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Stoltefuß S, Leuschner G, Milger K, Kauke T, Götschke J, Veit T, Lenoir A, Kneidinger N, Behr J. Assessing health-related quality of life in patients with interstitial lung diseases. BMC Pulm Med 2024; 24:452. [PMID: 39272068 PMCID: PMC11401309 DOI: 10.1186/s12890-024-03262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The R-Scale-PF was proposed to evaluate the health-related quality of life (HRQoL) in patients with idiopathic pulmonary fibrosis (IPF). We generated a German version of the R-Scale-PF (GR-Scale), representing the first translation of the questionnaire into another language and assessed HRQoL longitudinally in various interstitial lung diseases (ILDs) using the R-Scale-PF scoring system at a specialized ILD centre. METHODS We have translated the questionnaire in accordance with the WHO translation guidelines and applied it to 80 ILD patients of our department, with follow-ups after 3-6 months, assessing its internal consistency, floor and ceiling effects, concurrent validity, known-groups validity, and its responsiveness to changes over time. RESULTS At baseline, all 80 patients completed the GR-Scale. In 70 patients (87.5%), follow-up data could be obtained after 4.43 ± 1.2 months. The GR-Scale demonstrated acceptable internal consistency (Cronbach's α 0.749) and slight floor effects. Concurrent validity analysis showed weak but significant correlations with forced vital capacity (FVC; r=-0.282 p = 0.011) and diffusion capacity for carbon monoxide (DLco; r=-0.254 p = 0.025). In the follow-up analysis, moderate correlations were found with FVC (r=-0.41 p < 0.001) and DLco (r=-0.445 p < 0.001). No significant difference in the total score was found between patients with IPF (n = 10) and with non-IPF ILDs (n = 70). The GR-Scale successfully discriminated between groups of varying disease severity based on lung function parameters and the need for long-term oxygen therapy (LTOT). Furthermore, it was able to distinguish between patients showing improvement, stability or decline of lung function parameters. CONCLUSION Our prospective observational pilot study suggests that the GR-Scales is a simple and quick tool to measure HRQoL in patients with ILDs, thus providing an important additional information for the clinical assessment of ILD patients. TRIAL REGISTRATION Our study was retrospectively registered in the German Clinical Trial Register (DRKS) on 02.11.2022 (DRKS-ID: DRKS00030599).
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Affiliation(s)
- S Stoltefuß
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - G Leuschner
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - K Milger
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - T Kauke
- Department of Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - J Götschke
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - T Veit
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - A Lenoir
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
| | - N Kneidinger
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Marchioninistr. 15, 81377, Munich, Germany.
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Myall KJ, Cho PSP, Birring SS. What causes cough in pulmonary fibrosis, and how should we treat it? Curr Opin Pulm Med 2024; 30:523-529. [PMID: 38913018 DOI: 10.1097/mcp.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW To review the current understanding of the impact, mechanisms and treatments for cough in patients with interstitial lung disease (ILD). Evidence suggests that cough is a prevalent symptom in patients with ILD and has a significant impact on patients. RECENT FINDINGS There is increasing interest in the role of cough hypersensitivity as seen in chronic refractory cough in patients with ILD, and encouraging recent results suggest that ILD-associated cough responds to opiate therapy. SUMMARY Understanding the aetiology of cough in patients with ILD is crucial to continue to develop therapies which might be effective in reducing cough and increasing quality of life.
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Affiliation(s)
- Katherine J Myall
- Department of Respiratory Medicine, King's College Hospital
- King's College London, London, UK
| | - Peter S P Cho
- Department of Respiratory Medicine, King's College Hospital
- King's College London, London, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital
- King's College London, London, UK
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Green R, Baldwin M, Pooley N, Misso K, Mölken MPRV, Patel N, Wijsenbeek MS. The burden of cough in idiopathic pulmonary fibrosis and other interstitial lung diseases: a systematic evidence synthesis. Respir Res 2024; 25:325. [PMID: 39192278 PMCID: PMC11351049 DOI: 10.1186/s12931-024-02897-w] [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: 04/09/2024] [Accepted: 06/29/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Cough remains a persistent symptom in patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs). To inform future research, treatment and care models, we conducted the first systematic synthesis of evidence on its associated burden. METHODS A literature search was performed for articles published between January 2010 and October 2023 using databases including Embase, MEDLINE and the Cochrane Library. Studies in patients with IPF and other ILDs reporting cough-related measures were eligible for inclusion. Included studies were categorised based on the types of ILD they examined and their design. Study details, patient characteristics and outcomes were extracted, and the risk of bias was assessed. A narrative synthesis approach was employed to interpret the findings. RESULTS Sixty-one studies were included: 33 in IPF, 18 in mixed-ILDs, six in connective tissue disease-associated-ILDs and four in sarcoidosis. Across the studies, a range of tools to assess cough and its impact were used. The most frequently used measures of cough were cough severity visual analogue scale (VAS) and objective cough counts, whereas the most frequently used health-related quality of life (HRQoL)/impact measures were the St. George's Respiratory Questionnaire (SGRQ) and Leicester Cough Questionnaire (LCQ). In IPF, studies consistently reported correlations between various cough and HRQoL measures, including between cough VAS scores and objective cough counts, LCQ scores and SGRQ scores. Similar correlations were observed in studies in other ILDs, but data were more limited. Qualitative studies in both IPF and other ILDs consistently highlighted the significant cough-related burden experienced by patients, including disruption of daily activities, fatigue and social embarrassment. Although there were no studies specifically investigating the economic burden of cough, one study in patients with fibrotic ILD found cough severity was associated with workplace productivity loss. CONCLUSIONS Our study underscores the heterogeneity in assessing cough and its impact in IPF and other ILDs. The findings confirm the negative impact of cough on HRQoL in IPF and suggest a comparable impact in other ILDs. Our synthesis highlights the need for standardised assessment tools, along with dedicated studies, particularly in non-IPF ILDs and on the economic burden of cough.
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Affiliation(s)
| | - Michael Baldwin
- Value and Patient Access, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Nick Pooley
- Market Access, Maverex Limited, Manchester, UK
| | - Kate Misso
- Market Access, Maverex Limited, Manchester, UK
| | | | - Nina Patel
- Inflammation Medicine, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Marlies S Wijsenbeek
- Respiratory Medicine, Pulmonary Medicine, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
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4
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Rasheed AZ, Metersky ML, Ghazal F. Mechanisms and management of cough in interstitial lung disease. Expert Rev Respir Med 2023; 17:1177-1190. [PMID: 38159067 DOI: 10.1080/17476348.2023.2299751] [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: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Many patients with interstitial lung diseases (ILDs), especially fibrotic ILDs, experience chronic cough. It negatively impacts both physical and psychological well-being. Effective treatment options are limited. AREAS COVERED The pathophysiology of chronic cough in IPF is complex and involves multiple mechanisms, including mechanical distortion of airways, parenchyma, and nerve fibers. The pathophysiology of cough in other fibrosing ILDs is poorly understood and involves various pathways. The purpose of this review is to highlight mechanisms of chronic cough and to present therapeutic evidence for its management in the most commonly occurring diffuse fibrosing lung diseases including idiopathic pulmonary fibrosis (IPF), connective tissue disease-related interstitial lung disease (CTD-ILD), sarcoidosis-related ILD (Sc-ILD), chronic hypersensitivity pneumonitis-related ILD (CHP-ILD), and post-COVID-19-related interstitial lung disease (PC-ILD). EXPERT OPINION This review guides the management of chronic cough in fibrosing ILDs. In this era of precision medicine, chronic cough management should be individualized in each interstitial lung disease.
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Affiliation(s)
- Ameer Z Rasheed
- Division of Pulmonary, Critical Care and Sleep Medicine, UConn Health, Farmington, CT, USA
| | - Mark L Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, UConn Health, Farmington, CT, USA
| | - Fatima Ghazal
- Department of Internal Medicine, UConn Health, Farmington, CT, USA
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5
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Hirons B, Rhatigan K, Kesavan H, Turner RD, Birring SS, Cho PSP. Cough in chronic lung disease: a state of the art review. J Thorac Dis 2023; 15:5823-5843. [PMID: 37969279 PMCID: PMC10636467 DOI: 10.21037/jtd-22-1776] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Chronic cough (CC; ≥8 weeks in duration) is a common and burdensome feature of respiratory diseases. The understanding of cough has progressed significantly in recent years, albeit largely in refractory (unexplained) chronic cough (RCC) in the absence of other respiratory conditions. The prevalence of CC in respiratory diseases is poorly described, but estimates have been reported: asthma (8-58%), chronic obstructive pulmonary disease (COPD; 10-74%), bronchiectasis (82-98%), interstitial lung disease (ILD; 50-89%) and sarcoidosis (3-64%). CC in respiratory conditions generally predicts impaired health status and more severe disease. It is associated with increased symptom burden and disease severity in asthma, COPD, bronchiectasis and ILD, higher exacerbation frequency in asthma and bronchiectasis, and increased mortality and lung transplantation in idiopathic pulmonary fibrosis (IPF). Physiologically, heightened cough reflex sensitivity (CRS) has been reported and postulated to be mechanistic in isolated RCC. Cough reflex hypersensitivity (CRH) has also been reported in asthma, COPD, bronchiectasis, ILD and sarcoidosis. Unlike recent advances in isolated RCC, there are limited studies and understanding of central cough neuropathways in other respiratory conditions. Of note, dysfunctional central voluntary cough suppression neuropathways and physiology were observed in isolation in RCC; cough suppression is preserved in COPD. Understanding in the mechanism of RCC cannot be simply extrapolated to other respiratory conditions. The restricted understanding of cough mechanisms in these conditions has limited cough-specific therapeutic options in this context. There is currently an unmet need to expand our understanding of cough in chronic respiratory conditions, both in order to improve the quality of life of patients, and to improve knowledge of cough in general. This review aims to describe the prevalence, impact, pathophysiology and management of CC in asthma, COPD, bronchiectasis, ILD and sarcoidosis.
