidate biomarker of IPF.
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14
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Lassenius MI, Toppila I, Pöntynen N, Kasslin L, Kaunisto J, Kilpeläinen M, Laitinen T. Forced Vital Capacity (FVC) decline, mortality and healthcare resource utilization in idiopathic pulmonary fibrosis. Eur Clin Respir J 2019; 7:1702618. [PMID: 32002175 PMCID: PMC6968594 DOI: 10.1080/20018525.2019.1702618] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/28/2019] [Indexed: 01/31/2023] Open
Abstract
Aim of the study: Potential care implications of antifibrotic reimbursement restrictions were studied by forced vital capacity (FVC) decline, mortality and specialty care related healthcare resource utilization in patients with idiopathic pulmonary fibrosis (IPF). Material and methods: IPF patients were identified from the electronic medical records of the Hospital District of Southwest Finland between 2005 and 2017. Text-mining was used for patient identification to exclude other interstitial lung diseases (ILD) from the cohort. FVC reimbursement restriction (FVC 50-90%) was used for stratification. Results: Out of all patients with ILD, 27% (N = 266) were identified to have IPF. At baseline, 24% presented with FVC>90% and 63% with FVC 50-90% predicted. FVC at diagnosis did not improve during the study period. Median survival decreased by severity from 6.7 years in FVC>90% at baseline to 0.7 years in patient with FVC<50% predicted. In the FVC>90% group, 14% died before a change in FVC category could be noted. Overall, 4.7 million euro worth of specialty care resources were spent on IPF patients. The highest cost driver was inpatient days. Conclusions: IPF is associated with a high burden of disease, and reimbursement restrictions are in conflict with early care. As there are antifibrotic treatment options for IPF patients, early diagnosis is important.
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Affiliation(s)
| | | | | | | | - Jaana Kaunisto
- Department of Pulmonary Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Maritta Kilpeläinen
- Department of Pulmonary Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tarja Laitinen
- Hospital administration, Tampere University Hospital, Tampere, Finland
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15
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Lai RS, Chen CF, Chu KA, Lin MH. The effect of emphysema on survival in patients with idiopathic pulmonary fibrosis: A retrospective study in Taiwan. J Chin Med Assoc 2019; 82:922-928. [PMID: 31800533 DOI: 10.1097/jcma.0000000000000201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a rare and chronic fibrosing interstitial lung disease. However, the clinical features and outcomes of IPF in Taiwan have not been well studied. In addition, the survival difference between patients with IPF alone and combined pulmonary fibrosis and emphysema (CPFE) remains controversial. METHODS Patients diagnosed with IPF between 2006 and 2016 were retrospectively enrolled in this study. IPF was defined according to the 2011 American Thoracic Society/European Respiratory Society guideline. The clinical features, comorbidities, and outcomes of CPFE group and IPF-alone group were compared. The extents of emphysema and fibrosis were evaluated. RESULTS In total, 114 patients with IPF were enrolled, and 86.8% of them were men with a mean age of 77.8 years. The median survival was 3.33 years in all patients with IPF. Moreover, 30 patients (26.3%) met the CPFE criteria. The CPFE group had a higher percentage of smokers (90% vs 50%, p < 0.001), higher forced vital capacity (82% vs 59%, p < 0.001), and lower fibrosis scores (8.5 ± 2.9 vs 10 ± 3.2, p = 0.022) than did the IPF-alone group. The baseline room air saturation and percentage of pulmonary hypertension were similar between the two groups. The survival time was not significantly different between the CPFE and IPF-alone groups (median survival, 3.58 vs 2.39 years, p = 0.163). In the multivariate analysis, higher fibrosis score, room air saturation < 90%, and lung cancer were significant factors associated with mortality. CONCLUSION Our study showed that emphysema had no significant effect on the survival of patients with IPF. The outcome of IPF was mainly determined by the baseline disease severity and other comorbidities.
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Affiliation(s)
- Ruay-Sheng Lai
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chiu-Fan Chen
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, Taipei Veterans General Hospital, Taitung Branch, Taitung, Taiwan, ROC
| | - Kuo-An Chu
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Min-Hsi Lin
- Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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16
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Kaunisto J, Salomaa ER, Hodgson U, Kaarteenaho R, Kankaanranta H, Koli K, Vahlberg T, Myllärniemi M. Demographics and survival of patients with idiopathic pulmonary fibrosis in the FinnishIPF registry. ERJ Open Res 2019; 5:00170-2018. [PMID: 31304177 PMCID: PMC6612605 DOI: 10.1183/23120541.00170-2018] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 05/14/2019] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterised by unpredictable disease course and poor survival. After the introduction of novel antifibrotic drugs, the prognosis of patients with IPF is probably changing. FinnishIPF, a nationwide registry of carefully characterised patients, was initiated in Finland in 2011. For the data analysis, we included 453 incident IPF patients diagnosed during 2011-2015. In this study, we describe the demographics and prognosis of these real-life patients. The median overall survival time of registered IPF patients was 4.5 years. The transplant-free survival at 1, 2, 3, 4 and 5 years was 95%, 83%, 70%, 58% and 45%, respectively. Smoking did not have any effect on survival. 117 (26%) patients received pirfenidone or nintedanib. Patients who received ≥6 months of treatment had better survival compared with those who did not receive treatment but this difference disappeared after age adjustment. The transplantation rate was 3%. Although IPF is diagnosed in Finland at a older age, the prognosis is better than expected due to a relatively well preserved lung function at diagnosis. Age and pulmonary function were identified as independent predictors of survival in the entire IPF patient population as well as in patients who had received antifibrotic treatment.
