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Gomatou G, Masaoutis C, Vamvakaris I, Kotteas E, Bouros E, Tzilas V, Bouros D. Differential immunohistochemical expression of hTERT in lung cancer patients with and without idiopathic pulmonary fibrosis. Pulmonology 2024; 30:214-221. [PMID: 35153179 DOI: 10.1016/j.pulmoe.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human telomerase reverse transcriptase (hTERT) is the catalytic subunit of telomerase enzyme, which adds nucleotides to telomeres and counteracts their length shortening. The development of a telomere maintenance mechanism represents a hallmark of cancer. On the other hand, idiopathic pulmonary fibrosis (IPF) is associated with mutations in telomerase genes and shorter telomeres. IPF is frequently complicated with lung cancer. AIM To investigate the expression of hTERT in lung cancer with co-existing IPF and to compare with lung cancer without fibrosis. METHODS Diagnostic lung cancerous biopsies were retrieved from 18 patients with lung cancer and concomitant IPF, as well as 18 age and gender matched controls with lung cancer without pulmonary fibrosis. The expression of hTERT was studied with immunohistochemistry. ImajeJ software was used to quantitate subcellular stain intensity. Immunohistochemical investigation of two senescence-associated markers, p16 and p21, was also performed in all 36 cases. RESULTS Both groups highly expressed hTERT, without significant difference (100% vs 95%, p = 0.521). Evaluation of p16 and p21 immunostaining revealed negative to minimal immunoreactivity in both groups. hTERT localization exhibited higher median nuclear intensity in the group of lung cancer with IPF (0.62 vs 0.45, p = 0.016), while cytoplasmic intensity did not differ significantly (0.17 vs 0.15, p = 0.463). Higher median nuclear intensity was also correlated with small cell lung cancer subtype in the whole study sample (0.69 vs 0.45, p = 0.09). CONCLUSION hTERT is highly expressed in lung cancer with concomitant IPF, but with differential localization compared to lung cancer without IPF, implying differences in pathogenicity and requiring further investigation.
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Affiliation(s)
- G Gomatou
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece; Oncology Unit, Third Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece.
| | - C Masaoutis
- 1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - I Vamvakaris
- Department of Pathology, "Sotiria" Hospital for Diseases of the Chest, Athens, Greece
| | - E Kotteas
- Oncology Unit, Third Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - E Bouros
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - V Tzilas
- Center for Diseases of the Chest, Athens Medical Center, Athens, Greece
| | - D Bouros
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece; Center for Diseases of the Chest, Athens Medical Center, Athens, Greece
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Tzilas V, Tzouvelekis A, Sotiropoulou V, Panopoulos S, Bouros E, Avdoula E, Ryu JH, Bouros D. Presenting clinical and imaging features of patients with clinically amyopathic interstitial lung disease associated with myositis-specific autoantibodies. Front Med (Lausanne) 2024; 11:1392659. [PMID: 38711778 PMCID: PMC11070581 DOI: 10.3389/fmed.2024.1392659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Background Lung involvement in the context of idiopathic inflammatory myopathies has significant impact on outcome; early and accurate diagnosis is important but can be difficult to achieve. In particular, patients without clinically evident muscle involvement pose a significant diagnostic challenge. Methods A computer-assisted search was conducted to identify patients with amyopathic interstitial lung disease associated with the presence of myositis-specific autoantibodies. Medical records and chest imaging studies were reviewed to identify clinical and radiologic features at presentation. Results Of the 35 patients with amyopathic interstitial lung disease associated with myositis-specific autoantibodies, the median age was 65 years (range 43-78) and 20 were women (57%). Of the patients, 34% had previously visited the rheumatology department. Presenting symptoms consisted of dyspnea (94%), cough (43%), and arthritis (23%). Raynaud phenomenon, "mechanic hands," Gottron papules, and inspiratory crackles were present in 23, 31, 9, and 74% of patients, respectively. After a detailed history, none of the patients reported muscle weakness, while four (11%) exhibited increased CK levels; of these four, two had a concomitant increase in aldolase levels. Median FVC was 79% predicted (range: 49-135) and median DLco was 50% predicted (range: 17-103). HRCT pattern was suggestive of an alternative to UIP pattern in 31/33 (94%) patients; the most common imaging patterns were NSIP (49%) and NSIP/OP (39%). Conclusion In patients with NSIP and NSIP/OP pattern, the presence of amyopathic interstitial lung disease associated with myositis-specific autoantibodies should be considered even in the absence of clinical evident myositis.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Chest Diseases Hospital “Sotiria”, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
| | - Vasilina Sotiropoulou
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
| | - Stylianos Panopoulos
- 1st Department of Propaedeutic and Internal Medicine, and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Demosthenes Bouros
- 1st Department of Respiratory Medicine, Medical School, National Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece
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Tzilas V, Hartman TE, Ryu JH. Leukemic pulmonary infiltrates in chronic lymphocytic leukemia: Clinical and imaging features. Respir Investig 2024; 62:247-251. [PMID: 38241957 DOI: 10.1016/j.resinv.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western countries. Although various patterns of lung involvement with CLL have been reported, data on clinicoradiologic presentation are sparse. METHODS A computer-assisted search was conducted to identify patients encountered at Mayo Clinic from 1998 to 2022 and had leukemic pulmonary infiltrates (LPI) with CLL demonstrated on lung biopsy. Medical records and chest imaging studies were reviewed to identify clinical and radiologic features. RESULTS Among 13 patients, median age was 77 years (range: 60-88) and included 10 men (77 %). All patients were known to have CLL with a median duration of 96 months (range: 50-408), and none were on treatment. Most common symptoms were dyspnea (62 %), cough (54 %), and fatigue (46 %); 2 patients (15 %) were asymptomatic. Dominant abnormality on CT consisted of single or multiple nodular/mass-like opacities in 10 patients (77 %), while diffuse centrilobular nodules, pleural mass, and diffuse bronchial wall thickening were each seen in one patient, respectively; intrathoracic lymphadenopathy was present in all. After diagnosis of LPI, treatment for CLL was administered to 7 patients (54 %); 6 patients (86 %) exhibited improvement. During follow-up (median 41 months), 8 (62 %) patients died. Causes of death included progressive CLL or treatment-related complications (2 patients), pneumonia (1 patient), unrelated causes (3 patients), and unknown in 2 patients. CONCLUSIONS LPI in CLL is generally encountered in patients with known untreated CLL. The main imaging feature is single mass-like opacity or multiple nodular/mass-like opacities, associated with intrathoracic lymphadenopathy.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria", Mesogheion 152 , Athens, 11527, Greece.