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Affiliation(s)
- Barnaby Hirons
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Katherine Rhatigan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Harini Kesavan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
| | - Richard D. Turner
- Department of Respiratory Medicine, Gold Coast University Hospital, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Surinder S. Birring
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Peter S. P. Cho
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Varjú C, Pauling JD, Saketkoo LA. Multi-Organ System Screening, Care, and Patient Support in Systemic Sclerosis. Rheum Dis Clin North Am 2023; 49:211-248. [PMID: 37028832 DOI: 10.1016/j.rdc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a heterogenous systemic autoimmune disease of complex multi-organ manifestations with a disease-specific mortality of >50%. The patient journey is fraught with severe, diverse, and diffuse physical impairment, psychological burden, and diminishing health-related quality of life. SSc remains unfamiliar to many clinicians. Delayed/misdiagnosis, inadequate screening, and attention for common complications with potentially preventable disability/death contribute to patients feeling isolated and unsupported. We present actionable standards including screening, anticipatory guidance, and counseling in patient-centered SSc-care emphasizing psycho-social health as the central goal, whereas robust vigilance and efforts to improve biophysical health and survival are imperatives that support this goal.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, LA, USA; Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA; Tulane University School of Medicine, New Orleans, LA, USA.
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7
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Volkmann ER, Kreuter M, Hoffmann-Vold AM, Wijsenbeek M, Smith V, Khanna D, Denton CP, Wuyts W, Miede C, Alves M, Sambevski S, Allanore Y. Dyspnoea and cough in patients with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial. Rheumatology (Oxford) 2022; 61:4397-4408. [PMID: 35150246 PMCID: PMC9629379 DOI: 10.1093/rheumatology/keac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of these analyses was to investigate the rate of decline in forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (SSc-ILD) with and without cough or dyspnoea in the SENSCIS trial. METHODS Patients in the SENSCIS trial were randomized to receive nintedanib or placebo. Subgroups with and without cough or dyspnoea at baseline were defined by responses to the St George's Respiratory Questionnaire. RESULTS At baseline, 114/575 patients (19.8%) did not have cough and 172/574 patients (30.0%) did not have dyspnoea. In the placebo group, the rate of FVC decline over 52 weeks was similar in patients with and without cough (-95.6 and -83.4 mL/year, respectively) or dyspnoea (-95.8 and -87.7 mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough [difference: 74.4 (95% CI -11.1, 159.8) vs 31.5 (-11.1, 74.1)] and without than with dyspnoea [79.8 (9.8, 149.7) vs 25.7 (-19.9, 71.3)], but interaction P-values did not indicate heterogeneity in the treatment effect between these subgroups (P = 0.38 and P = 0.20, respectively). CONCLUSION In the placebo group of the SENSCIS trial, the rate of FVC decline was similar irrespective of the presence of cough or dyspnoea at baseline. The effect of nintedanib on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough or dyspnoea at baseline, but no statistically significant heterogeneity was observed between the subgroups. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02597933.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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8
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Lee J, White E, Freiheit E, Scholand MB, Strek ME, Podolanczuk AJ, Patel NM. Cough-Specific Quality of Life Predicts Disease Progression Among Patients With Interstitial Lung Disease: Data From the Pulmonary Fibrosis Foundation Patient Registry. Chest 2022; 162:603-613. [PMID: 35337809 PMCID: PMC9808640 DOI: 10.1016/j.chest.2022.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cough is a common symptom of interstitial lung disease (ILD) and negatively impacts health-related quality of life (QOL). Previous studies have shown that among patients with idiopathic pulmonary fibrosis, cough may predict progression of lung disease and perhaps even respiratory hospitalizations and mortality. RESEARCH QUESTION Does cough-specific QOL predict disease progression, respiratory hospitalization, lung transplantation, and death among patients with ILD? STUDY DESIGN AND METHODS We analyzed data from the Pulmonary Fibrosis Foundation Registry, which comprises a multicenter population of well-characterized patients with ILD. We first examined associations between patient factors and baseline scores on the Leicester Cough Questionnaire (LCQ), a cough-specific QOL tool, using a proportional odds model. Next, we examined associations between baseline LCQ scores and patient-centered clinical outcomes, as well as pulmonary function parameters, using a univariable and multivariable proportional hazards model that was adjusted for clinically relevant variables, including measures of disease severity. RESULTS One thousand four hundred forty-seven patients with ILD were included in our study. In the multivariable proportional odds model, we found that the following patient factors were associated with worse cough-specific QOL: younger age, diagnosis of "other ILD," gastroesophageal reflux disease, and lower FVC % predicted. Multivariable Cox regression models, adjusting for several variables including baseline disease severity, showed that a 1-point decrease in LCQ score (indicating lower cough-specific QOL) was associated with a 6.5% higher risk of respiratory-related hospitalization (hazard ratio [HR], 1.065; 95% CI, 1.025-1.107), a 7.4% higher risk of death (HR, 1.074; 95% CI, 1.020-1.130), and an 8.7% higher risk of lung transplantation (HR, 1.087; 95% CI, 1.022-1.156). INTERPRETATION Among a large population of well-characterized patients with ILD, cough-specific QOL was associated independently with respiratory hospitalization, death, and lung transplantation.
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Affiliation(s)
- Janet Lee
- Section of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Emily White
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Elizabeth Freiheit
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Mary Beth Scholand
- Section of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Mary E Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, NY
| | - Nina M Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY; Boehringer-Inghelheim, Ridgefield, CT.
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9
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Kruizinga MD, Zhuparris A, Dessing E, Krol FJ, Sprij AJ, Doll RJ, Stuurman FE, Exadaktylos V, Driessen GJA, Cohen AF. Development and technical validation of a smartphone-based pediatric cough detection algorithm. Pediatr Pulmonol 2022; 57:761-767. [PMID: 34964557 PMCID: PMC9306830 DOI: 10.1002/ppul.25801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Coughing is a common symptom in pediatric lung disease and cough frequency has been shown to be correlated to disease activity in several conditions. Automated cough detection could provide a noninvasive digital biomarker for pediatric clinical trials or care. The aim of this study was to develop a smartphone-based algorithm that objectively and automatically counts cough sounds of children. METHODS The training set was composed of 3228 pediatric cough sounds and 480,780 noncough sounds from various publicly available sources and continuous sound recordings of 7 patients admitted due to respiratory disease. A Gradient Boost Classifier was fitted on the training data, which was subsequently validated on recordings from 14 additional patients aged 0-14 admitted to the pediatric ward due to respiratory disease. The robustness of the algorithm was investigated by repeatedly classifying a recording with the smartphone-based algorithm during various conditions. RESULTS The final algorithm obtained an accuracy of 99.7%, sensitivity of 47.6%, specificity of 99.96%, positive predictive value of 82.2% and negative predictive value 99.8% in the validation dataset. The correlation coefficient between manual- and automated cough counts in the validation dataset was 0.97 (p < .001). The intra- and interdevice reliability of the algorithm was adequate, and the algorithm performed best at an unobstructed distance of 0.5-1 m from the audio source. CONCLUSION This novel smartphone-based pediatric cough detection application can be used for longitudinal follow-up in clinical care or as digital endpoint in clinical trials.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Eva Dessing
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Fas J Krol
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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10
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Saketkoo LA, Escorpizo R, Varga J, Keen KJ, Fligelstone K, Birring SS, Alexanderson H, Pettersson H, Chaudhry HA, Poole JL, Regardt M, LeSage D, Sarver C, Lanario J, Renzoni E, Scholand MB, Lammi MR, Kowal-Bielecka O, Distler O, Frech T, Shapiro L, Varju C, Volkmann ER, Bernstein EJ, Drent M, Obi ON, Patterson KC, Russell AM. World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease. Front Pharmacol 2022; 13:979788. [PMID: 36313333 PMCID: PMC9615472 DOI: 10.3389/fphar.2022.979788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022] Open
Abstract
Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new 'Personal Factors' emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. 'pf_embarrassed by cough' or 'pf_panic/afraid when can't get a breath'. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington, VT, United States
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kevin John Keen
- Department of Mathematics and Statistics and Health Research Institute, University of Northern British Columbia, Prince George, BC, Canada
- Department of Medicine, University of British Columbia & Centre for Heart Lung Innovation, Providence Research, Vancouver, BC, Canada
| | - Kim Fligelstone
- Patient Research Partner Scleroderma & Raynaud Society, UK (SRUK) and Federation of European Scleroderma Associations, London, United Kingdom
- Royal Free Hospital Scleroderma Unit, London, United Kingdom
| | - Surinder S. Birring
- Division of Asthma, Allergy and Lung Biology, King’s College London, London, United Kingdom
| | - Helene Alexanderson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Humza Ahmad Chaudhry
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Janet L. Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, United States
| | - Malin Regardt
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Daphne LeSage
- Patient Research Partner, New Orleans, LA, United States
| | | | - Joseph Lanario
- Research Fellow in Respiratory Health—Exeter Respiratory Institute Royal Devon University Hospitals NHS Foundation Trust, Exeter, United Kingdom
| | - Elisabetta Renzoni
- Royal Brompton Hospital, National Heart and Lung Institute, London, United Kingdom
| | - Mary Beth Scholand
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Matthew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tracy Frech
- Division of Rheumatology Vanderbilt University School of Medicine, Nashville, TN, United States
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, United States
- Steffens Scleroderma Foundation, Albany, NY, United States
| | - Cecilia Varju
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pecs, Hungary
| | - Elizabeth R. Volkmann
- Department of Medicine, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elana J. Bernstein
- Department of Medicine, Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Columbia University College of Physician2s and Surgeons, New York, NY, United States
| | - Marjolein Drent
- Department of Pulmonology, Interstitial Lung Diseases (ILD) Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Nieuwegein, Netherlands
| | - Ogugua Ndili Obi
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Karen C. Patterson
- Department of Clinical & Experimental Medicine, Brighton & Sussex Medical School, Falmer, United Kingdom
- Division Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anne-Marie Russell
- Respiratory Institute to Exeter Respiratory Innovation Center, University of Exeter, Exeter, United Kingdom
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, London, United Kingdom
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
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11
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Aycicek O, Cetinkaya E, Demirci Ucsular F, Bayram N, Senyigit A, Aksel N, Atilla N, Sarıoglu N, Niksarlıoglu EY, Ilgazlı A, Kılıc T, Gunbatar H, Cilekar S, Ekici A, Arınc S, Bircan HA, Duman D, Sengoren Dikis O, Yazıcı O, Kansu A, Tutar N, Ozsarı E, Berk S, Varol Y, Erbaycu AE, Sertogullarından B, Cırak AK, Cortuk M, Karadeniz G, Simsek A, Sezgi C C, Erel F, Ciftci T, Sunnetcioglu A, Ekici MS, Gunay E, Ağca M, Ozturk O, Ogun H, Acar E, Dogan OT, Alizoroglu D, Gezer E, Ozlu T. Research Burden of Interstitial Lung Diseases in Turkey - RBILD. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2022; 39:e2022006. [PMID: 35494165 PMCID: PMC9007027 DOI: 10.36141/svdld.v39i1.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. MATERIAL-METHOD The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. RESULTS In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. CONCLUSION We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.