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Affiliation(s)
- Jaana Kaunisto
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Eija-Riitta Salomaa
- Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Ulla Hodgson
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Dept of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta Kaarteenaho
- Respiratory Medicine, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Katri Koli
- Research Programs Unit, Individrug Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Tero Vahlberg
- Dept of Biostatistics, University of Turku, Turku, Finland
| | - Marjukka Myllärniemi
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Individrug Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland
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17
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Demographic and clinical profile of idiopathic pulmonary fibrosis patients in Spain: the SEPAR National Registry. Respir Res 2019; 20:127. [PMID: 31208406 PMCID: PMC6580511 DOI: 10.1186/s12931-019-1084-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Little is known on the characteristics of patients diagnosed with idiopathic pulmonary fibrosis (IPF) in Spain. We aimed to characterize the demographic and clinical profile of IPF patients included in the IPF National Registry of the Spanish Respiratory Society (SEPAR). Methods This is a prospective, observational, multicentre and nationwide study that involved 608 IPF patients included in the SEPAR IPF Registry up to June 27th, 2017, and who received any treatment for their disease. IPF patients were predominantly males, ex-smokers, and aged in their 70s, similar to other registries. Results Upon inclusion, mean ± SD predicted forced vital capacity was 77.6% ± 19.4, diffusing capacity for carbon monoxide was 48.5% ± 17.7, and the 6-min walk distance was 423.5 m ± 110.4. The diagnosis was mainly established on results from the high-resolution computed tomography in the proper clinical context (55.0% of patients), while 21.2% of patients required invasive procedures (surgical lung biopsy) for definitive diagnosis. Anti-fibrotic treatment was prescribed in 69.4% of cases, 51.5% pirfenidone and 17.9% nintedanib, overall with a good safety profile. Conclusions The SEPAR IPF Registry should help to further characterize current characteristics and future trends of IPF patients in Spain and compare/pool them with other registries and cohorts.
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18
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Inorganic particulate matter in the lung tissue of idiopathic pulmonary fibrosis patients reflects population density and fine particle levels. Ann Diagn Pathol 2019; 40:136-142. [DOI: 10.1016/j.anndiagpath.2019.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022]
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19
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Wuyts WA, Dahlqvist C, Slabbynck H, Schlesser M, Gusbin N, Compere C, Maddens S, Kirchgaessler KU, Bartley K, Bondue B. Baseline clinical characteristics, comorbidities and prescribed medication in a real-world population of patients with idiopathic pulmonary fibrosis: the PROOF registry. BMJ Open Respir Res 2018; 5:e000331. [PMID: 30555708 PMCID: PMC6267319 DOI: 10.1136/bmjresp-2018-000331] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/02/2018] [Indexed: 11/08/2022] Open
Abstract
Introduction PROOF (a Prospective Observational Registry to Describe the Disease Course and Outcomes of Idiopathic Pulmonary Fibrosis) is an ongoing, observational registry initiated in 2013 with the aim of collecting real-world data from patients with idiopathic pulmonary fibrosis (IPF). Here, we present comprehensive baseline data, which were collected from patients on registry inclusion. Methods Patients with IPF were enrolled across eight centres in Belgium and Luxembourg. Baseline data collected included demographics, diagnostic information and clinical characteristics, including lung function and health-related quality of life. Data on comorbidities and prescribed medication were also collected. Results A total of 277 patients were enrolled in the PROOF registry. At inclusion, 92.8% and 6.5% of patients had a definite or probable diagnosis of IPF, respectively. Mean per cent predicted forced vital capacity and carbon monoxide diffusing capacity were 80.6% and 46.9%, respectively. Mean St. George’s Respiratory Questionnaire total score was 47.0, and mean Cough-Visual Analogue Scale score was 30.5 mm. The most prevalent comorbidities reported at inclusion were gastrointestinal disorders (50.2%), including gastro-oesophageal reflux disease (47.3%) and metabolism and nutrition disorders (39.7%). At inclusion, 67.2% and 2.2% of patients were prescribed pirfenidone and nintedanib, respectively, with treatment initiated either prior to, or at the time of, inclusion. Medication prescribed concomitantly with pirfenidone included antihypertensives (54.8%), statins (37.1%) and prophylactic antithrombotics/anticoagulants (36.6%). Conclusion The PROOF registry provides valuable demographic and clinical data from a real-world population of patients with IPF in Belgium and Luxembourg, demonstrating the high burden of comorbidities and prescribed medication in these patients. Longitudinal data from this patient population will be investigated in future analyses. Trial registration PROOF is registered with the relevant authorities in Belgium and Luxembourg, with registration to Comité National d’Éthique et de Recherché (CNER) N201309/03 – 12 September 2013 and a notification to Comité National de Protection des Données (CNDP).