| | - Thomas E Hartman
- Department of Radiology, Mayo Clinic, Rochester, MN, 200 First St. SW, 55905 ,USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, 200 First St. SW, MN, 55905,USA
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Tzilas V, Bouros D, Ryu JH. In pursuit of personalized medicine in fibrotic interstitial lung diseases. Divide and conquer. Pulmonology 2024; 30:101-103. [PMID: 38709866 DOI: 10.1016/j.pulmoe.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 05/08/2024] Open
Affiliation(s)
- V Tzilas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria", Athens, Greece
| | - D Bouros
- Medical School, National Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece.
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
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Tzilas V, Nicholson AG, Gavriatopoulou M, Ntanasis-Stathopoulos I, Dimopoulos MA, Bouros D. A 74-Year-Old Man With Waldenström Macroglobulinemia and Progressive Dyspnea. Chest 2024; 165:e39-e43. [PMID: 38336442 DOI: 10.1016/j.chest.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 02/12/2024] Open
Abstract
CASE PRESENTATION A 74-year-old man presented to our department with progressive dyspnea on exertion over the last year. The patient did not report any other symptoms. He had previously smoked with a 60 pack-year history. He worked in an office and did not report any environmental, occupational, or domestic exposures. His history included asymptomatic Waldenström's macroglobulinemia that was diagnosed 18 months before respiratory symptoms. He was not receiving any treatment and was monitored regularly by the hematology department.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Hospital for Diseases of the Chest, "Sotiria," Athens, Greece.
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Medical School, National and Kapodistrian University of Athens, Athens, Greece; Athens Medical Center, Athens, Greece
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Papiris SA, Veith M, Papaioannou AI, Apollonatou V, Ferrarotti I, Ottaviani S, Tzouvelekis A, Tzilas V, Rovina N, Stratakos G, Gerogianni I, Daniil Z, Kolilekas L, Dimakou K, Pitsidianakis G, Tzanakis N, Tryfon S, Fragopoulos F, Antonogiannaki EM, Lazaratou A, Fouka E, Papakosta D, Emmanouil P, Anagnostopoulos N, Karampitsakos T, Vlami K, Kallieri M, Lyberopoulos P, Loukides S, Bouros D, Bush A, Balduyck M, Lombard C, Cottin V, Mornex JF, Vogelmeier CF, Greulich T, Manali ED. Alpha1-antitrypsin deficiency in Greece: Focus on rare variants. Pulmonology 2024; 30:43-52. [PMID: 36797151 DOI: 10.1016/j.pulmoe.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023] Open
Abstract
PURPOSE A1Antitrypsin deficiency (AATD) pathogenic mutations are expanding beyond the PI*Z and PI*S to a multitude of rare variants. AIM to investigate genotype and clinical profile of Greeks with AATD. METHODS Symptomatic adult-patients with early-emphysema defined by fixed airway obstruction and computerized-tomography scan and lower than normal serum AAT levels were enrolled from reference centers all over Greece. Samples were analyzed in the AAT Laboratory, University of Marburg-Germany. RESULTS Included are 45 adults, 38 homozygous or compound heterozygous for pathogenic variants and 7 heterozygous. Homozygous were 57.9% male, 65.8% ever-smokers, median (IQR) age 49.0(42.5-58.5) years, AAT-levels 0.20(0.08-0.26) g/L, FEV1(%predicted) 41.5(28.8-64.5). PI*Z, PI*Q0, and rare deficient allele's frequency was 51.3%, 32.9%,15.8%, respectively. PI*ZZ genotype was 36.8%, PI*Q0Q0 21.1%, PI*MdeficientMdeficient 7.9%, PI*ZQ0 18.4%, PI*Q0Mdeficient 5.3% and PI*Zrare-deficient 10.5%. Genotyping by Luminex detected: p.(Pro393Leu) associated with MHeerlen (M1Ala/M1Val); p.(Leu65Pro) with MProcida; p.(Lys241Ter) with Q0Bellingham; p.(Leu377Phefs*24) with Q0Mattawa (M1Val) and Q0Ourem (M3); p.(Phe76del) with MMalton (M2), MPalermo (M1Val), MNichinan (V) and Q0LaPalma (S); p.(Asp280Val) with PLowell (M1Val); PDuarte (M4), YBarcelona (p.Pro39His). Gene-sequencing (46.7%) detected Q0GraniteFalls, Q0Saint-Etienne, Q0Amersfoort(M1Ala), MWürzburg, NHartfordcity and one novel-variant (c.1A>G) named Q0Attikon.Heterozygous included PI*MQ0Amersfoort(M1Ala), PI*MMProcida, PI*Mp.(Asp280Val), PI*MOFeyzin. AAT-levels were significantly different between genotypes (p = 0.002). CONCLUSION Genotyping AATD in Greece, a multiplicity of rare variants and a diversity of rare combinations, including unique ones were observed in two thirds of patients, expanding knowledge regarding European geographical trend in rare variants. Gene sequencing was necessary for genetic diagnosis. In the future the detection of rare genotypes may add to personalize preventive and therapeutic measures.
