A Volumetric Computed Tomography Analysis of the Normal Lung in Idiopathic Pulmonary Fibrosis: The Relationship with the Survival

Productive cough associated with patient-reported outcomes and computed tomography analysis results in idiopathic pulmonary fibrosis: a single centre cross-sectional study

The high frequency of productive cough in idiopathic pulmonary fibrosis (IPF) impacts quality of life. Reduced normal lung volume is linked to cough severity, predicting poorer outcomes. Insights could enhance IPF management and patient wellbeing. https://bit.ly/4bPOCzC.

Efficacy of dupilumab for airway hypersecretion and airway wall thickening in patients with moderate-to-severe asthma: A prospective, observational study

BACKGROUND

Dupilumab has clinical effects in patients with moderate-to-severe asthma. When considering interleukin (IL)-4 and IL-13 signaling, effects of dupilumab on airway mucus hypersecretion and airway remodeling are expected, but they have been reported in only a few short-term studies. Its efficacy for airway hyperresponsiveness (AHR) remains unknown. We comprehensively assessed the efficacy of dupilumab, especially for subjective and objective measures of airway mucus hypersecretion and airway dimensions in moderate-to-severe asthmatic patients.

METHODS

In 28 adult patients with moderate-to-severe uncontrolled asthma, the comprehensive efficacy of 48-week dupilumab treatment, including the Cough and Sputum Assessment Questionnaire (CASA-Q), radiological mucus scores and airway dimensions on computed tomography (CT), was assessed prospectively. Treatment responsiveness to dupilumab was analyzed.

RESULTS

With 48-week dupilumab treatment, all four cough and sputum domain scores of CASA-Q improved significantly. Radiological mucus scores and airway wall thickening on CT were significantly decreased. The decreases in mucus scores were significantly associated with improvements in Asthma Control Questionnaire scores, Asthma Quality of Life Questionnaire (AQLQ) overall scores, airway obstruction, and airway type 2 inflammation. When defined by > 0.5 improvement in AQLQ overall scores, 18 patients (64%) were identified as responders.

CONCLUSIONS

Dupilumab reversed subjective and objective measures of airway mucus hypersecretion and some aspects of airway remodeling in patients with moderate-to-severe uncontrolled asthma.

Novel Artificial Intelligence-based Technology for Chest Computed Tomography Analysis of Idiopathic Pulmonary Fibrosis

RATIONALE

There is a growing need to accurately estimate the prognosis of idiopathic pulmonary fibrosis (IPF) in clinical practice, given the development of effective drugs for treating IPF.

OBJECTIVE

To develop artificial intelligence-based image analysis software to detect parenchymal and airway abnormalities on chest computed tomography (CT) and to explore their prognostic importance in patients with IPF.

METHODS

A novel artificial intelligence-based quantitative CT image analysis software (AIQCT) was developed by applying 304 HRCT scans from patients with diffuse lung diseases as the training set. AIQCT automatically categorized and quantified ten types of parenchymal patterns as well as airways, expressing the volumes as percentages of the total lung volume. To validate the software, the area percentages of each lesion quantified by AIQCT were compared with those of the visual scores using 30 plain HRCT images with lung diseases. In addition, three-dimensional analysis for similarity with ground truth was performed using HRCT images from 10　patients with IPF. AIQCT was then applied to 120 patients with IPF who underwent chest HRCT scanning at our institute. Associations between the measured volumes and survival were analyzed.

RESULTS

The correlations between AIQCT and the visual scores were moderate to strong (correlation coefficient 0.44 to 0.95) depending on the parenchymal pattern. The Dice indexes for similarity between AIQCT data and ground truth were 0.67, 0.76, and 0.64 for reticulation, honeycomb, and bronchi, respectively. During a median follow-up period of 2,184 days, 66 patients died, and 1 underwent lung transplantation. In multivariable Cox regression analysis, bronchial volumes [adjusted hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.16 to 1.53] and normal lung volumes (adjusted HR, 0.97; 95% CI, 0.94 to 0.99) were independently associated with survival after adjusting for the GAP stage of IPF.

CONCLUSIONS

Our newly developed artificial intelligence-based image analysis software successfully quantified parenchymal lesions and airway volumes. Bronchial and normal lung volumes on chest HRCT may provide additional prognostic information on the GAP stage of IPF.

Survival of patients with asbestosis can be assessed by risk-predicting models

OBJECTIVES

Our aim was to investigate the pulmonary function test (PFT) results of patients with asbestosis and determine whether baseline PFTs and the risk-predicting models such as gender, age and physiologic (GAP) variables model and composite physiologic index (CPI) would be useful in predicting survival in these patients.

METHODS

Demographics and PFTs of 100 patients with asbestosis were evaluated. The survival difference between the GAP stages was determined with Kaplan-Meier survival curves with statistical significance analysed with log-rank test. The suitability of the risk-predicting models and baseline PFTs to predict the survival of patients was analysed with Cox regression.

RESULTS

At baseline, the mean value of diffusion capacity for carbon monoxide (DLCO) was 65%; for forced vital capacity it was 81%, with restrictive lung function being the most common impairment. The median estimated survival of the patients was 124 months, that is, 171 months in GAP stage I, 50 months in stage II and 21 months in stage III (p<0.001). CPI, DLCO% predicted, age at baseline and GAP stage were significant predictors of mortality (all p values under 0.001).

CONCLUSIONS

GAP and CPI as well as baseline DLCO% predicted were significant parameters in the evaluation of the prognosis of the patients with asbestosis; they may be useful in clinical practice when considering treatment strategies of individual patients.

Early decrease in erector spinae muscle area and future risk of mortality in idiopathic pulmonary fibrosis

Computed tomography (CT) assessment of the cross-sectional area of the erector spinae muscles (ESM_CSA) can be used to evaluate sarcopenia and cachexia in patients with lung diseases. This study aimed to confirm whether serial changes in ESM_CSA are associated with survival in patients with idiopathic pulmonary fibrosis (IPF). Data from consecutive patients with IPF who were referred to a single centre were retrospectively reviewed. We measured the ESM_CSA at the level of the 12th thoracic vertebra on CT images at referral and 6 months later (n = 119). The follow-up time was from 817–1633 days (median, 1335 days) and 59 patients (49.6%) died. A univariate Cox regression analysis showed that the decline in % predicted forced vital capacity (FVC) (Hazard ratios [HR] 1.041, 95% confidence interval [CI] 1.013–1.069, P = 0.004), the decline in body mass index (BMI) (HR 1.084, 95% CI 1.037–1.128; P < 0.001) and that in ESM_CSA (HR 1.057, 95% CI 1.027–1.086; P < 0.001) were prognostic factors. For multivariate analyses, the decline in ESM_CSA (HR 1.039, 95% CI 1.007–1.071, P = 0.015) was a significant prognostic factor, while those in % FVC and BMI were discarded. Early decrease in ESM_CSA may be a useful predictor of prognosis in patients with IPF.