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Affiliation(s)
- Wim A Wuyts
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerp, Belgium
| | - Marc Schlesser
- Department of Respiratory Medicine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | | | | | | | - Karen Bartley
- Genentech, Inc., South San Francisco, California, USA
| | - Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Brussels, Belgium
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20
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Rajala K, Lehto JT, Sutinen E, Kautiainen H, Myllärniemi M, Saarto T. Marked deterioration in the quality of life of patients with idiopathic pulmonary fibrosis during the last two years of life. BMC Pulm Med 2018; 18:172. [PMID: 30458739 PMCID: PMC6247520 DOI: 10.1186/s12890-018-0738-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/08/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic disease with a high symptom burden and poor survival that influences patients' health-related quality of life (HRQOL). We aimed to evaluate IPF patients' symptoms and HRQOL in a well-documented clinical cohort during their last two years of life. METHODS In April 2015, we sent the Modified Medical Research Council Dyspnea Scale (MMRC), the modified Edmonton Symptom Assessment Scale (ESAS) and a self-rating HRQOL questionnaire (RAND-36) to 300 IPF patients, of which 247 (82%) responded. Thereafter, follow-up questionnaires were sent every six months for two years. RESULTS Ninety-two patients died by August 2017. Among these patients, HRQOL was found to be considerably low already two years before death. The most prominent declines in HRQOL occurred in physical function, vitality, emotional role and social functioning (p < 0.001). The proportion of patients with MMRC scores ≥3 increased near death. Breathlessness and fatigue were the most severe symptoms. Symptom severity for the following symptoms increased significantly and reached the highest mean scores during the last six months of life (numeric rating scale/standard deviation): breathlessness (7.1/2.8), tiredness (7.0/2.3), dry mouth (6.0/3.0), cough (5.8/2.9), and pain with movement (5.0/3.5). CONCLUSIONS To our knowledge this is the first study demonstrating, that IPF patients experience remarkably low HRQOL already two years before death, especially regarding physical role. In addition, they suffer from severe breathlessness and fatigue. Furthermore, physical, social and emotional wellbeing deteriorate, and symptom burden increases near death. Regular symptom and HRQOL measurements are essential to assess palliative care needs in patients with IPF.
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Affiliation(s)
- K. Rajala
- Department of Palliative Care, Comprehensive Cancer Center,, Helsinki University Hospital, Paciuksenkatu 21, Po BOX 180, FI-00290 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J. T. Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - E. Sutinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - H. Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Finland and Folkhälsan Research Center, Helsinki, Finland
| | - M. Myllärniemi
- University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Department of Pulmonary Medicine, Helsinki, Finland
| | - T. Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, Department of Palliative Care and Faculty of Medicine, University of Helsinki, Helsinki, Finland
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21
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Diagnosis of Idiopathic Pulmonary Fibrosis in a Possible Usual Interstitial Pneumonia Pattern: a meta-analysis. Sci Rep 2018; 8:15886. [PMID: 30367143 PMCID: PMC6203840 DOI: 10.1038/s41598-018-34230-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/11/2018] [Indexed: 11/09/2022] Open
Abstract
This study aimed to determine whether a surgical lung biopsy is essential for IPF diagnosis with the possible UIP CT pattern. We performed literature searches of the MEDLINE and EMBASE databases and included studies that conducted a radiologic-pathologic evaluation of IPF according to the 2011 guideline. Outcomes were pooled using a random-effects model. Twelve studies were included. Pooled proportions of IPF for a UIP pattern were 99% (95%CI, 93% to 100%; I2 = 51.7%) and for a possible UIP pattern were 94% (scenario inclusive of probable IPF; 95%CI, 87% to 99%; I2 = 82.9%) and 88% (scenario exclusive of probable IPF; 95%CI, 79% to 95%; I2 = 82.7%). The pooled percentage difference in the proportion of IPF between the UIP and possible UIP patterns was −2% (95%CI, −4% to 1%; I2 = 0.0%) in the former scenario and 4% (95%CI, 0% to 8%; I2 = 0.1%) in the latter scenario. The proportion of IPF with the possible UIP pattern was moderately correlated with the prevalence of IPF (correlation coefficient, 0.605; 95%CI, 0.550–0.860). There was a negligible pooled percentage difference in the proportion of IPF between the UIP and possible UIP patterns, indicating that IPF diagnosis can be confirmed without biopsy in suspected IPF cases with the possible UIP pattern.
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Barratt SL, Creamer A, Hayton C, Chaudhuri N. Idiopathic Pulmonary Fibrosis (IPF): An Overview. J Clin Med 2018; 7:jcm7080201. [PMID: 30082599 PMCID: PMC6111543 DOI: 10.3390/jcm7080201] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 02/07/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease characterised by chronic, progressive scarring of the lungs and the pathological hallmark of usual interstitial pneumonia. Current paradigms suggest alveolar epithelial cell damage is a key initiating factor. Globally, incidence of the disease is rising, with associated high morbidity, mortality, and economic healthcare burden. Diagnosis relies on a multidisciplinary team approach with exclusion of other causes of interstitial lung disease. Over recent years, two novel antifibrotic therapies, pirfenidone and nintedanib, have been developed, providing treatment options for many patients with IPF, with several other agents in early clinical trials. Current efforts are directed at identifying key biomarkers that may direct more customized patient-centred healthcare to improve outcomes for these patients in the future.