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Affiliation(s)
- S A Papiris
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece.
| | - M Veith
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - A I Papaioannou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - V Apollonatou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - I Ferrarotti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - S Ottaviani
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - A Tzouvelekis
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - V Tzilas
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - N Rovina
- 1st Department of Pulmonary Medicine and Intensive Care Unit, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - G Stratakos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - I Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Z Daniil
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - L Kolilekas
- 7thPulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - K Dimakou
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - G Pitsidianakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - N Tzanakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - S Tryfon
- General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - F Fragopoulos
- Pulmonary Department, General Hospital of Nicosia, Cyprus
| | - E M Antonogiannaki
- 4th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - A Lazaratou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - E Fouka
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | - D Papakosta
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | | | - N Anagnostopoulos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - T Karampitsakos
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - K Vlami
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - M Kallieri
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - P Lyberopoulos
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - S Loukides
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - D Bouros
- Iatriko Medical Center, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Athens Greece
| | - A Bush
- Paediatrics and Paediatric Respirology, Imperial College, Imperial Centre for Paediatrics and Child Health, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - M Balduyck
- laboratoire de Biochimie et Biologie Moléculaire (HMNO), Centre de Biologie Pathologie, Faculté de pharmacie et EA 7364 RADEME, Laboratoire de Biochimie et Biologie Moléculaire, CHU de Lille, Université de Lille, Lille, France
| | - C Lombard
- Laboratoire d'Immunologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon and Université Claude Bernard-Lyon 1, Lyon, France
| | - V Cottin
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - J F Mornex
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - T Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - E D Manali
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
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Tzilas V, Digalaki A, Bouros E, Avdoula E, Tzouvelekis A, Bouros D. Diagnostic Utility of Bronchoalveolar Lavage Lymphocytosis in Patients with Interstitial Lung Diseases. Respiration 2023; 102:944-947. [PMID: 37866357 DOI: 10.1159/000534429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are extremely challenging in terms of diagnosis. Extreme bronchoalveolar lavage (BAL) lymphocytosis is thought to strongly point towards the diagnosis of hypersensitivity pneumonitis (HP). OBJECTIVES Explore the range of different ILD that can present with BAL lymphocytosis, including cases of pronounced lymphocytosis and its diagnostic utility. METHODS Patients with ILD that were subjected to BAL were identified retrospectively from a cohort of consecutive patients. RESULTS BAL lymphocytosis ≥20% was recorded in 106 patients (27%), while pronounced BAL lymphocytosis ≥40% was recorded in 49 patients (12.5%). The most common diagnoses in patients with BAL lymphocytosis ≥20% and ≥40%, were HP (32.1%), connective tissue disease (CTD)-ILD (26.4%), sarcoidosis (16%), and HP (38.8%), CTD-ILD (24.5%), sarcoidosis (14.3%), respectively. CONCLUSIONS Neither the presence nor the degree of BAL lymphocytosis can point to a specific diagnosis.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Antonia Digalaki
- 5th Respiratory Department, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Evangelos Bouros
- Medical School, National Kapodistrian University of Athens, Zografou, Greece
- Athens Medical Center, Athens, Greece
| | - Eleni Avdoula
- Medical School, National Kapodistrian University of Athens, Zografou, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
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Tzilas V, Roussis I, Sakellaropoulou K, Chrysikos S, Hillas G, Ryu JH. A 68-Year-Old Patient With Dyspnea and Hypoxemia After Total Hip Arthroplasty. Chest 2023; 164:e107-e110. [PMID: 37805247 DOI: 10.1016/j.chest.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/09/2023] [Accepted: 04/29/2023] [Indexed: 10/09/2023] Open
Abstract
CASE PRESENTATION A 68-year-old patient with obesity (BMI, 4 7 kg/m2) was transferred to the ED of our hospital because of dyspnea and pronounced hypoxemia. The patient underwent total right hip arthroplasty in an outside hospital because of osteoarthritis; there was no history of trauma. After 48 h, she experienced dyspnea with severe hypoxemia. The next day she was transferred to our hospital. Her history was notable for arterial hypertension and depression, but not heart failure. Her medications included candesartan (16 mg once daily) and sertraline (100 mg once daily). Perioperatively, she received enoxaparin 4.000 International Units subcutaneously once daily. There was no family history of respiratory diseases. The patient currently smokes (50 pack-years) with no recent increase in her habit and denied vaping, alcohol consumption, illicit drug use, and any home or occupational exposures. Prior to surgery, the family of the patient reported that she maintained modest mobility despite her osteoarthritis and was able to fulfill her daily activities. Interestingly, she reported a similar event of severe dyspnea and hypoxemia after total knee arthroplasty 3 years earlier; however, no further details were available.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece.
| | - Ioannis Roussis
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | | | - Serafeim Chrysikos
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | - Georgios Hillas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Tzilas V, Samhouri BF, Hartman TE, Ryu JH. Unveiling Many Clinicopathologic Entities and Causes Within COPD Using CT Scan. Chest 2023; 164:e85-e86. [PMID: 37689479 DOI: 10.1016/j.chest.2023.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 09/11/2023] Open
Affiliation(s)
- Vasilios Tzilas
- 5(th) Respiratory Department, Chest Diseases Hospital "Sotiria", Athens, Greece
| | - Bilal F Samhouri
- Division of Pulmonary and Critical Care Medicine, Asante Health System, Medford, OR
| | | | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Panopoulos S, Tzilas V, Bournia VK, Karamanakos A, Laskari K, Bouros D, Tektonidou M, Sfikakis PP. COVID-19 and protection of vaccination in patients with systemic sclerosis-associated interstitial lung disease. J Scleroderma Relat Disord 2023; 8:113-119. [PMID: 37284697 PMCID: PMC9755035 DOI: 10.1177/23971983221143252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/10/2022] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Data on COVID-19 in patients with interstitial lung disease are scarce and whether SARS-CoV-2 may trigger interstitial lung disease progression remains unknown. We aimed to analyze outcomes of COVID-19 in patients with systemic sclerosis-associated interstitial lung disease, including possible thoracic radiographic progression. PATIENTS AND METHODS All 43 patients with systemic sclerosis-associated interstitial lung disease followed in our center (mean ± SD, 55.2 ± 11.6 years, 36 female) with confirmed SARS-CoV2 infection up to 1 September 2022 were analyzed. Individual interstitial lung disease extent on high resolution CT (HRCT) performed before (up to 3 months) and after COVID-19 (2-5 months) was compared. RESULTS At SARS-CoV-2 infection, 9/43 patients were unvaccinated, whereas 5, 26, and 3 had received 2, 3, or 4 doses of an mRNA vaccine, respectively. Thirty-one patients were either on monotherapy with immunosuppressives (mycophenolate, n = 7; cyclophosphamide, n = 2; methotrexate, n = 10; tocilizumab, n = 7; rituximab, n = 1; etanercept, n = 1), or their combinations (n = 3). Eight patients (20%), of whom four unvaccinated, required hospitalization for pneumonia and three (7%) died of acute respiratory failure (n = 2, both unvaccinated) or cardiac arrest. Lack of vaccination was the only independent predictor for hospitalization (OR = 7.98, 95% CI: 1.25-51.09) and marginally for death (OR = 32.7, 95% CI: 0.97-1110.98), regardless of the presence of diffuse systemic sclerosis, interstitial lung disease extent greater than 20% or immunosuppressive treatment. In 22 patients with available HRCT pairs (vaccinated = 20), the interstitial lung disease extent before COVID-19 (20.4%± 17.8%) remained unchanged (22.4% ± 18.5%) in all but one patient. CONCLUSION SARS-CoV-2 vaccination is of outmost importance for every systemic sclerosis patient with interstitial lung disease. COVID-19 does not seem to promote progression of systemic sclerosis-associated interstitial lung disease in vaccinated patients, but further studies are warranted.