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Affiliation(s)
- Olcay Aycicek
- Karadeniz University Faculty of Medicine Department of Chest Diseases
| | | | | | - Nazan Bayram
- Gaziantep University Faculty of Medicine Department of Chest Diseases
| | | | - Nimet Aksel
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | - Nurhan Atilla
- Sutcu Imam University Faculty of Medicine, Department of Chest Diseases
| | - Nurhan Sarıoglu
- Balikesir University Faculty of Medicine, Department of Chest Diseases
| | | | - Ahmet Ilgazlı
- Kocaeli University Faculty of Medicine Department of Chest Diseases
| | - Talat Kılıc
- Inonu University Faculty of Medicine, Department of Chest Diseases
| | - Hulya Gunbatar
- Van Yuzuncu Yıl University Faculty of Medicine, Department of Chest Diseases
| | - Sule Cilekar
- Afyonkarahisar University Faculty of Medicine, Department of Chest Diseases
| | - Aydanur Ekici
- Kirikkale University Faculty of Medicine, Department of Chest Diseases
| | | | - Hacı Ahmet Bircan
- Suleyman Demirel University Faculty of Medicine, Department of Chest Diseases
| | | | | | - Onur Yazıcı
- Adnan Menderes University Faculty of Medicine, Department of Chest Diseases
| | - Abdullah Kansu
- Bezmialem Vakif University Faculty of Medicine Chest Diseases Department
| | - Nuri Tutar
- Erciyes University Faculty of Medicine Chest Diseases Department
| | - Emine Ozsarı
- Abant İzzet Baysal University Faculty of Medicine Chest Diseases Department
| | - Serdar Berk
- Cumhuriyet University Faculty of Medicine Chest Diseases Department
| | - Yelda Varol
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | - Ahmet Emin Erbaycu
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | | | - Ali Kadri Cırak
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | - Mustafa Cortuk
- SBU Yedikule Chest Diseases and Thoracic Surgery Hospital
| | - Gulistan Karadeniz
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | - Alper Simsek
- Gaziantep University Faculty of Medicine Department of Chest Diseases
| | | | - Fuat Erel
- Balikesir University Faculty of Medicine, Department of Chest Diseases
| | - Tuba Ciftci
- Kocaeli University Faculty of Medicine Department of Chest Diseases
| | - Aysel Sunnetcioglu
- Van Yuzuncu Yıl University Faculty of Medicine, Department of Chest Diseases
| | | | - Ersin Gunay
- Afyonkarahisar University Faculty of Medicine, Department of Chest Diseases
| | | | - Onder Ozturk
- Suleyman Demirel University Faculty of Medicine, Department of Chest Diseases
| | - Hamza Ogun
- Bezmialem Vakif University Faculty of Medicine Chest Diseases Department
| | - Elif Acar
- Abant İzzet Baysal University Faculty of Medicine Chest Diseases Department
| | - Omer Tamer Dogan
- Cumhuriyet University Faculty of Medicine Chest Diseases Department
| | - Dursun Alizoroglu
- SBU Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
| | - Esma Gezer
- Izmir Katip Celebi University Faculty of Medicine Chest Diseases Department
| | - Tevfik Ozlu
- Karadeniz University Faculty of Medicine Department of Chest Diseases
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12
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van den Bosch L, Luppi F, Ferrara G, Mura M. Immunomodulatory treatment of interstitial lung disease. Ther Adv Respir Dis 2022; 16:17534666221117002. [PMID: 35938712 PMCID: PMC9364223 DOI: 10.1177/17534666221117002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) have an array of immunomodulatory treatment options compared with IPF, due to their inflammatory component. However, there is a relative paucity of guidance on the management of this heterogeneous group of diseases. In ILDs other than IPF, immunosuppression is the cornerstone of therapy, with varying levels of evidence for different immunomodulatory agents and for each specific ILD. Classification of ILDs is important for guiding treatment decisions. Immunomodulatory agents mainly include corticosteroids, mycophenolate mofetil (MMF), azathioprine, methotrexate, cyclophosphamide and rituximab. In this review, the available evidence for single agents in the most common ILDs is first discussed. We then reviewed practical therapeutic approaches in connective tissue disease-related ILD and interstitial pneumonia with autoimmune features, scleroderma-related ILD, vasculitis and dermatomyositis with hypoxemic respiratory failure, idiopathic non-specific interstitial pneumonia, hypersensitivity pneumonitis sarcoidosis, fibrosing organizing pneumonia and eosinophilic pneumonia. The treatment of acute exacerbations of ILD is also discussed. Therapy augmentation in ILD is dictated by the recognition of progression of disease. Criteria for the evaluation of progression of disease are then discussed. Finally, specific protocol and measures to increase patients' safety are reviewed as well, including general monitoring and serologic surveillance, Pneumocystis jirovecii prophylaxis, patients' education, genetic testing for azathioprine, MMF serum levels and cyclophosphamide administration protocols. Immunomodulatory therapies are largely successful in the management of ILDs and can be safely managed with the application of specific protocols, precautions and monitoring.
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Affiliation(s)
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marco Mura
- London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, Room E6-203, London, ON N6A 5W9, Canada
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13
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Roofeh D, Barratt SL, Wells AU, Kawano-Dourado L, Tashkin D, Strand V, Seibold J, Proudman S, Brown KK, Dellaripa PF, Doyle T, Leonard T, Matteson EL, Oddis CV, Solomon JJ, Sparks JA, Vassallo R, Maxwell L, Beaton D, Christensen R, Townsend W, Khanna D. Outcome measurement instrument selection for lung physiology in systemic sclerosis associated interstitial lung disease: A systematic review using the OMERACT filter 2.1 process. Semin Arthritis Rheum 2021; 51:1331-1341. [PMID: 34493396 PMCID: PMC8678187 DOI: 10.1016/j.semarthrit.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) is a research organization focused on improving health care outcomes for patients with autoimmune and musculoskeletal diseases. The Connective Tissue Disease-Interstitial Lung Disease (CTD-ILD) Working Group on Lung Physiology is a group within OMERACT charged with identifying outcome measures that should be implemented in studies of patients with CTD-ILD. The OMERACT Filter 2.1 is an evidence-based algorithm used to identify outcome measures that are truthful, feasible, and able to discriminate between groups of interest. Our objective was to summate evidence (published literature, key opinion leader input, patient perspectives) that would influence the CTD-ILD Working Group's vote to accept or reject the use of two measures of lung physiology, the forced vital capacity (FVC) and the diffusion capacity of carbon monoxide (DLco) for use in randomized controlled trials (RTCs) and longitudinal observational studies (LOSs) involving patients with systemic sclerosis associated ILD (SSc-ILD). METHODS Patient Research Partners (those afflicted with SSc-ILD) and the CTD-ILD Working Group on Lung Physiology were polled to assess their opinion on the FVC and DLco in terms of feasibility; the CTD-ILD Working Group was also queried on these instruments' face and content validity. We then conducted a systematic literature review to identify articles in the SSc-ILD population that assessed the following measurement properties of FVC and DLco: (1) construct validity, (2) test-retest reliability, (3) longitudinal construct validity, (4) clinical trial discrimination/sensitivity to detect change in clinical trials, and (5) thresholds of meaning. Results were summarized in a Summary of Measurement Properties (SOMP) table for each instrument. OMERACT CTD-ILD Working Group members discussed and voted on the strength of evidence supporting these two instruments and voted to endorse, provisionally endorse, or not endorse either instrument. RESULTS Forty Patient Research Partners reported these two measures are feasible (are not an unnecessary burden or represent an infeasible longitudinal assessment of their disease). A majority of the 18 CTD-ILD Working Group members voted that both the FVC and DLco are feasible and have face and content validity. The systematic literature review returned 1,447 non-duplicated articles, of which 177 met eligibility for full text review. Forty-eight studies (13 RCTs, 35 LOSs) were included in the qualitative analysis. The FVC SOMP table revealed high quality, consistent data with evidence of good performance for all five measurement properties, suggesting requisite published evidence to proceed with endorsement. The DLco SOMP table showed a lack of data to support test-retest reliability and inadequate evidence to support clinical trial discrimination. There was unanimous agreement (15 [100%]) among voting CTD-ILD Working Group members to endorse the FVC as an instrument for lung physiology in RCTs and LOSs in SSc-ILD. Based on currently available evidence, DLco did not meet the OMERACT criteria and is not recommended for use in RCTs to represent lung physiology of SSc-ILD. The OMERACT Technical Advisory Group agreed with these decisions. CONCLUSION The OMERACT Filter 2.1 was successfully applied to the domain of lung physiology in patients with SSc-ILD. The FVC was endorsed for use in RCTs and LOSs based on the Working Group's vote; DLco was not endorsed.