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Affiliation(s)
- Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK.
- Academic Respiratory Unit, University of Bristol, Bristol BS16 1QY, UK.
| | - Andrew Creamer
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK.
| | - Conal Hayton
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe, Manchester M23 9LT, UK.
| | - Nazia Chaudhuri
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe, Manchester M23 9LT, UK.
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Pesonen I, Carlson L, Murgia N, Kaarteenaho R, Sköld CM, Myllärniemi M, Ferrara G. Delay and inequalities in the treatment of idiopathic pulmonary fibrosis: the case of two Nordic countries. Multidiscip Respir Med 2018; 13:14. [PMID: 29785264 PMCID: PMC5950183 DOI: 10.1186/s40248-018-0126-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is characterized by progressive loss of lung function with high mortality within the first 5 years from diagnosis. In 2011-2014, two drugs, pirfenidone and nintedanib, have been approved worldwide for prevention of IPF progression. National IPF-registries have been established in both Finland and Sweden. Our study explored potential differences in the care of IPF in these two countries. Methods Patients included consecutively in the Finnish and Swedish IPF-registries from January 1, 2014 through December 31, 2016 were included in the study. Data on demographics and lung function at the time of inclusion were collected. Access to antifibrotic drugs and data on disease outcomes, mortality and the proportion of patients who underwent lung transplantation, was collected during a 3-year follow up. Results One-hundred and fifty-two patients from the Finnish and 160 patients from the Swedish IPF-cohorts were included in the study. At inclusion, Finnish patients were significantly older than the Swedish patients (74.6 years vs 72.5 years, p = 0.017). The proportion of non-smokers was significantly higher in the Finnish cohort (41.7% vs 26.9%, p = 0.007). Forced vital capacity (FVC), % of predicted (78.2 vs 71.7 for Finnish and Swedish patients, respectively, p = 0.01) and diffusion capacity for carbon monoxide (DLCO), % of predicted (53.3 vs 48.2 for Finnish and Swedish patients, respectively, p = 0.002) were significantly higher in the Finnish cohort compared to the Swedish cohort at the time of inclusion. During the 3-year follow up period, 45 (29.6%) Finnish and 111 (69.4%) Swedish patients, respectively, were initiated on treatment with an antifibrotic drug (pirfenidone or nintedanib) (p < 0.001). When comparing possible determinants of treatment, patients with higher FVC % were less likely to start antifibrotic drugs (OR 0.96, 95%CI 0.93-1.00, p < 0.024). To be resident in Sweden was the main determinant for receiving antifibrotic drugs (OR 5.48, 95%CI 2.65-11.33, p < 0.0001). No significant difference in number of deaths and lung transplantation during the follow up period was found. Conclusions This study highlights differences concerning how IPF patients are treated in Finland and Sweden. How these differences will influence the long-term outcome of these patients is unknown.
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Affiliation(s)
- Ida Pesonen
- 1Department of Respiratory Medicine and Allergy, Karolinska University Hospital, SE-17176 Stockholm, Sweden.,2Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Carlson
- 1Department of Respiratory Medicine and Allergy, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Nicola Murgia
- 3Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy.,4Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Riitta Kaarteenaho
- 5Research Unit of Internal Medicine, University of Oulu and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Carl Magnus Sköld
- 1Department of Respiratory Medicine and Allergy, Karolinska University Hospital, SE-17176 Stockholm, Sweden.,2Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marjukka Myllärniemi
- 6University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Giovanni Ferrara
- 1Department of Respiratory Medicine and Allergy, Karolinska University Hospital, SE-17176 Stockholm, Sweden.,2Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Analysis of the Histologic Features Associated With Interobserver Variation in Idiopathic Pulmonary Fibrosis. Am J Surg Pathol 2018; 42:672-678. [DOI: 10.1097/pas.0000000000001031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with high mortality. Two novel antifibrotic agents, pirfenidone and nintedanib, have received licences for use in IPF in recent years. Phase III, multinational, randomised control trials have provided evidence that both drugs reduce decline in forced vital capacity (FVC) over time, while further post hoc studies have suggested that both pirfenidone and nintedanib can be efficacious, regardless of age and severity of baseline lung function. Both therapeutic agents have manageable side effect profiles. In the absence of head-to-head data, decisions regarding which agent to choose when starting treatment for IPF should take into consideration joint decision making between patients and clinicians based on accurate information in the decision-making process. Questions remain as to the role of combination antifibrotic therapy as a future treatment option.