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Affiliation(s)
- Stylianos Panopoulos
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Vasilios Tzilas
- 5th Respiratory Medicine Department, “Sotiria” Chest Diseases Hospital, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Anastasios Karamanakos
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Katerina Laskari
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Demosthenes Bouros
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
- Medical Center, Athens, Greece
| | - Maria Tektonidou
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Petros P. Sfikakis
- 1st Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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11
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Tzilas V, Ryu JH, Sfikakis PP, Tzouvelekis A, Bouros D. Antisynthetase syndrome with predominant lung involvement. An easy to miss diagnosis. Pulmonology 2023:S2531-0437(23)00047-8. [PMID: 36906463 DOI: 10.1016/j.pulmoe.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- V Tzilas
- 5thRespiratory Department, Chest Diseases Hospital "Sotiria", Athens, Greece
| | - J H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - P P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - A Tzouvelekis
- Division of Respiratory Medicine, Medical School University of Patras, Greece
| | - D Bouros
- 1st Department of Respiratory Medicine, Medical School, National Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece.
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12
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Karampitsakos T, Tzilas V, Papaioannou O, Chrysikos S, Vasarmidi E, Juge PA, Vizirianaki S, Bibaki E, Reppa A, Sidiropoulos P, Katsaras M, Sotiropoulou V, Tsiri P, Koulousousa E, Theochari E, Tsirikos G, Christopoulos I, Malakounidou E, Zarkadi E, Sampsonas F, Hillas G, Karageorgas T, Daoussis D, Kalogeropoulou C, Dimakou K, Tzanakis N, Borie R, Dieudé P, Antoniou K, Crestani B, Bouros D, Tzouvelekis A. Clinical features and outcomes of patients with myositis associated-interstitial lung disease. Front Med (Lausanne) 2023; 9:1096203. [PMID: 36698813 PMCID: PMC9868310 DOI: 10.3389/fmed.2022.1096203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Myositis associated interstitial lung disease (ILD) seems to be an under-recognized entity. Methods In this multicenter, retrospective study, we recorded between 9/12/2019 and 30/9/2021 consecutive patients who presented in five different ILD centers from two European countries (Greece, France) and received a multidisciplinary diagnosis of myositis associated-ILD. The primary outcome was all-cause mortality over 1 year in specific subgroups of patients. Secondary outcomes included comparison of disease characteristics between patients diagnosed with the amyopathic subtype and patients with evidence of myopathy at diagnosis. Results We identified 75 patients with myositis associated-ILD. Median age (95% CI) at the time of diagnosis was 64.0 (61.0-65.0) years. Antinuclear antibody testing was positive in 40% of the cohort (n = 30/75). Myopathy onset occurred first in 40.0% of cases (n = 30), ILD without evidence of myopathy occurred in 29 patients (38.7%), while 16 patients (21.3%) were diagnosed concomitantly with ILD and myopathy. The commonest radiographic pattern was cellular non-specific interstitial pneumonia (NSIP) and was observed in 29 patients (38.7%). The radiographic pattern of organizing pneumonia was significantly more common in patients diagnosed with the amyopathic subtype compared to patients that presented with myopathy [24.1% (n = 7/29) vs. 6.5% (n = 3/46), p = 0.03]. One year survival was 86.7% in the overall population. Kaplan-Meier analysis demonstrated significantly higher all-cause 1-year mortality in patients with the amyopathic subtype compared to patients with evidence of myopathy [H R 4.24 (95% CI: 1.16-15.54), p = 0.03]. Patients diagnosed following hospitalization due to acute respiratory failure experienced increased risk of 1-year all-cause mortality compared to patients diagnosed in outpatient setting [HR 6.70 (95% CI: 1.19-37.81), p = 0.03]. Finally, patients with positive anti-MDA5 presented with higher 1-year all-cause mortality compared to anti-MDA5 negative patients [HR 28.37 (95% CI: 5.13-157.01), p = 0.0001]. Conclusion Specific ILD radiographic patterns such as NSIP and organizing pneumonia may herald underlying inflammatory myopathies. Hospitalized patients presenting with bilateral organizing pneumonia refractory to antibiotics should be meticulously evaluated for myositis associated-ILD even if there is no overt muscular involvement. Incorporation of ILD radiological patterns in the diagnostic criteria of inflammatory myopathies may lead to timely therapeutic interventions and positively impact patients' survival.