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Affiliation(s)
- David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Shaney L Barratt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, UK; Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, UK
| | - Athol U Wells
- Department of Internal Medicine, Division of Pulmonology, Royal Brompton Hospital and National Heart and Lung Institute; London, UK
| | - Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coração, São Paulo, Brazil; Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Donald Tashkin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - James Seibold
- Scleroderma Research Consultants, Aiken, South Carolina, USA
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital and Professor Discipline of Medicine, University of Adelaide, Adelaide, AUS
| | - Kevin K Brown
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Hospital, Denver, Colorado, USA
| | - Paul F Dellaripa
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tracy Doyle
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Leonard
- From Clinical Development and Medical Affairs, Specialty Care Boehringer Ingelheim Pharmaceuticals, Inc. USA
| | - Eric L Matteson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joshua J Solomon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Hospital, Denver, Colorado, USA
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Vassallo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, CA
| | - Dorcas Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, CA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA.
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14
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Sato R, Handa T, Matsumoto H, Hirai K, Ohkura N, Kubo T, Hirai T. Antitussive Effect of a Chest Band in Patients with Interstitial Lung Disease: The Preliminary Results from a Pre-post Intervention Study. Intern Med 2021; 60:3701-3707. [PMID: 34853257 PMCID: PMC8710375 DOI: 10.2169/internalmedicine.6716-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Evidence supporting the efficiency of clinically administered therapies against interstitial lung disease (ILD)-related cough is limited. Thus, we conducted a study to evaluate the efficacy of short-term use of chest bands on cough in patients with ILD. Methods This pre-post intervention study was performed at two university hospitals between April 2017 and August 2020. Scores of the visual analog scale (VAS) for cough severity (in terms of frequency and intensity), Leicester Cough Questionnaire (LCQ)-acute, and frequency scale for symptoms of gastroesophageal reflux disease (FSSG) were assessed before and after the use of the chest band (24/48 hours). Patients The study included patients with idiopathic interstitial pneumonias (IIPs) or connective tissue disease-associated interstitial lung disease (CTD-ILD). Results Four patients with IIPs and seven with CTD-ILD were included in the analysis. The cough intensity and LCQ-acute total score improved significantly after the use of the chest band (p=0.007 and p=0.005, respectively), although the cough frequency showed no significant reduction (p=0.074). Furthermore, the FSSG total and acid-reflux symptom scores improved (p=0.018 and p=0.027, respectively), and a negative correlation between the change in LCQ-acute total score and that in FSSG score for acid-reflux symptoms was observed (Spearman rho =-0.841, p=0.001). Conclusion The results of the current study suggest that chest bands might be useful for treating chronic refractory cough in patients with ILD and gastroesophageal reflux disease. However, these results should be interpreted with caution due to methodological limitations associated with this study.
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Affiliation(s)
- Ryuhei Sato
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, Japan
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | | | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
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15
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Vonk MC, Smith V, Sfikakis PP, Cutolo M, Del Galdo F, Seibold JR. Pharmacological treatments for SSc-ILD: Systematic review and critical appraisal of the evidence. Autoimmun Rev 2021; 20:102978. [PMID: 34718159 DOI: 10.1016/j.autrev.2021.102978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Many therapies have been investigated for systemic sclerosis-associated interstitial lung disease (SSc-ILD), including immunosuppressive therapies, antifibrotic agents, immunomodulators and monoclonal antibodies. There is a high unmet medical need to better understand the current evidence for treatment efficacy and safety. This systematic review aims to present the existing literature on different drug treatments investigated for SSc-ILD and to critically assess the level of evidence for these drugs. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A structured literature search was performed for clinical trials and observational studies on the treatment of SSc-ILD with pharmaceutical interventions from 1 January 1990 to 15 December 2020. The quality of each reference was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. A total of 77 references were reviewed and 13 different treatments were identified. We found high-quality evidence for the use of cyclophosphamide, nintedanib, mycophenolate and tocilizumab. Therefore, we would posit that the clinical community has four valid options for treatment of SSc-ILD. Further research is mandatory to provide more evidence for the optimal treatment strategy in SSc-ILD, including the optimal time to initiate treatment, selection of patients for treatment and upfront combination therapy.
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Affiliation(s)
- Madelon C Vonk
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Petros P Sfikakis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology, Postgraduate School of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Genova, Genoa, Italy
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16
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Saketkoo LA, Frech T, Varjú C, Domsic R, Farrell J, Gordon JK, Mihai C, Sandorfi N, Shapiro L, Poole J, Volkmann ER, Lammi M, McAnally K, Alexanderson H, Pettersson H, Hant F, Kuwana M, Shah AA, Smith V, Hsu V, Kowal-Bielecka O, Assassi S, Cutolo M, Kayser C, Shanmugam VK, Vonk MC, Fligelstone K, Baldwin N, Connolly K, Ronnow A, Toth B, Suave M, Farrington S, Bernstein EJ, Crofford LJ, Czirják L, Jensen K, Hinchclif M, Hudson M, Lammi MR, Mansour J, Morgan ND, Mendoza F, Nikpour M, Pauling J, Riemekasten G, Russell AM, Scholand MB, Seigart E, Rodriguez-Reyna TS, Hummers L, Walker U, Steen V. A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc. Best Pract Res Clin Rheumatol 2021; 35:101707. [PMID: 34538573 PMCID: PMC8670736 DOI: 10.1016/j.berh.2021.101707] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic sclerosis (SSc), the most lethal of rheumatologic conditions, is the cause of death in >50% of SSc cases, led by pulmonary fibrosis followed by pulmonary hypertension and then scleroderma renal crisis (SRC). Multiple other preventable and treatable SSc-related vascular, cardiac, gastrointestinal, nutritional and musculoskeletal complications can lead to disability and death. Vascular injury with subsequent inflammation transforming to irreversible fibrosis and permanent damage characterizes SSc. Organ involvement is often present early in the disease course of SSc, but requires careful history-taking and vigilance in screening to detect. Inflammation is potentially reversible provided that treatment intensity quells inflammation and other immune mechanisms. In any SSc phenotype, opportunities for early treatment are prone to be under-utilized, especially in slowly progressive phenotypes that, in contrast to severe progressive ILD, indolently accrue irreversible organ damage resulting in later-stage life-limiting complications such as pulmonary hypertension, cardiac involvement, and malnutrition. A single SSc patient visit often requires much more physician and staff time, organization, vigilance, and direct management for multiple organ systems compared to other rheumatic or pulmonary diseases. Efficiency and efficacy of comprehensive SSc care enlists trending of symptoms and bio-data. Financial sustainability of SSc care benefits from understanding insurance reimbursement and health system allocation policies for complex patients. Sharing care between recognised SSc centers and local cardiology/pulmonary/rheumatology/gastroenterology colleagues may prevent complications and poor outcomes, while providing support to local specialists. As scleroderma specialists, we offer a practical framework with tools to facilitate an optimal, comprehensive and sustainable approach to SSc care. Improved health outcomes in SSc relies upon recogntion, management and, to the extent possible, prevention of SSc and treatment-related complications.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA.
| | - Tracy Frech
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | | | - Jessica Farrell
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Jessica K Gordon
- Department of Rheumatology at Hospital for Special Surgery, New York, NY, USA
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Lee Shapiro
- Steffens Scleroderma Foundation, Albany, NY, USA; Division of Rheumatology, Albany Medical Center, Albany, NY, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | | | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | - Helene Alexanderson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Faye Hant
- Division of Rheumatology, Medical University of South Caroline, SC, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Vivien Hsu
- Rutgers- RWJ Scleroderma Program, New Brunswick, NJ, USA
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Shervin Assassi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genova, Italy
| | - Cristiane Kayser
- Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) São Paulo, SP, Brazil
| | - Victoria K Shanmugam
- Department of Rheumatology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Madelon C Vonk
- Department of the rheumatic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Fligelstone
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Nancy Baldwin
- Patient Research Partner, Scleroderma Foundation, Chicago, IL, USA
| | | | - Anneliese Ronnow
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Beata Toth
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | | | - Sue Farrington
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Elana J Bernstein
- Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Kelly Jensen
- Tulane University School of Medicine, New Orleans, USA; Oregon Health and Science University, Portland, OR, USA
| | - Monique Hinchclif
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA
| | - Marie Hudson
- Division of heumatology and Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA
| | | | - Nadia D Morgan
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian Mendoza
- Rheumatology Division, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mandana Nikpour
- Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Pauling
- University of Melbourne, Melbourne at St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Gabriela Riemekasten
- Royal National Hospital for Rheumatic Diseases, Bath, UK; University of Lübeck, University Clinic of Schleswig-Holstein, Dept Rheumatology and Clinical Immunology, Lübeck, Germany
| | | | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Elise Seigart
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Laura Hummers
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Walker
- Dept. of Rheumatology, Basel University Hospital, Basel, Switzerland
| | - Virginia Steen
- Division of Rheumatology, Department of Medicine, Georgetown University, Washington, DC, USA
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17
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Aronson KI, Danoff SK, Russell AM, Ryerson CJ, Suzuki A, Wijsenbeek MS, Bajwah S, Bianchi P, Corte TJ, Lee JS, Lindell KO, Maher TM, Martinez FJ, Meek PM, Raghu G, Rouland G, Rudell R, Safford MM, Sheth JS, Swigris JJ. Patient-centered Outcomes Research in Interstitial Lung Disease: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e3-e23. [PMID: 34283696 PMCID: PMC8650796 DOI: 10.1164/rccm.202105-1193st] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: In the past two decades, many advances have been made to our understanding of interstitial lung disease (ILD) and the way we approach its treatment. Despite this, many questions remain unanswered, particularly those related to how the disease and its therapies impact outcomes that are most important to patients. There is currently a lack of guidance on how to best define and incorporate these patient-centered outcomes in ILD research. Objectives: To summarize the current state of patient-centered outcomes research in ILD, identify gaps in knowledge and research, and highlight opportunities and methods for future patient-centered research agendas in ILD. Methods: An international interdisciplinary group of experts was assembled. The group identified top patient-centered outcomes in ILD, reviewed available literature for each outcome, highlighted important discoveries and knowledge gaps, and formulated research recommendations. Results: The committee identified seven themes around patient-centered outcomes as the focus of the statement. After a review of the literature and expert committee discussion, we developed 28 research recommendations. Conclusions: Patient-centered outcomes are key to ascertaining whether and how ILD and interventions used to treat it affect the way patients feel and function in their daily lives. Ample opportunities exist to conduct additional work dedicated to elevating and incorporating patient-centered outcomes in ILD research.