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Hilberg O, Bendstrup E, Løkke A, Ibsen R, Fløe A, Hyldgaard C. Co-morbidity and mortality among patients with interstitial lung diseases: A population-based study. Respirology 2017; 23:606-612. [DOI: 10.1111/resp.13234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/09/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Ole Hilberg
- Department of Medicine; Vejle Hospital; Vejle Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases; Aarhus University Hospital; Aarhus Denmark
| | - Anders Løkke
- Department of Respiratory Diseases; Aarhus University Hospital; Aarhus Denmark
| | | | - Andreas Fløe
- Department of Respiratory Diseases; Aarhus University Hospital; Aarhus Denmark
| | - Charlotte Hyldgaard
- Department of Respiratory Diseases; Aarhus University Hospital; Aarhus Denmark
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Rajala K, Lehto JT, Sutinen E, Kautiainen H, Myllärniemi M, Saarto T. mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis. ERJ Open Res 2017; 3:00084-2017. [PMID: 29255720 PMCID: PMC5731772 DOI: 10.1183/23120541.00084-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/02/2017] [Indexed: 11/05/2022] Open
Abstract
This study was undertaken to investigate idiopathic pulmonary fibrosis (IPF) patients' health-related quality of life (HRQoL) and symptoms in a real-life cross-sectional study. Our secondary aim was to create a simple identification method for patients with increased need for palliative care by studying the relationship between modified Medical Research Council (mMRC) dyspnoea scale, HRQoL and symptoms. We sent a self-rating HRQoL questionnaire (RAND-36) and modified Edmonton Symptom Assessment Scale (ESAS) to 300 IPF patients; 84% of the patients responded to these questionnaires. The most prevalent (>80%) symptoms were tiredness, breathlessness, cough and pain in movement. An increasing mMRC score showed a linear relationship (p<0.001) to impaired HRQoL in all dimensions of RAND-36 and the severity of all symptoms in ESAS. Dimensions of RAND-36 fell below general population reference values in patients with mMRC score ≥2. The intensity of pain in movement (p<0.001) and at rest (p=0.041), and the prevalence of chest pain (p<0.001) had a positive linear relationship to increased mMRC score. An increasing mMRC score reflects impaired HRQoL and a high symptom burden. In clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care. mMRC indicates impaired HRQoL and pain in IPFhttp://ow.ly/oRB430gIW7U
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Affiliation(s)
- Kaisa Rajala
- Helsinki University Hospital, Comprehensive Cancer Center, Dept of Palliative Care, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juho T Lehto
- Dept of Oncology, Palliative Care Unit, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Eva Sutinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Marjukka Myllärniemi
- University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Dept of Pulmonary Medicine, Helsinki, Finland
| | - Tiina Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, Dept of Palliative Care, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Tzilas V, Tzouvelekis A, Chrysikos S, Papiris S, Bouros D. Diagnosis of Idiopathic Pulmonary Fibrosis "Pragmatic Challenges in Clinical Practice". Front Med (Lausanne) 2017; 4:151. [PMID: 28979896 PMCID: PMC5611388 DOI: 10.3389/fmed.2017.00151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/04/2017] [Indexed: 12/04/2022] Open
Abstract
The past few years have signaled a major breakthrough on the management of idiopathic pulmonary fibrosis (IPF). Finally, we have drugs in our arsenal able to slow down the inexorable disease natural course. On the other hand, the latter evidence has increased the responsibility for a timely and accurate diagnosis. Establishment of IPF diagnosis directly affects the choice of appropriate treatment. The current diagnostic guidelines represent a major step forward providing an evidence-based road map; yet, clinicians are encountering major diagnostic dilemmas that inevitably affect therapeutic decisions. This review article aims to summarize the current state of knowledge on the diagnostic procedure of IPF based on the current guidelines and discuss pragmatic difficulties and challenges encountered by clinicians with regards to their applicability in the everyday clinical practice.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Serafim Chrysikos
- 5th Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Athens, Greece
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kärkkäinen M, Kettunen HP, Nurmi H, Selander T, Purokivi M, Kaarteenaho R. Effect of smoking and comorbidities on survival in idiopathic pulmonary fibrosis. Respir Res 2017; 18:160. [PMID: 28830514 PMCID: PMC5567897 DOI: 10.1186/s12931-017-0642-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 08/13/2017] [Indexed: 12/20/2022] Open
Abstract
Background Cigarette smoking has been associated with the risk of idiopathic pulmonary fibrosis (IPF). Certain comorbidities have been associated with reduced survival although some studies have indicated that current smokers have a longer survival than ex-smokers. Comorbidities in relation to smoking history have not been previously analyzed. Methods Retrospective data was collected and patients were categorized according to gender and smoking habits. Comorbidities and medications were collected. Predictive values for mortality were identified by COX proportional hazard analyses. Results We examined 45 non-smokers (53.3% female), 66 ex-smokers (9.1% female) and 17 current smokers (17.6% female) with IPF. Current smokers were younger at baseline (58.1 ± 8.74 years) compared to non-smokers (71.4 ± 8.74, p < 0.001) and ex-smokers (72.5 ±7.95, p <0.001). Median survival of non-smokers and current smokers was longer (55.0 and 52.0 months, respectively) than that of ex-smokers (36.0 months) (p=0.028 and 0.034, respectively). In age and severity adjusted analyses, smoking was not related to survival. Cardiovascular diseases (CVD) (72.7 %) were the most common comorbidities, current smokers had more chronic obstructive pulmonary disease (COPD) and lung cancer compared to ex-smokers (p<0.001). CVD, COPD and use of insulin were related to poorer survival in adjusted analyses. Conclusions Smoking seems to influence the course of disease in IPF since current smokers developed the disease at a younger age in comparison to non-smokers and ex-smokers. No significant differences in the major comorbidities were detected between IPF patients with different smoking histories. The mechanism through which smoking influences IPF progression requires further investigation.