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Affiliation(s)
| | - Vasilios Tzilas
- 5th Department of Pneumonology, General Hospital for Thoracic Diseases Sotiria, Athens, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Serafeim Chrysikos
- 5th Department of Pneumonology, General Hospital for Thoracic Diseases Sotiria, Athens, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece,Université de Paris, INSERM UMR 1152, F-75018, Paris, France,Assistance Publique – Hôpitaux de Paris (APHP), Service de Pneumologie A, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Fédération Hospitalo-Universitaire (FHU) APOLLO, Hôpital Bichat, Paris, France
| | - Pierre-Antoine Juge
- Université de Paris, INSERM UMR 1152, F-75018, Paris, France,Assistance Publique – Hôpitaux de Paris (APHP), Service de Rheumatologie, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | - Styliani Vizirianaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Eleni Bibaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Argyro Reppa
- Department of Rheumatology, Medical School, University of Crete, Heraklion, Greece
| | | | - Matthaios Katsaras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Panagiota Tsiri
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Electra Koulousousa
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eva Theochari
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Georgios Tsirikos
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Elli Malakounidou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Georgios Hillas
- 5th Department of Pneumonology, General Hospital for Thoracic Diseases Sotiria, Athens, Greece
| | - Theofanis Karageorgas
- Department of Rheumatology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Daoussis
- Department of Rheumatology, University Hospital of Patras, University of Patras Medical School, Patras, Greece
| | | | - Katerina Dimakou
- 5th Department of Pneumonology, General Hospital for Thoracic Diseases Sotiria, Athens, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Raphael Borie
- Université de Paris, INSERM UMR 1152, F-75018, Paris, France,Assistance Publique – Hôpitaux de Paris (APHP), Service de Pneumologie A, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Fédération Hospitalo-Universitaire (FHU) APOLLO, Hôpital Bichat, Paris, France
| | - Philippe Dieudé
- Université de Paris, INSERM UMR 1152, F-75018, Paris, France,Assistance Publique – Hôpitaux de Paris (APHP), Service de Rheumatologie, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | - Katerina Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Bruno Crestani
- Université de Paris, INSERM UMR 1152, F-75018, Paris, France,Assistance Publique – Hôpitaux de Paris (APHP), Service de Pneumologie A, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Fédération Hospitalo-Universitaire (FHU) APOLLO, Hôpital Bichat, Paris, France
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, “SOTIRIA”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece,*Correspondence: Argyris Tzouvelekis, ,
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13
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Theodorakis SG, Kolios G, Tzilas V, Bouros D. Influence of inhalation device, active substance, and drug formulation on the compliance of patients with obstructive pulmonary diseases. A physicians... perspective. Pulmonology 2023; 29:13-19. [PMID: 33388297 DOI: 10.1016/j.pulmoe.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/06/2023] Open
Abstract
AIM To investigate the perspective of physicians treating chronic airway diseases on the importance of device and substance characteristics influencing the compliance of patients with chronic obstructive airways diseases. OBJECTIVE We surveyed physicians... perspective on the impact of device and substance characteristics on patients... compliance. METHODS This study was carried out by running a structured questionnaire, to a total of 144 physicians, conducting personal interviews and evaluating answers on a scale from 1 for most to 6 for least important influencing parameter. RESULTS Overall, the most important parameters influencing patients... compliance according to physicians... perspective were rapid onset of action, type of inhalation device and duration of action. Adverse events were considered as the least important parameter. When COPD and asthma were examined separately, the most important parameters influencing compliance were rapid onset of action, ease of use and duration of action. Rapid onset of action was significantly more important in asthma than COPD. CONCLUSION Onset and duration of action and ease of use were classified higher as important parameters to increase patients... compliance, according to physicians... PERSPECTIVE
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Affiliation(s)
| | - G Kolios
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - V Tzilas
- Interstitial Lung Disease Unit, 1st Dept of Pneumonology, Medical School, National and Kapodistrian University, Athens, Greece
| | - D Bouros
- Interstitial Lung Disease Unit, 1st Dept of Pneumonology, Medical School, National and Kapodistrian University, Athens, Greece.
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14
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Tzilas V, Tzouvelekis A, Ryu JH, Bouros D. 2022 update on clinical practice guidelines for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. Lancet Respir Med 2022; 10:729-731. [PMID: 35760077 DOI: 10.1016/s2213-2600(22)00223-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, Medical School, University of Patras, Patras, Greece
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Demosthenes Bouros
- Medical School, National Kapodistrian University of Athens and Athens Medical Center, Athens 15125, Greece.
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15
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Karampitsakos T, Kalogeropoulou C, Tzilas V, Papaioannou O, Kazantzi A, Koukaki E, Katsaras M, Bouros E, Tsiri P, Tsirikos G, Zarkadi E, Ntoulias N, Sotiropoulou V, Efthymiou P, Chrysikos S, Malakounidou E, Sampsonas F, Bouros D, Tzouvelekis A. Safety and Effectiveness of Mycophenolate Mofetil in Interstitial Lung Diseases: Insights from a Machine Learning Radiographic Model. Respiration 2021; 101:262-271. [PMID: 34592744 DOI: 10.1159/000519215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects. METHODS Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns. RESULTS Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7-70.0], mean forced vital capacity %predicted [FVC %pred.] ± standard deviation [SD]: 69.4 ± 18.3, mean diffusing capacity of lung for carbon monoxide %pred. ± SD: 40.8 ± 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 ± 2.04) and 1 year (-0.39 ± 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4-30.0] vs. 20.0 [95% CI: 14.4-25.6]) and %reticulation (5.0 [95% CI: 2.0-15.6] vs. 7.5 [95% CI: 2.0-17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression. CONCLUSION Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools.