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18
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Lan NSH, Moore I, Lake F. Understanding cough in interstitial lung disease: a cross‐sectional study on the adequacy of treatment. Intern Med J 2021; 51:923-929. [DOI: 10.1111/imj.14837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/05/2020] [Accepted: 03/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Norris S. H. Lan
- Medical School University of Western Australia Perth Western Australia Australia
| | - Irene Moore
- Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth Western Australia Australia
| | - Fiona Lake
- Medical School University of Western Australia Perth Western Australia Australia
- Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth Western Australia Australia
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19
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Hoffmann-Vold AM, Maher TM, Philpot EE, Ashrafzadeh A, Distler O. Assessment of recent evidence for the management of patients with systemic sclerosis-associated interstitial lung disease: a systematic review. ERJ Open Res 2021; 7:00235-2020. [PMID: 33644224 PMCID: PMC7897846 DOI: 10.1183/23120541.00235-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
This systematic review summarises current evidence to help guide treatment decisions for patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). A systematic search of the literature (January 2012 to April 2018), including grey literature (searched between 1992 and 2011), was conducted using multiple electronic databases. Guidelines, meta-analyses, randomised controlled trials and observational studies reporting on risk stratification, screening, diagnosis, treatment and management outcomes for patients with SSc-ILD were included. A quality assessment of the included evidence was undertaken. In total, 2464 publications were identified and 280 included. Multiple independent risk factors for ILD in patients with SSc were identified, including older age, male sex and baseline pulmonary function. High-resolution computed tomography (HRCT) has been used for characterising ILD in patients with SSc, and pulmonary function tests are a key adjunctive component in the diagnostic and monitoring pathway. The clinical value of biomarkers relating to SSc-ILD diagnosis or assessment for disease progression is unknown at present. Immunosuppressive therapy (monotherapy or combined therapy) is the current standard of care for SSc-ILD; long-term evidence for effective and safe treatment of SSc-ILD is limited. Identification of patients at risk for SSc-ILD remains challenging. HRCT and pulmonary function tests are key to diagnosing and monitoring for disease progression. Although immunosuppressive therapy is considered current first-line treatment, it is partly associated with adverse effects and long-term follow-up evidence is limited. Novel therapies and biomarkers should be further explored in well-controlled clinical studies.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Dept of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- These authors contributed equally
| | - Toby M. Maher
- National Institute of Health Research Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College London, London, UK
- These authors contributed equally
| | | | - Ali Ashrafzadeh
- Rheumatology Center of Excellence, IQVIA, San Diego, CA, USA
| | - Oliver Distler
- Dept of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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20
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Abstract
PURPOSE OF REVIEW Many patients with interstitial lung diseases (ILDs), especially fibrotic ILDs, experience chronic cough. Cough has a major impact on wellbeing, affecting both physical and psychological aspects of life. The pathophysiology of cough in ILDs is poorly understood and currently no good antitussive therapy exists. RECENT FINDINGS Research on cough in ILDs is increasing. A recent proof-of-concept study with nebulized sodium cromoglycate for patients with idiopathic pulmonary fibrosis (IPF)-related cough showed a promising effect on cough. Observational data suggest that antifibrotic pirfenidone might reduce cough in IPF. Studies on the effect of acid inhibition on cough in ILDs show contradicting results. SUMMARY The first steps in analyzing new treatment options for chronic cough in patients with ILDs, especially in IPF, have been taken, but an effective treatment is still lacking.
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21
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Faverzani S, Becciolini A, Di Donato E, Santilli D, Mozzani F, Monica L, Barone L, Barbieri A, Riva M, Ariani A. Comment on: Lower urinary tract symptoms in systemic sclerosis: a detailed investigation. Rheumatology (Oxford) 2020; 59:1455-1456. [PMID: 31958136 DOI: 10.1093/rheumatology/kez678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Silvia Faverzani
- Department of Geriatric and Rehabilitation, Rehabilitation Unit-Respiratory Rehabilitation, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Daniele Santilli
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Flavio Mozzani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Lorenza Monica
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Lissette Barone
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Annalisa Barbieri
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Riva
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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22
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Paolino S, Goegan F, Pizzorni C, Sulli A, Smith V, Cutolo M, Pacini G. Comment on: Lower urinary tract symptoms in systemic sclerosis patients: a detailed investigation: reply. Rheumatology (Oxford) 2020; 59:1456-1457. [PMID: 31930320 DOI: 10.1093/rheumatology/kez665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabrina Paolino
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Goegan
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, VIB Inflammation Research Centre, Ghent University Hospital, Ghent, Belgium
| | - Maurzio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Greta Pacini
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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23
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Volkmann ER, Tashkin DP, LeClair H, Roth MD, Kim G, Goldin J, Clements PJ, Furst DE, Khanna D. Treatment With Mycophenolate and Cyclophosphamide Leads to Clinically Meaningful Improvements in Patient-Reported Outcomes in Scleroderma Lung Disease: Results of Scleroderma Lung Study II. ACR Open Rheumatol 2020; 2:362-370. [PMID: 32432411 PMCID: PMC7301868 DOI: 10.1002/acr2.11125] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/14/2020] [Indexed: 01/17/2023] Open
Abstract
Objective Our objective was to determine if treatment with cyclophosphamide (CYC) and mycophenolate mofetil (MMF) improves patient‐reported outcomes (PROs) among patients with systemic sclerosis‐related interstitial lung disease (SSc‐ILD). Methods This study examined PROs in patients with SSc‐ILD (N = 142) who participated in the Scleroderma Lung Study II, a randomized controlled trial comparing MMF for 2 years with oral CYC for 1 year followed by 1 year of a placebo. Joint models were created to evaluate the course of PROs over 2 years. The difference in PRO scores from baseline to 24 months was measured, and the percentage of patients meeting the minimum clinically important difference (MCID) was calculated. Correlations between PROs and SSc‐ILD disease severity measures were also examined. Results Treatment with CYC and MMF led to improvements in several PROs with no between‐treatment differences. Scores for the Transitional Dyspnea Index (TDI) and St. George’s Respiratory Questionnaire (SGRQ) improved significantly over 2 years, and 29%/24% and 28%/25% of participants in the CYC/MMF groups met or exceeded the MCID estimates for TDI and SGRQ, respectively. At baseline, the forced vital capacity (FVC) percentage predicted (FVC%‐predicted) did not correlate with the Baseline Dyspnea Index or SGRQ. However, improvements in the FVC%‐predicted were weakly associated with improvements in dyspnea (assessed by the TDI) and SGRQ scores. Conclusion Treatment with CYC and MMF improved overall health‐related quality of life in patients with SSc‐ILD. The relationship between PRO measures and the FVC was relatively weak, suggesting that PROs provide complementary information about treatment efficacy not captured by changes in the FVC alone in this patient population.
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Affiliation(s)
| | | | | | | | - Grace Kim
- University of California, Los Angeles
| | | | | | - Daniel E Furst
- University of California, Los Angeles, University of Washington, Seattle, and University of Florence, Florence, Italy
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24
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Saketkoo LA, Scholand MB, Lammi MR, Russell AM. Patient-reported outcome measures in systemic sclerosis-related interstitial lung disease for clinical practice and clinical trials. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:48-60. [PMID: 32455167 DOI: 10.1177/2397198320904178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Systemic sclerosis (SSc) is a progressive vasculopathic, fibrosing autoimmune condition, portending significant mortality; wherein interstitial lung disease (ILD) is the leading cause of death. Although lacking a definitive cure, therapeutics for (SSc-ILD) that stave progression exist with further promising primary and adjuvant compounds in development, as well as interventions to reduce symptom burden and increase quality of life. To date, there has been a significant but varied history related to systemic sclerosis-related interstitial lung disease trial design and endpoint designation. This is especially true of endpoints measuring patient-reported perceptions of efficacy and tolerability. This article describes the underpinnings and complexity of the science, methodology, and current state of patient-reported outcome measures used in (SSc-ILD) systemic sclerosis-related interstitial lung disease in clinical practice and trials.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Interstitial Lung Disease Clinic Programs, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA.,Division of Pulmonary Diseases, School of Medicine, Louisiana State University, New Orleans, LA, USA.,School of Medicine, Tulane University, New Orleans, LA, USA
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Interstitial Lung Disease Clinic Programs, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA.,Division of Pulmonary Diseases, School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Anne-Marie Russell
- National Heart and Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
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25
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Roofeh D, Distler O, Allanore Y, Denton CP, Khanna D. Treatment of systemic sclerosis-associated interstitial lung disease: Lessons from clinical trials. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:61-71. [PMID: 35382226 PMCID: PMC8168368 DOI: 10.1177/2397198320903208] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/26/2019] [Indexed: 10/18/2023]
Abstract
Systemic sclerosis-associated interstitial lung disease remains a leading cause of mortality. Despite decades of clinical trials, the treatment effects of disease modifying anti-rheumatic drugs continue to be modest and there remains a great need for therapies that attenuate and hopefully ameliorate parenchymal lung disease. In this review, we highlight the key clinical trials that have shaped the management strategies employed by the authors, providing their strength of recommendation based on level of evidence. We also review lessons learned in more recent years, suggesting a benefit in targeting patients with subclinical interstitial lung disease with high risk for progression early in the disease course, as well as the benefit seen in a large clinical trial leading to the first Food and Drug Administration-approved treatment for systemic sclerosis-associated interstitial lung disease. These lessons come in a context of heterogeneity of patient populations and response to therapy, as well as the inherent constraints of time-limited studies to detect meaningful outcomes for patients.