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Affiliation(s)
- Miia Kärkkäinen
- The Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Puijonlaaksontie 2, 70210, Kuopio, Finland. .,Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Hannu-Pekka Kettunen
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland
| | - Hanna Nurmi
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Harjula Hospital, the Municipal Hospital of Kuopio, Niuvantie 4, 70101, Kuopio, Finland
| | - Tuomas Selander
- The Science Services Center, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland
| | - Minna Purokivi
- The Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Riitta Kaarteenaho
- The Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Puijonlaaksontie 2, 70210, Kuopio, Finland.,Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Respiratory Medicine, Internal Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 20, 90029, Oulu, Finland
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Jo HE, Glaspole I, Grainge C, Goh N, Hopkins PMA, Moodley Y, Reynolds PN, Chapman S, Walters EH, Zappala C, Allan H, Keir GJ, Hayen A, Cooper WA, Mahar AM, Ellis S, Macansh S, Corte TJ. Baseline characteristics of idiopathic pulmonary fibrosis: analysis from the Australian Idiopathic Pulmonary Fibrosis Registry. Eur Respir J 2017; 49:49/2/1601592. [PMID: 28232409 DOI: 10.1183/13993003.01592-2016] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/27/2016] [Indexed: 11/05/2022]
Abstract
7The prevalence of idiopathic pulmonary fibrosis (IPF), a fatal and progressive lung disease, is estimated at 1.25-63 out of 100 000, making large population studies difficult. Recently, the need for large longitudinal registries to study IPF has been recognised.The Australian IPF Registry (AIPFR) is a national registry collating comprehensive longitudinal data of IPF patients across Australia. We explored the characteristics of this IPF cohort and the effect of demographic and physiological parameters and specific management on mortality.Participants in the AIPFR (n=647, mean age 70.9±8.5 years, 67.7% male, median follow up 2 years, range 6 months-4.5 years) displayed a wide range of age, disease severity and co-morbidities that is not present in clinical trial cohorts. The cumulative mortality rate in year one, two, three and four was 5%, 24%, 37% and 44% respectively. Baseline lung function (forced vital capacity, diffusing capacity of the lung for carbon monoxide, composite physiological index) and GAP (gender, age, physiology) stage (hazard ratio 4.64, 95% CI 3.33-6.47, p<0.001) were strong predictors of mortality. Patients receiving anti-fibrotic medications had better survival (hazard ratio 0.56, 95% CI 0.34-0.92, p=0.022) than those not on anti-fibrotic medications, independent of underlying disease severity.The AIPFR provides important insights into the understanding of the natural history and clinical management of IPF.
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Affiliation(s)
- Helen E Jo
- Dept of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia .,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ian Glaspole
- Dept of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia.,Faculty of Medicine, Monash University, Melbourne, Australia
| | | | - Nicole Goh
- Dept of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia.,Dept of Respiratory Medicine, Austin Hospital, Heidelberg, Australia
| | | | - Yuben Moodley
- Dept of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Paul N Reynolds
- Dept of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Sally Chapman
- Dept of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Christopher Zappala
- Dept of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | | | - Gregory J Keir
- Dept of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrew Hayen
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Samantha Ellis
- Dept of Radiology, The Alfred Hospital, Melbourne, Australia
| | | | - Tamera J Corte
- Dept of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia .,Faculty of Medicine, University of Sydney, Sydney, Australia
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Purokivi M, Hodgson U, Myllärniemi M, Salomaa ER, Kaarteenaho R. Are physicians in primary health care able to recognize pulmonary fibrosis? Eur Clin Respir J 2017; 4:1290339. [PMID: 28326180 PMCID: PMC5345592 DOI: 10.1080/20018525.2017.1290339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/21/2017] [Indexed: 11/01/2022] Open
Abstract
Background: The early diagnosis of idiopathic pulmonary fibrosis (IPF) has become increasingly important due to evolving treatment options. IPF patients experience a significant delay in receiving an accurate diagnosis, thus delayed access to tertiary care is associated with higher mortality independently from disease severity. Objective: The aims were to evaluate whether there had been a delay in the referral process, and to determine whether the referring doctors had suspected IPF or other interstitial lung disease (ILD) already during the time of referral. Methods: Ninety-five referral letters of patients with IPF identified from the FinnishIPF registry were evaluated with respect to time of referral, referring unit, grounds for referral, symptoms, smoking status, occupational history, clinical examinations, co-morbidities, medication, radiological findings and lung function. Results: Fifty-nine percent of referral letters originated from primary public health care. The time from symptom onset to referral was reported in 60% of cases, mean time being 1.5 (0.8-2.3) (95%CI) years. The main reason for referral was a suspicion of interstitial lung disease (ILD) (63%); changes in chest X-ray were one reason for referring in 53% of cases. Lung auscultation was reported in 70% and inspiratory crackles in 52% of referral letters. Conclusions: Primary care doctors suspected lung fibrosis early in the course of disease. Lung auscultation and chest X-rays were the most common investigational abnormalities in the referrals. Providing general practitioners with more information of ILDs might shorten the delay from symptom onset to referral.