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Affiliation(s)
| | | | - Vasilios Tzilas
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Evangelia Koukaki
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Panagiota Tsiri
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Georgios Tsirikos
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Nikolaos Ntoulias
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Efthymiou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Serafeim Chrysikos
- 5th Department of Pneumonology, Hospital for Thoracic Diseases "SOTIRIA,", Athens, Greece
| | - Elli Malakounidou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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16
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Panagou P, Tzilas V, Bouros D. Dynamic lung compliance in non-smokers with asthma and fixed, non-reversible airflow obstruction. Eur Respir J 2021; 58:13993003.02361-2021. [PMID: 34561287 DOI: 10.1183/13993003.02361-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Panagiotis Panagou
- Center of Excellence for Diseases of the Chest, Athens Medical Center, Athens, Greece
| | - Vasilios Tzilas
- Center of Excellence for Diseases of the Chest, Athens Medical Center, Athens, Greece
| | - Demosthenes Bouros
- Center of Excellence for Diseases of the Chest, Athens Medical Center, Athens, Greece .,Medical School, National and Kapodistrian University of Athens, Athens, Greece
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17
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Tzilas V, Bouros D. Diagnostic Confidence and Prognosis in Fibrotic Hypersensitivity Pneumonitis: Classification Is Fundamental. Respiration 2021; 100:937-939. [PMID: 34515244 DOI: 10.1159/000518736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vasilios Tzilas
- Center of Excellence for Diseases of the Chest, Athens Medical Center, Athens, Greece
| | - Demosthenes Bouros
- Center of Excellence for Diseases of the Chest, Athens Medical Center, Athens, Greece.,Center of Excellence for Diseases of the Chest, Athens Medical Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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18
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Abstract
CASE PRESENTATION A 58-year-old woman was referred to our department with a cough of 1 year duration; her condition was unresponsive to the administration of inhaled steroid and beta-2 agonists. She denied the presence of dyspnea, chest pain, or other extrapulmonary symptoms. She was a never-smoker with a negative medical history and no occupational or domestic exposures. There was no history of cancer, gastroesophageal reflux disease, asthma, allergic rhinitis, or other allergies.
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Affiliation(s)
| | - Demosthenes Bouros
- Athens Medical Center, Athens, Greece; First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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19
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Tzilas V, Charokopos A, Kolilekas L, Manali E, Papiris S, Ryu JH, Bouros D. Presenting features and clinical course of chronic nitrofurantoin-induced lung toxicity. Chest 2021; 161:748-752. [PMID: 34242634 DOI: 10.1016/j.chest.2021.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/19/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Antonios Charokopos
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lykourgos Kolilekas
- 7th Pulmonary Department, Hospital for Chest Diseases "Sotiria", Athens, Greece
| | - Effrosyni Manali
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Demosthenes Bouros
- Athens Medical Center, Athens, Greece; Interstitial Lung Disease Unit, 1(st) Department of Respiratory Medicine, Medical School, National Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece.
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20
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Tzilas V, Sfikakis PP, Bouros D. Antisynthetase Syndrome Masquerading as Hypersensitivity Pneumonitis. Respiration 2021; 100:1105-1113. [PMID: 34148050 DOI: 10.1159/000516508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
Interstitial lung diseases (ILDs) cover a wide heterogeneous group of disorders, both of unknown and known causes. Accurate diagnosis is essential but, at the same time, presents many challenges. Typically, the distinction between idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis (HP) can prove extremely difficult. However, another major, but underestimated, challenge is the diagnosis of connective tissue disease-associated ILD (CTD-ILD), specifically when ILD is the initial manifestation or when extrapulmonary manifestations are subclinical. Antisynthetase syndrome (ASyS) is a characteristic example where lung involvement can be the predominant feature in the absence of other evidence suggestive of CTD. In ASyS, lung involvement can be the initial manifestation or muscle involvement can be subclinical with normal muscle enzymes. Furthermore, a negative antinuclear antibody test does not indicate autoantibody negativity in the context of ASyS. Imaging and pathology findings in ASyS are not specific and overlap with other ILDs. Finally, bronchoalveolar lavage can exhibit pronounced lymphocytosis (>30-40%). The latter, in combination with a history of exposure to an inciting antigen, can lead to an erroneous diagnosis of HP with obvious negative impact on patients' outcome. Herein, we report 3 female patients aged 61, 65, and 70 years and 1 male patient aged 43 years, with ASyS masquerading as HP and analyze the underlying reasons of misdiagnosis, aiming to raise awareness of the need for close collaboration between pulmonologists and rheumatologists.
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Affiliation(s)
- Vasilios Tzilas
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Demosthenes Bouros
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece.,First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece
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21
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Tzilas V, Marinos L, Tzouvelekis A, Bouros D. A 77-Year-Old Woman With Sjogren Syndrome Experiencing Progressive Dyspnea on Exertion and Nonproductive Cough. Chest 2021; 158:e117-e121. [PMID: 32892887 DOI: 10.1016/j.chest.2020.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
CASE PRESENTATION A 77-year-old woman was referred to our interstitial lung disease unit. She presented with a history of progressive dyspnea on exertion and nonproductive, persistent cough over the previous year. She was diagnosed with Sjogren syndrome two years ago by a rheumatologist. In the context of Sjogren syndrome, she reported chronic xerostomia and xerophthalmia for the last 5 years. Her history was also notable for the presence of arterial hypertension and hypothyroidism. She denied the presence of shortness of breath, chest pain, arthralgia, muscle weakness, weight loss, night sweats, and fatigue. She reported exposure to house mold. There was no family history of respiratory diseases. The patient never smoked and denied alcohol consumption, illicit drug use, or any occupational exposures.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Leonidas Marinos
- Hematopathology Department, Evangelismos General Hospital, Athens, Greece
| | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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22
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Karampitsakos T, Torrisi S, Antoniou K, Manali E, Korbila I, Papaioannou O, Sampsonas F, Katsaras M, Vasarmidi E, Papakosta D, Domvri K, Fouka E, Organtzis I, Daniil Z, Dimeas I, Kirgou P, Gourgoulianis KI, Papanikolaou IC, Markopoulou K, Kounti G, Tsapakidou E, Papadopoulou E, Tatsis K, Gogali A, Kostikas K, Tzilas V, Chrysikos S, Papiris S, Bouros D, Kreuter M, Tzouvelekis A. Increased monocyte count and red cell distribution width as prognostic biomarkers in patients with Idiopathic Pulmonary Fibrosis. Respir Res 2021; 22:140. [PMID: 33952261 PMCID: PMC8097815 DOI: 10.1186/s12931-021-01725-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
Background Idiopathic Pulmonary Fibrosis (IPF) represents a chronic lung disease with unpredictable course.