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Affiliation(s)
- David Roofeh
- Scleroderma Program, University of
Michigan, Ann Arbor, MI, USA
| | - Oliver Distler
- Department of Rheumatology, University
Hospital Zurich, Zurich, Switzerland
| | - Yannick Allanore
- Department of Rheumatology A, Cochin
Hospital, Paris Descartes University, Paris, France
| | - Christopher P Denton
- Centre for Rheumatology and Connective
Tissue Diseases, Royal Free Hospital, London, UK
| | - Dinesh Khanna
- Scleroderma Program, University of
Michigan, Ann Arbor, MI, USA
- Division of Rheumatology, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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26
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Sato R, Handa T, Matsumoto H, Kubo T, Hirai T. Clinical significance of self-reported cough intensity and frequency in patients with interstitial lung disease: a cross-sectional study. BMC Pulm Med 2019; 19:247. [PMID: 31842848 PMCID: PMC6916448 DOI: 10.1186/s12890-019-1012-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/26/2019] [Indexed: 01/17/2023] Open
Abstract
Background The intensity and frequency of cough remain unclear in interstitial lung disease (ILD). The aim of this study was to evaluate the intensity and frequency of cough in idiopathic interstitial pneumonias (IIPs), connective tissue disease-associated interstitial lung disease (CTD-ILD), and chronic hypersensitivity pneumonia (CHP), and examine their associations with clinical indices. Methods In this cross-sectional study, the intensity and frequency of cough were evaluated using a 100-mm visual analogue scale. Scores on the Leicester Cough Questionnaire, chronic dyspnoea scale, and a frequency scale for symptoms of gastro-oesophageal reflux disease (FSSG) were collected. The correlations of cough intensity and frequency with potential predictor variables were tested using bivariate and multiple logistic regression analysis. Results The study included 70 patients with IIPs, 49 with CTD-ILD, and 10 with CHP. Patients with IIPs had the most severe cough intensity among the three patient groups. In patients with IIPs, both the intensity and frequency of cough were negatively associated with the diffusing capacity of the lung for carbon monoxide and positively with the Composite Physiologic Index (CPI). In CTD-ILD, both the intensity and frequency of cough were correlated with a higher FSSG score. In multivariate analysis of patients with ILD, IIPs and the FSSG score were independently associated with both components of cough, and CPI tended to be independently associated with cough frequency. Finally, we examined the features of the differences between cough intensity and frequency in all patients with ILD. Patients in whom cough frequency was predominant had a greater impairment of health status relative to other patients. Conclusions Cough intensity was greater in IIPs than in other ILDs. Different clinical indices were associated with patient-reported cough intensity and frequency according to the subtype of ILD. Cough frequency was more strongly associated with health status than was cough intensity. These findings suggest that medical staff could manage patients with ILD by considering cough-related factors when assessing the intensity and frequency of cough.
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Affiliation(s)
- Ryuhei Sato
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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27
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Fischer A, Patel NM, Volkmann ER. Interstitial Lung Disease in Systemic Sclerosis: Focus on Early Detection and Intervention. Open Access Rheumatol 2019; 11:283-307. [PMID: 31849543 PMCID: PMC6910104 DOI: 10.2147/oarrr.s226695] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022] Open
Abstract
Systemic sclerosis (SSc) is a progressive and often devastating disease characterized by autoimmune dysfunction, vasculopathy, and fibrosis. Interstitial lung disease (ILD) is identified in the majority of patients with SSc and is the leading cause of SSc-related mortality. Although clinical manifestations and ILD severity vary among patients, lung function typically declines to the greatest extent during the first 3-4 years after disease onset. We aim to provide an overview of SSc-associated ILD (SSc-ILD) with a focus on current and emerging tools for early diagnosis of ILD and current and novel treatments under investigation. Early detection of ILD provides the opportunity for early therapeutic intervention, which could improve patient outcomes. Thoracic high-resolution computed tomography is the most effective method of identifying ILD in patients with SSc; it enables detection of mild lung abnormalities and plays an important role in monitoring disease progression. Cyclophosphamide and mycophenolate mofetil are the most commonly prescribed treatments for SSc-ILD. Recently, nintedanib (an antifibrotic) was approved by the Food and Drug Administration for patients with SSc-ILD; it is indicated for slowing the rate of decline in pulmonary function. However, there is a need for additional effective and well-tolerated disease-modifying therapy. Ongoing studies are evaluating other antifibrotics and novel agents. We envision that early detection of lung involvement, combined with the emergence and integration of novel therapies, will lead to improved outcomes in patients with SSc-ILD.
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Affiliation(s)
- Aryeh Fischer
- Division of Rheumatology, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Nina M Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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28
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Cottin V, Brown KK. Interstitial lung disease associated with systemic sclerosis (SSc-ILD). Respir Res 2019; 20:13. [PMID: 30658650 PMCID: PMC6339436 DOI: 10.1186/s12931-019-0980-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a rare connective tissue disease with a heterogeneous clinical course. Interstitial lung disease (ILD) is a common manifestation of SSc and a leading cause of death. Main body All patients newly diagnosed with SSc should receive a comprehensive clinical evaluation, including assessment of respiratory symptoms, a high-resolution computed tomography (HRCT) scan of the chest, and pulmonary function tests. ILD can develop in any patient with SSc, including those with pulmonary hypertension, but the risk is increased in those with diffuse (rather than limited) cutaneous SSc, those with anti-Scl-70/anti-topoisomerase I antibody, and in the absence of anti-centromere antibody. While it can occur at any time, the risk of developing ILD is greatest early in the course of SSc, so patients should be monitored closely in the first few years after diagnosis. An increased extent of lung fibrosis on HRCT and a low forced vital capacity (FVC) are predictors of early mortality. While not all patients will require treatment, current approaches to the treatment of progressive SSc-ILD focus on immunosuppressant therapies, including cyclophosphamide and mycophenolate mofetil. In patients with severe and/or rapidly progressive disease, both haematopoietic stem cell transplantation (HSCT) and lung transplantation have been successfully used. A number of medications, including the two drugs approved for the treatment of idiopathic pulmonary fibrosis (IPF), are under active investigation as potential new therapies for SSc-ILD. Conclusions Physicians managing patients with SSc should maintain a high level of suspicion and regularly monitor for ILD, particularly in the first few years after diagnosis.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Claude Bernard University Lyon 1, 28 Avenue du Doyen Lepine, 69677 Lyon Cedex, Lyon, France.
| | - Kevin K Brown
- National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
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Abstract
It is common in longitudinal studies that missing data occur due to subjects' no response, missed visits, dropout, death or other reasons during the course of study. To perform valid analysis in this setting, data missing not at random (MNAR) have to be considered. However, models for data MNAR often suffer from the identifiability issue and hence result in difficulty in estimation and computational convergence. To ameliorate this issue, we propose the LASSO and ridge-regularized selection models that regularize the missing data mechanism model to handle data MNAR, with the regularization parameter selected via a cross-validation procedure. The proposed models can be also employed for sensitivity analysis to examine the effects on inference of different assumptions about the missing data mechanism. We illustrate the performance of the proposed models via simulation studies and the analysis of data from a randomized clinical trial.
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Birring SS, Kavanagh JE, Irwin RS, Keogh KA, Lim KG, Ryu JH. Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report. Chest 2018; 154:904-917. [PMID: 30036496 DOI: 10.1016/j.chest.2018.06.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Chronic cough in interstitial lung disease (ILD) causes significant impairment in quality of life. Effective treatment approaches are needed for cough associated with ILD. METHODS This systematic review asked: Is there evidence of clinically relevant treatment effects for therapies for cough in ILD? Studies of adults aged > 18 years with a chronic cough ≥ 8 weeks' duration were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using CHEST guideline methodology. RESULTS Eight randomized controlled trials and two case series (≥ 10 patients) were included that reported data on patients with idiopathic pulmonary fibrosis, sarcoidosis, and scleroderma-related ILD who received a variety of interventions. Study quality was high in all eight randomized controlled trials. Inhaled corticosteroids were not supported for cough associated with sarcoidosis. Cyclophosphamide and mycophenolate were not supported for solely treating cough associated with scleroderma-associated ILD. A recommendation for thalidomide to treat cough associated with idiopathic pulmonary fibrosis did not pass the panel vote. In view of the paucity of antitussive treatment options for refractory cough in ILD, the guideline panel suggested that the CHEST unexplained chronic cough guideline be followed by considering options such as the neuromodulator gabapentin and speech pathology management. Opiates were also suggested for patients with cough refractory to alternative therapies. CONCLUSIONS The evidence supporting the management of chronic cough in ILD is limited. This guideline presents suggestions for managing and treating cough on the best available evidence, but future research is clearly needed.
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Affiliation(s)
- Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, King's Health Partners, London, UK.
| | | | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Karina A Keogh
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Asano Y, Jinnin M, Kawaguchi Y, Kuwana M, Goto D, Sato S, Takehara K, Hatano M, Fujimoto M, Mugii N, Ihn H. Diagnostic criteria, severity classification and guidelines of systemic sclerosis. J Dermatol 2018; 45:633-691. [PMID: 29687465 DOI: 10.1111/1346-8138.14162] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023]
Abstract
Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side-effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.