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Affiliation(s)
- Minna Purokivi
- Center for Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Ulla Hodgson
- Department of Pulmonary Medicine, Heart and Lung Center , Helsinki , Finland
| | - Marjukka Myllärniemi
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki, Finland; Department of Clinical Medicine and Transplantation Laboratory and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Riitta Kaarteenaho
- Center for Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland; Unit of Medicine and Clinical Research, Pulmonary Division, University of Eastern Finland, Kuopio, Finland; Respiratory Medicine, Internal Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Rajala K, Lehto JT, Saarinen M, Sutinen E, Saarto T, Myllärniemi M. End-of-life care of patients with idiopathic pulmonary fibrosis. BMC Palliat Care 2016; 15:85. [PMID: 27729035 PMCID: PMC5059981 DOI: 10.1186/s12904-016-0158-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/13/2016] [Indexed: 02/03/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. Methods We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death. Results Hospital was the place of death for 47 patients (80 %). A majority of the patients (93 %) were hospitalized for a mean of 30 days (range 1–96 days) during the last 6 months of their life. Altogether, patients spent 15 % of their last 6 months of life in a hospital. End-of-life decisions and do not resuscitate (DNR) orders were made for 19 (32 %) and 34 (57 %) of the patients, respectively, and 22 (42 %) of these decisions were made ≤ 3 days prior to death. During the final hospital stay, antibiotics were given to 79 % and non-invasive ventilation to 36 % of patients. During the last 24 h of life, radiologic imaging or laboratory tests were taken in 19 % and 53 % of the hospitalized patients, respectively. These tests and life prolonging therapies were more common in tertiary hospitals compared to other places of death. Dyspnea (66 %) and pain (31 %) were the most common symptoms recorded. Opioids were prescribed to 71 % of the patients during the last week before death. Conclusions The majority of IPF patients died in a hospital with ongoing life-prolonging procedures until death. The frequent use of opioids is an indicator of an intention to relieve symptoms, but end-of-life decisions were still made very late. Early integrated palliative care with advance care plan could improve the end-of-life care of dying IPF patients.
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Affiliation(s)
- Kaisa Rajala
- Helsinki University Central Hospital, Comprehensive Cancer Center and Faculty of Medicine, University of Helsinki, Cancer Center, PoBox 180, FI-00029, HUS, Helsinki, Finland. .,Palliative Unit, Helsinki University Central Hospital, Comprehensive Cancer Center, Haartmaninkatu 4, FI-00290, Helsinki, Finland.
| | - Juho T Lehto
- TAYS Palliative Unit, Department of Oncology, Tampere University Hospital and School of Medicine, University of Tampere, Teiskontie 35, 33520, Tampere, Finland
| | - M Saarinen
- University of Helsinki, Faculty of Medicine, Helsinki, Finland.,Transplantantation Laboratory, Pulmonary Medicine, B411 Haartmaninkatu 3, FI-00290, Helsinki, Finland
| | - E Sutinen
- University of Helsinki, Faculty of Medicine, Helsinki, Finland.,Transplantantation Laboratory, Pulmonary Medicine, B411 Haartmaninkatu 3, FI-00290, Helsinki, Finland
| | - T Saarto
- Helsinki University Central Hospital, Comprehensive Cancer Center and Faculty of Medicine, University of Helsinki, Cancer Center, PoBox 180, FI-00029, HUS, Helsinki, Finland
| | - M Myllärniemi
- Department of Pulmonary Medicine, University of Helsinki and Helsinki University Hospital, Heart and Lung Center, PoBox372, FI-00029, HUS, Helsinki, Finland
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Poletti V, Ravaglia C, Gurioli C, Piciucchi S, Dubini A, Cavazza A, Chilosi M, Rossi A, Tomassetti S. Invasive diagnostic techniques in idiopathic interstitial pneumonias. Respirology 2016; 21:44-50. [PMID: 26682637 DOI: 10.1111/resp.12694] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022]
Abstract
Fibrosing interstitial lung diseases (f-ILDs) represent a heterogeneous group of disorders in which the aetiology may be identified or, not infrequently, remain unknown. Establishing a correct diagnosis of a distinct f-ILD requires a multidisciplinary approach, integrating clinical profile, physiological and laboratory data, radiological appearance and, when appropriate, histological findings. Surgical lung biopsy is still considered the most important diagnostic tool as it is able to provide lung samples large enough for identification of complex patterns such as usual interstitial pneumonitis (UIP) and nonspecific interstitial pneumonitis. However, this procedure is accompanied by significant morbidity and mortality. Bronchoalveolar lavage is still a popular diagnostic tool allowing identification of alternative diagnoses in patients with suspected idiopathic pulmonary fibrosis (IPF) when an increase in lymphocytes is detected. Conventional transbronchial lung biopsy has a very low sensitivity in detecting the UIP pattern and its role in this clinical-radiological context is marginal. The introduction of less invasive methods such as transbronchial cryobiopsy show great promise to clinical practice as they can be used to obtain samples large enough to morphologically support a diagnosis of IPF or other idiopathic interstitial pneumonias, along with fewer complications. Recent advances in the field suggest that less invasive methods of lung sampling, without significant side effects, in combination with other diagnostic methods could replace the need for surgical lung biopsy in the future. Indeed, these new multidisciplinary procedures may become the main diagnostic work-up method for patients with suspected idiopathic interstitial pneumonia.