Methods We aimed to investigate prognostic performance of complete blood count parameters in IPF. Treatment-naïve patients with IPF were retrospectively enrolled from two independent cohorts (derivation and validation) and split into subgroups (high and low) based on median baseline monocyte count and red cell distribution width (RDW).
Results Overall, 489 patients (derivation cohort: 300, validation cohort: 189) were analyzed. In the derivation cohort, patients with monocyte count ≥ 0.60 K/μL had significantly lower median FVC%pred [75.0, (95% CI 71.3–76.7) vs. 80.9, (95% CI 77.5–83.1), (P = 0.01)] and DLCO%pred [47.5, (95% CI 44.3–52.3) vs. 53.0, (95% CI 48.0–56.7), (P = 0.02)] than patients with monocyte count < 0.60 K/μL. Patients with RDW ≥ 14.1% had significantly lower median FVC%pred [75.5, (95% CI 71.2–79.2) vs. 78.3, (95% CI 76.0–81.0), (P = 0.04)] and DLCO%pred [45.4, (95% CI 43.3–50.5) vs. 53.0, (95% CI 50.8–56.8), (P = 0.008)] than patients with RDW < 14.1%. Cut-off thresholds from the derivation cohort were applied to the validation cohort with similar discriminatory value, as indicated by significant differences in median DLCO%pred between patients with high vs. low monocyte count [37.8, (95% CI 35.5–41.1) vs. 45.5, (95% CI 41.9–49.4), (P < 0.001)] and RDW [37.9, (95% CI 33.4–40.7) vs. 44.4, (95% CI 41.5–48.9), (P < 0.001)]. Patients with high monocyte count and RDW of the validation cohort exhibited a trend towards lower median FVC%pred (P = 0.09) and significantly lower median FVC%pred (P = 0.001), respectively. Kaplan–Meier analysis in the derivation cohort demonstrated higher all-cause mortality in patients with high (≥ 0.60 K/μL) vs. low monocyte count (< 0.60 K/μL) [HR 2.05, (95% CI 1.19–3.53), (P = 0.01)].
Conclusions Increased monocyte count and RDW may represent negative prognostic biomarkers in patients with IPF.
Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01725-9.
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Affiliation(s)
| | - Sebastiano Torrisi
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,German Center for Lung Research, Heidelberg, Germany
| | - Katerina Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Effrosyni Manali
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Korbila
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Despoina Papakosta
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. PAPANIKOLAOU'' General Hospital, Exochi, Thessaloniki, Greece
| | - Kalliopi Domvri
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. PAPANIKOLAOU'' General Hospital, Exochi, Thessaloniki, Greece
| | - Eva Fouka
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. PAPANIKOLAOU'' General Hospital, Exochi, Thessaloniki, Greece
| | - Ioannis Organtzis
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, "G. PAPANIKOLAOU'' General Hospital, Exochi, Thessaloniki, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Ilias Dimeas
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | | | | | | | - Georgia Kounti
- Pulmonary Department "G. PAPANIKOLAOU" General Hospital, Thessaloniki, Greece
| | - Eirini Tsapakidou
- Pulmonary Department "G. PAPANIKOLAOU" General Hospital, Thessaloniki, Greece
| | | | - Konstantinos Tatsis
- Department of Respiratory Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Athena Gogali
- Department of Respiratory Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Konstantinos Kostikas
- Department of Respiratory Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serafeim Chrysikos
- 5th Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Athens, Greece
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, "ATTIKON" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,German Center for Lung Research, Heidelberg, Germany
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece. .,First Academic Department of Pneumonology, Hospital for Thoracic Diseases, "SOTIRIA", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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23
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Tzilas V, Poletti V, Bouros D. Reversed halo sign in radiation induced organizing pneumonia: natural course of the underlying pathophysiology. Pulmonology 2021; 27:460-464. [PMID: 33853753 DOI: 10.1016/j.pulmoe.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- V Tzilas
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece
| | - V Poletti
- Department of Diseases of the Thorax, Azienda USL Romagna, GB Morgagni Hospital, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - D Bouros
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece; First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Greece.
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24
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Papiris SA, Bouros D, Markopoulou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Fouka E, Papakosta D, Daniil Z, Steiropoulos P, Gogali A, Papanikolaou IC, Xyfteri A, Haritou A, Korbila I, Tomos IP, Loukides S, Bellelli R, Kounti G, Rampiadou C, Karampitsakos T, Dimeas I, Kirgou P, Bompoki A, Vasarmidi E, Loverdos K, Antonogiannaki EM, Blizou M, Bouros E, Kagouridis K, Maniati M, Karakatsani A, Antoniou KM, Manali ED. Early COVID-19 lockdown in Greece and idiopathic pulmonary fibrosis: a beneficial "impact" beyond any expectation. Eur Respir J 2021; 57:13993003.03111-2020. [PMID: 33334934 DOI: 10.1183/13993003.03111-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Eva Fouka
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paschalis Steiropoulos
- Dept of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Athina Gogali
- Dept of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ioanna Korbila
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rita Bellelli
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kounti
- Pulmonary Dept, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Theodoros Karampitsakos
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Ilias Dimeas
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Andromachi Bompoki
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Elvira-Markela Antonogiannaki
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Blizou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina M Antoniou
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,These authors contributed equally to this work
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally to this work
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25
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Gomatou G, Tzilas V, Kotteas E, Syrigos K, Bouros D. Immune Checkpoint Inhibitor-Related Pneumonitis. Respiration 2020; 99:932-942. [PMID: 33260191 DOI: 10.1159/000509941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Immune checkpoint inhibitors are novel agents that have been proved efficacious in a variety of cancer types, but they are associated with a unique set of organ-specific, immune-related adverse events. Among them, immune-related pneumonitis requires special attention because it is difficult to diagnose and potentially lethal. Accumulating real-world epidemiological data suggest that immune-related pneumonitis is more frequent than previously reported. Its diagnosis requires exclusion of other causes and assessment of radiographic features on high-resolution CT of the chest. Management of immune-related pneumonitis is based on the use of immunosuppressants. Future research should be focused on finding predictive biomarkers for immune-related pneumonitis as well as optimizing its management.