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Affiliation(s)
- Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Goto
- Department of Rheumatology, Faculty of Medicine, Univertity of Tsukuba, Ibaraki, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Masaru Hatano
- Graduate School of Medicine Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoki Mugii
- Section of Rehabilitation, Kanazawa University Hospital, Ishikawa, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Barnes H, Holland AE, Westall GP, Goh NSL, Glaspole IN. Cyclophosphamide for connective tissue disease-associated interstitial lung disease. Cochrane Database Syst Rev 2018; 1:CD010908. [PMID: 29297205 PMCID: PMC6491200 DOI: 10.1002/14651858.cd010908.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately one-third of individuals with interstitial lung disease (ILD) have associated connective tissue disease (CTD). The connective tissue disorders most commonly associated with ILD include scleroderma/systemic sclerosis (SSc), rheumatoid arthritis, polymyositis/dermatomyositis, and Sjögren's syndrome. Although many people with CTD-ILD do not develop progressive lung disease, a significant proportion do progress, leading to reduced physical function, decreased quality of life, and death. ILD is now the major cause of death amongst individuals with systemic sclerosis.Cyclophosphamide is a highly potent immunosuppressant that has demonstrated efficacy in inducing and maintaining remission in autoimmune and inflammatory illnesses. However this comes with potential toxicities, including nausea, haemorrhagic cystitis, bladder cancer, bone marrow suppression, increased risk of opportunistic infections, and haematological and solid organ malignancies.Decision-making in the treatment of individuals with CTD-ILD is difficult; the clinician needs to identify those who will develop progressive disease, and to weigh up the balance between a high level of need for therapy in a severely unwell patient population against the potential for adverse effects from highly toxic therapy, for which only relatively limited data on efficacy can be found. Similarly, it is not clear whether histological subtype, disease duration, or disease extent can be used to predict treatment responsiveness. OBJECTIVES To assess the efficacy and adverse effects of cyclophosphamide in the treatment of individuals with CTD-ILD. SEARCH METHODS We performed searches on CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science up to May 2017. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. SELECTION CRITERIA We included randomised controlled parallel-group trials that compared cyclophosphamide in any form, used individually or concomitantly with other immunomodulating therapies, versus non-cyclophosphamide-containing therapies for at least six months, with follow-up of at least 12 months from the start of treatment. DATA COLLECTION AND ANALYSIS We imported studies identified by the search into a reference manager database. We retrieved the full-text versions of relevant studies, and two review authors independently extracted data. Primary outcomes were change in lung function (change in forced vital capacity (FVC) % predicted and diffusing capacity of the lung for carbon monoxide (DLCO) % predicted), adverse events, and health-related quality of life measures. Secondary outcomes included all-cause mortality, dyspnoea, cough, and functional exercise testing. When appropriate, we performed meta-analyses and subgroup analyses by severity of lung function, connective tissue disease diagnosis, and radiological pattern of fibrosis. We assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and created 'Summary of findings' tables. MAIN RESULTS We included in the analysis four trials with 495 participants (most with systemic sclerosis). We formed two separate comparisons: cyclophosphamide versus placebo (two trials, 195 participants) and cyclophosphamide versus mycophenolate (two trials, 300 participants). We found evidence to be of low quality, as dropout rates were high in the intervention groups, and as we noted a wide confidence interval around the effect with small differences, which affected the precision of results.The data demonstrates significant improvement in lung function with cyclophosphamide compared with placebo (post-treatment FVC % mean difference (MD) 2.83, 95% confidence interval (CI) 0.80 to 4.87; P = 0.006) but no significant difference in post-treatment DLCO (% MD -1.68, 95% CI -4.37 to 1.02; P = 0.22; two trials, 182 participants).Risk of adverse effects was increased in the cyclophosphamide treatment groups compared with the placebo groups, in particular, haematuria, leukopenia, and nausea, leading to a higher rate of withdrawal from cyclophosphamide treatment. The data demonstrates statistically significant improvement in one-measure of quality of life in one trial favouring cyclophosphamide over placebo and clinically and statistically significant improvement in breathlessness in one trial favouring cyclophosphamide compared with placebo, with no significant impact on mortality.Trialists reported no significant impact on lung function when cyclophosphamide was used compared with mycophenolate at 12 months (FVC % MD -0.82, 95% CI -3.95 to 2.31; P = 0.61; two trials, 149 participants; DLCO % MD -1.41, 95% CI -10.40 to 7.58; P = 0.76; two trials, 149 participants).Risk of side effects was increased with cyclophosphamide versus mycophenolate, in particular, leukopenia and thrombocytopenia.The data demonstrates no significant impact on health-related quality of life, all-cause mortality, dyspnoea, or cough severity in the cyclophosphamide group compared with the mycophenolate group. No trials reported outcomes associated with functional exercise tests.We performed subgroup analysis to determine whether severity of lung function, connective tissue disease diagnosis, or radiological pattern had any impact on outcomes. One trial reported that cyclophosphamide protected against decreased FVC in individuals with worse fibrosis scores, and also showed that cyclophosphamide may be more effective in those with worse lung function. No association could be made between connective tissue disease diagnosis and outcomes. AUTHORS' CONCLUSIONS This review, which is based on studies of varying methodological quality, demonstrates that overall, in this population, small benefit may be derived from the use of cyclophosphamide in terms of mean difference in % FVC when compared with placebo, but not of the difference in % DLCO, or when compared with mycophenolate. Modest clinical improvement in dyspnoea may be noted with the use of cyclophosphamide. Clinical practice guidelines should advise clinicians to consider individual patient characteristics and to expect only modest benefit at best in preserving FVC. Clinicians should carefully monitor for adverse effects during treatment and in the years thereafter.Further studies are required to examine the use of cyclophosphamide; they should be adequately powered to compare outcomes within different subgroups, specifically, stratified for extent of pulmonary infiltrates on high-resolution computed tomography (HRCT) and skin involvement in SSc. Studies on other forms of connective tissue disease are needed. Researchers may consider comparing cyclophosphamide (a potent immunosuppressant) versus antifibrotic agents, or comparing both versus placebo, in particular, for those with evidence of rapidly progressive fibrotic disease, who may benefit the most.
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Affiliation(s)
- Hayley Barnes
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Anne E Holland
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe UniversityDiscipline of PhysiotherapyMelbourneVictoriaAustralia3086
- The Alfred HospitalDepartment of PhysiotherapyMelbourneVictoriaAustralia3181
- Austin HealthInstitute for Breathing and SleepMelbourneAustralia
| | - Glen P Westall
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Nicole SL Goh
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Ian N Glaspole
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
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Ashmore P, Tikly M, Wong M, Ickinger C. Interstitial lung disease in South Africans with systemic sclerosis. Rheumatol Int 2017; 38:657-662. [PMID: 29185086 DOI: 10.1007/s00296-017-3893-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/23/2017] [Indexed: 02/06/2023]
Abstract
To investigate the frequency, severity and predictors of interstitial lung disease (ILD) in a cohort of South Africans with systemic sclerosis (SSc). Retrospective record review of SSc patients attending a tertiary Connective Tissue Diseases Clinic. Patients with ILD, defined by a combination of clinical findings, imaging, and lung function tests were compared to patients without ILD in terms of demographics, clinical features and autoantibodies. The majority (86.8%) of the 151 patients included were of Black ethnicity, 40% had ILD, of whom 39% had moderate-severe lung disease. Univariate predictors of ILD included: disease duration (OR 1.08, 95% CI 1.01-1.15); cough (OR 2.93, 95% CI 1.37-6.29); dyspnoea (OR 2.44, 95% CI 1.23-4.87); bibasal crackles (OR 7.58, 95% CI 3.31-17.37); diffuse cutaneous SSc (dcSSc) (OR 4.55, 95% CI 2.10-9.86) and a speckled anti-nuclear antibody (ANA) pattern (OR 2.47, 95% CI 1.25-4.90). Conversely, limited cutaneous disease (OR 0.22, 95% CI 0.09-0.50) and anti-centromere antibody (ACA) (OR 0.12, 95% CI 0.02-0.97) were protective. Independent predictors of ILD on multivariate analysis were bibasal crackles (OR 9.43, 95% CI 3.25-27.39), disease duration (OR 1.19, 95% CI 1.09-1.30) and speckled ANA (OR 2.95, 95% CI 1.22-7.15). Almost all (86.4%) patients received immunosuppressive treatment and the leading cause of death was related to ILD itself (44.4%). In this cohort of predominantly Black South Africans, SSc ILD was common and carried a poor prognosis. ILD occurred mainly, but not exclusively, in patients with dcSSc, especially those with a speckled ANA pattern. Conversely, the presence of ACA was protective against ILD.
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Affiliation(s)
- Philippa Ashmore
- Division of Rheumatology, Department of Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Wong
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Claudia Ickinger
- Division of Rheumatology, Department of Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Zhou YH, Mak YW. Psycho-Physiological Associates of Dyspnea in Hospitalized Patients with Interstitial Lung Diseases: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1277. [PMID: 29064440 PMCID: PMC5664777 DOI: 10.3390/ijerph14101277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 01/16/2023]
Abstract
Dyspnea has been found to be an independent predictor of mortality among patients with respiratory diseases and is often regarded as a difficult symptom to control in patients with interstitial lung diseases (ILDs). Previous studies have found an association of psychological and physiological factors with dyspnea among patients with chronic obstructive airway diseases. However, symptom management of hospitalized patients with ILDs has been hampered by difficulty in priority, since they are often admitted with multiple psycho-physiological needs. This study examined the prevalence of dyspnea and the psycho-physiological factors associated with it among hospitalized Chinese patients with ILDs. We studied 165 hospitalized patients with ILDs recruited consecutively over three months in a public hospital in Guangzhou, China. Dyspnea and common psycho-physiological factors, including cough symptoms, activity capacity, lung function, physical and mental health status, and anxiety and depression symptoms, were measured. By ordered logistic regression, level of dyspnea statistically significantly affected performance in a six-minute walk test and physical functioning in work or other regular daily activities in hospitalized patients with ILDs. Respiratory rehabilitation with an appropriate intensity of exercise training or other strategies for enhancing the physical functioning of this population with moderate and severe levels of dyspnea should be prioritized.