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Affiliation(s)
- Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Carlo Gurioli
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Departments of Radiology, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | | | - Alberto Cavazza
- Operative Unit of Pathology, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Marco Chilosi
- Department of Pathology, Verona University, Verona, Italy
| | - Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | - Sara Tomassetti
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
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Sköld CM, Janson C, Elf ÅK, Fiaschi M, Wiklund K, Persson HL. A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study. Eur Clin Respir J 2016; 3:32035. [PMID: 27435431 PMCID: PMC4951637 DOI: 10.3402/ecrj.v3.32035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/23/2016] [Indexed: 12/14/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that usually results in respiratory failure and death. Pirfenidone was approved as the first licensed therapy for IPF in Europe based on phase III trials where patients with a forced vital capacity (FVC) >50% of predicted were included. The aim of this study was to characterise patients treated with pirfenidone in Swedish clinical practice and to describe the adherence to the reimbursement restriction since reimbursement was only applied for patients with FVC below 80% of predicted. Methods This was a retrospective, observational chart review of IPF patients treated with pirfenidone from three Swedish university clinics. Patients initiated on treatment during the period 28 June 2012 to 20 November 2014 were included. Data on patient characteristics, basis of diagnosis, treatment duration, quality of life, and adverse drug reactions (ADRs) were collected from medical charts. Results Forty-four patients were screened and 33 were included in the study. The mean treatment duration from start of pirfenidone until discontinuation or end of study was 38 weeks. At the initiation of pirfenidone treatment, FVC was 62.7% (12.1) [mean (SD)], diffusion capacity (DLco) was 45.1% (13.8) of predicted, and the ratio of forced expiratory volume on 1 sec (FEV1) to FVC was 0.78 (0.1). The percentage of patients with an FVC between 50 and 80% was 87%. Ten of the patients had ADRs including gastrointestinal and skin-related events, cough and signs of impaired hepatic function, but this led to treatment discontinuation in only two patients. Conclusion Data from this chart review showed that adherence to the Swedish reimbursement restriction was followed in the majority of patients during the study period. At the start of pirfenidone treatment, lung function, measured as FVC, was lower in the present cohort of Swedish IPF patients compared with other registry and real-life data. About a third of the patients had ADRs, but discontinuation of the treatment because of ADRs was relatively uncommon.
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Affiliation(s)
- Carl Magnus Sköld
- Department of Medicine Solna, Karolinska Institutet, Lung-Allergy Clinic, Karolinska University Hospital Solna, Stockholm, Sweden;
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | | | - Hans Lennart Persson
- Division of Pulmonary Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkö ping University, Linkö ping, Sweden
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Ferrara G, Carlson L, Palm A, Einarsson J, Olivesten C, Sköld M. Idiopathic pulmonary fibrosis in Sweden: report from the first year of activity of the Swedish IPF-Registry. Eur Clin Respir J 2016; 3:31090. [PMID: 27105945 PMCID: PMC4841864 DOI: 10.3402/ecrj.v3.31090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/29/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is an emerging problem in the western world, being related to increasing age and implying significant costs for the diagnosis and management of affected patients. The epidemiology of IPF is not well understood. METHODS To allow estimates of the problem and eventually to evaluate quality of the care of IPF patients in Sweden, a national IPF Registry was started in the autumn of 2014. Data on criteria used to diagnose IPF, demographics, lung function, and quality of life (measured with the King's Brief Interstitial Lung Disease Questionnaire, K-BILD) were reported directly to the registry, based at the coordinating centre (Karolinska University Hospital, Stockholm, Sweden) via a web-based platform. RESULTS During the first year, the registry was implemented in 11 (33%) of the 33 respiratory units in the country. Seventy-one patients were registered between October 2014 and October 2015, 50 (70.4%) males and 21 (29.6%) females. Median age was 70 (range 47-86). The mean K-BILD score at the first inclusion in the registry was 54.3+9.5. CONCLUSIONS The main features of IPF patients in this first Swedish cohort were consistent with data published in the literature in main multinational randomized controlled trials. The K-BILD questionnaire showed that quality of life of patients with IPF and their perception of the disease are quite poor at the time of inclusion in the registry.
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Affiliation(s)
- Giovanni Ferrara
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden;
| | - Lisa Carlson
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jonas Einarsson
- Skåne University Hospital, Malmö, Sweden
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Magnus Sköld
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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