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Affiliation(s)
- Yan Hua Zhou
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Yim Wah Mak
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
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Cheng JZ, Wilcox PG, Glaspole I, Corte TJ, Murphy D, Hague CJ, Ryerson CJ. Cough is less common and less severe in systemic sclerosis-associated interstitial lung disease compared to other fibrotic interstitial lung diseases. Respirology 2017; 22:1592-1597. [DOI: 10.1111/resp.13084] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/25/2017] [Accepted: 04/10/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Jasmine Z. Cheng
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
- Centre for Heart Lung Innovation; University of British Columbia; Vancouver British Columbia Canada
| | - Pearce G. Wilcox
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Hospital; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Tamera J. Corte
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Darra Murphy
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Cameron J. Hague
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Christopher J. Ryerson
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
- Centre for Heart Lung Innovation; University of British Columbia; Vancouver British Columbia Canada
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36
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Tashkin DP, Volkmann ER, Tseng CH, Roth MD, Khanna D, Furst DE, Clements PJ, Theodore A, Kafaja S, Kim GH, Goldin J, Ariolla E, Elashoff RM. Improved Cough and Cough-Specific Quality of Life in Patients Treated for Scleroderma-Related Interstitial Lung Disease: Results of Scleroderma Lung Study II. Chest 2017; 151:813-820. [PMID: 28012804 PMCID: PMC5472514 DOI: 10.1016/j.chest.2016.11.052] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cough is a common symptom of scleroderma-related interstitial lung disease (SSc-ILD), but its relationship to other characteristics of SSc-ILD, impact on cough-specific quality of life (QoL), and response to therapy for SSc-ILD have not been well studied. METHODS We investigated frequent cough (FC) in patients with SSc-ILD (N = 142) enrolled in the Scleroderma Lung Study II, a randomized controlled trial comparing mycophenolate mofetil (MMF) and oral cyclophosphamide (CYC) as treatments for interstitial lung disease (ILD). We determined the impact of FC on QoL (Leicester Cough Questionnaire [LCQ]), evaluated the change in FC in response to treatment for SSc-ILD, and examined the relationship between gastroesophageal reflux disease (GERD) and cough during the trial. RESULTS Study participants who reported FC at baseline (61.3%) reported significantly more dyspnea, exhibited more extensive ILD on high-resolution CT, had a lower diffusing capacity for carbon monoxide, and reported more GERD symptoms than did those without FC. Cough-specific QoL was modestly impaired in patients with FC (total LCQ score, 15.4 ± 3.7; normal range, 3-21 [higher scores indicate worse QoL]). The proportion of patients with FC at baseline declined by 44% and 41% over 2 years in the CYC and MMF treatment arms, respectively, and this decline was significantly related to changes in GERD and ILD severity. CONCLUSIONS FC occurs commonly in SSc-ILD, correlates with both the presence and severity of GERD and ILD at baseline, and declines in parallel with improvements in both ILD and GERD over a 2-year course of therapy. Frequent cough might serve as a useful surrogate marker of treatment response in SSc-ILD trials. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00883129; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Elizabeth R Volkmann
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael D Roth
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Daniel E Furst
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Philip J Clements
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arthur Theodore
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Suzanne Kafaja
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Grace Hyun Kim
- Department of Radiologic Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jonathan Goldin
- Department of Radiologic Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Edgar Ariolla
- Department of Pharmaceutical Services, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Robert M Elashoff
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Abstract
Systemic sclerosis (SSc) is a multi-systemic autoimmune disease that mainly affects the skin, lungs, gastrointestinal tract, heart and kidneys. Pulmonary disease in patients with SSc is strongly associated with mortality. The mechanisms involved into its pathophysiology include the activation of autoimmune cells and hyperplasia of fibroblasts with an increased capacity to produce collagen and diminished collagen breakdown. Although pulmonary biopsy is the gold standard for the diagnosis of interstitial lung disease in SSc, the most commonly used method is high-resolution computed tomography due to its high sensitivity and specificity. Herein, a comprehensive review on the pulmonary involvement in SSc is presented highlighting the radiologic-pathologic correlations.
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38
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Cough in interstitial lung disease. Pulm Pharmacol Ther 2015; 35:122-8. [DOI: 10.1016/j.pupt.2015.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 12/15/2022]
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Abstract
Systemic sclerosis is a heterogeneous disease of unknown etiology with limited effective therapies. It is characterized by autoimmunity, vasculopathy, and fibrosis and is clinically manifested by multiorgan involvement. Interstitial lung disease is a common complication of systemic sclerosis and is associated with significant morbidity and mortality. The diagnosis of interstitial lung disease hinges on careful clinical evaluation and pulmonary function tests and high-resolution computed tomography. Effective therapeutic options are still limited. Several experimental therapies are currently in early-phase clinical trials and show promise.
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Affiliation(s)
- Sara R Schoenfeld
- Division of Rheumatology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Flavia V Castelino
- Division of Rheumatology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Lammi MR, Baughman RP, Birring SS, Russell AM, Ryu JH, Scholand M, Distler O, LeSage D, Sarver C, Antoniou K, Highland KB, Kowal-Bielecka O, Lasky JA, Wells AU, Saketkoo LA. Outcome Measures for Clinical Trials in Interstitial Lung Diseases. CURRENT RESPIRATORY MEDICINE REVIEWS 2015; 11:163-174. [PMID: 27019654 PMCID: PMC4806861 DOI: 10.2174/1573398x11666150619183527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The chronic fibrosing idiopathic interstitial pneumonias (IIPs) are a group of heterogeneous pulmonary parenchymal disorders described by radiologic and histological patterns termed usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). These include idiopathic pulmonary fibrosis (IPF) and those related to connective tissue disease (CTD) and are associated with substantial morbidity and mortality. Beyond the importance of establishing an appropriate diagnosis, designing optimal clinical trials for IIPs has been fraught with difficulties in consistency of clinical endpoints making power analyses, and the establishment of efficacy and interpretation of results across trials challenging. Preliminary recommendations, developed by rigorous consensus methods, proposed a minimum set of outcome measures, a 'core set', to be incorporated into future clinical trials (Saketkoo et al, THORAX. 2014.). This paper sets out to examine the candidate instruments for each domain (Dyspnea, Cough, Health Related Quality of Life, Imaging, Lung Physiology and Function, Mortality). Candidate measures that were not selected as well as measures that were not available for examination at the time of the consensus process will also be discussed.
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Affiliation(s)
- Matthew R. Lammi
- Louisiana State University Health Sciences Center, New Orleans,
New Orleans, LA, USA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
| | | | | | - Anne-Marie Russell
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Jay H. Ryu
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich,
Switzerland
| | - Daphne LeSage
- Patient Research Partner, Office of Public Health, New Orleans,
LA, USA
| | | | | | | | | | - Joseph A. Lasky
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
| | - Athol U. Wells
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
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Lee AS, Mira-Avendano I, Ryu JH, Daniels CE. The burden of idiopathic pulmonary fibrosis: An unmet public health need. Respir Med 2014; 108:955-67. [DOI: 10.1016/j.rmed.2014.03.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/24/2014] [Accepted: 03/30/2014] [Indexed: 12/11/2022]
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Saketkoo LA, Mittoo S, Huscher D, Khanna D, Dellaripa PF, Distler O, Flaherty KR, Frankel S, Oddis CV, Denton CP, Fischer A, Kowal-Bielecka OM, LeSage D, Merkel PA, Phillips K, Pittrow D, Swigris J, Antoniou K, Baughman RP, Castelino FV, Christmann RB, Christopher-Stine L, Collard HR, Cottin V, Danoff S, Highland KB, Hummers L, Shah AA, Kim DS, Lynch DA, Miller FW, Proudman SM, Richeldi L, Ryu JH, Sandorfi N, Sarver C, Wells AU, Strand V, Matteson EL, Brown KK, Seibold JR. Connective tissue disease related interstitial lung diseases and idiopathic pulmonary fibrosis: provisional core sets of domains and instruments for use in clinical trials. Thorax 2013; 69:428-36. [PMID: 24368713 PMCID: PMC3995282 DOI: 10.1136/thoraxjnl-2013-204202] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
RATIONALE Clinical trial design in interstitial lung diseases (ILDs) has been hampered by lack of consensus on appropriate outcome measures for reliably assessing treatment response. In the setting of connective tissue diseases (CTDs), some measures of ILD disease activity and severity may be confounded by non-pulmonary comorbidities. METHODS The Connective Tissue Disease associated Interstitial Lung Disease (CTD-ILD) working group of Outcome Measures in Rheumatology-a non-profit international organisation dedicated to consensus methodology in identification of outcome measures-conducted a series of investigations which included a Delphi process including >248 ILD medical experts as well as patient focus groups culminating in a nominal group panel of ILD experts and patients. The goal was to define and develop a consensus on the status of outcome measure candidates for use in randomised controlled trials in CTD-ILD and idiopathic pulmonary fibrosis (IPF). RESULTS A core set comprising specific measures in the domains of lung physiology, lung imaging, survival, dyspnoea, cough and health-related quality of life is proposed as appropriate for consideration for use in a hypothetical 1-year multicentre clinical trial for either CTD-ILD or IPF. As many widely used instruments were found to lack full validation, an agenda for future research is proposed. CONCLUSION Identification of consensus preliminary domains and instruments to measure them was attained and is a major advance anticipated to facilitate multicentre RCTs in the field.
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Affiliation(s)
- Lesley Ann Saketkoo
- Louisiana State University Health Sciences Center, , New Orleans, Louisiana, USA
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Lim KG. Scleroderma lung-associated cough: more than meets the eye? Chest 2013; 142:556-557. [PMID: 22948573 DOI: 10.1378/chest.12-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kaiser G Lim
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN.
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