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Affiliation(s)
- Georgia Gomatou
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece, .,Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece,
| | - Vasilios Tzilas
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Kotteas
- Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
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26
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Tzilas V, Bouros D. Update on COVID-19: A teleconference with the Paediatric Virology Study Group (Review). Exp Ther Med 2020; 20:293. [PMID: 33209137 PMCID: PMC7668150 DOI: 10.3892/etm.2020.9423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/06/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans mainly via contact and droplet transmission and its entry into cells is mediated by the efficient binding of the spike (S) viral protein with the angiotensin converting enzyme-2 (ACE2) receptors. Although acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 fulfills the criteria of the Berlin definition, in a considerable proportion of patients with COVID-19, there is a dissociation between their relatively well-preserved lung mechanics and the severity of hypoxaemia. The extent of pneumococcal related morbidity and mortality is largely unknown. Respiratory comorbidities that increase the risk of severe disease and mortality due to SARS-CoV-2 include chronic obstructive pulmonary disease, asthma, bronchiectasis and fibrotic interstitial lung diseases, regardless of aetiology. Pneumococcal and seasonal influenza vaccinations are useful in preventing a substantial burden of mortality in high-risk populations, while general quarantine and social distancing can reduce the infiltration of the virus within the community. To date, several therapeutic agents have been studied or are currently examined, such as hydroxychloroquine, chloroquine, ritonavir/lopinavir, remdesivir, colchicines and interleukin-6 inhibitors. However, the usage of most of these into clinical practice was not based on randomised clinical trials and their results should be viewed with extreme caution; remdesivir seems to be the more promising option. Rigorous efforts are under way for the development of a safe and successful vaccine against SARS-CoV-2.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece
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27
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Tzilas V, Manali E, Papiris S, Bouros D. Intravenous Immunoglobulin for the Treatment of COVID-19: A Promising Tool. Respiration 2020; 99:1087-1089. [PMID: 33212437 PMCID: PMC7801989 DOI: 10.1159/000512727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Effrosyni Manali
- Second Pulmonary Medicine Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Papiris
- Second Pulmonary Medicine Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece, .,Athens Medical Center, Athens, Greece,
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28
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Tzilas V, Tzouvelekis A, Bouros E, Karampitsakos T, Ntassiou M, Avdoula E, Trachalaki A, Antoniou K, Raghu G, Bouros D. Clinical experience with antifibrotics in fibrotic hypersensitivity pneumonitis: a 3-year real-life observational study. ERJ Open Res 2020; 6:00152-2020. [PMID: 33263028 PMCID: PMC7682660 DOI: 10.1183/23120541.00152-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background Fibrotic hypersensitivity pneumonitis (f-HP) can exhibit a progressive course similar to idiopathic pulmonary fibrosis (IPF). The lack of diagnostic guidelines and randomised controlled trials in this population represent a significant unmet need. Objectives To describe our clinical experience with antifibrotics in patients with f-HP. Material and methods Retrospective study of 30 patients diagnosed with f-HP upon re-evaluation within a multidisciplinary team discussion of 295 consecutive patients (January 2012 to December 2017) who had been diagnosed initially with IPF at outside facilities and were referred to our centres. Results Pirfenidone was initially administered to 14 (46.7%) patients and nintedanib to 16 (53.3%) patients. There were 26 (86.7%) males, with mean±sd age 70.2±8.4 years. The annual rate of decline in forced vital capacity (FVC) % predicted over the 3-year treatment period adjusted for baseline FVC % pred measurement was 4.2% (95% CI 1.9–6.6%, p=0.001) and 7.5% (95% CI 3.3–11.7%; p=0.001) in imputation analysis. The annual rate of decline in diffusing capacity of the lung for carbon monoxide (DLCO) % predicted throughout the 3-year treatment period adjusted for baseline DLCO % pred was 5.7% (95% CI 3.1–8.4%, p<0.001) and 5.8% (95% CI 3.4–8.1%, p<0.001) in imputation analysis. The nature of adverse events was related to the type of antifibrotic agent administered. Conclusion In patients with f-HP receiving antifibrotics there is a statistically significant annual decline in FVC % pred and DLCO % pred over a period of 3 years. Prospective randomised trials exceeding 1 year are warranted to determine the long-term efficacy of antifibrotics. In patients with fibrotic hypersensitivity pneumonitis receiving antifibrotics, there is a statistically significant annual decline in FVC % predicted and DLCO % predicted over a period of 3 years. Prospective randomised trials exceeding 1 year are needed.https://bit.ly/3abhAL9
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Affiliation(s)
- Vasilios Tzilas
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally
| | - Argyris Tzouvelekis
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally
| | - Evangelos Bouros
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Karampitsakos
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Ntassiou
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Avdoula
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athena Trachalaki
- Dept of Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Katerina Antoniou
- Dept of Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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29
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Tzilas V, Kahn N, Bouros D. Azathioprine for Connective Tissue Disease-Associated Interstitial Lung Disease: In Search for Evidence-Based Medicine. Respiration 2020; 99:930-931. [PMID: 33022675 DOI: 10.1159/000509612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece
| | - Nicolas Kahn
- Department of Pneumology and Respiratory Critical Care Medicine, Center for Interstitial and Rare Lung Diseases, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, and Athens Medical Center, Athens, Greece,
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30
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Affiliation(s)
- Vasilios Tzilas
- Medical School, National and Kapodistrian University of Athens, Athens Medical Centre, Athens 15125, Greece
| | - Argyris Tzouvelekis
- Department of Pneumonology, Medical School, University of Patras, Patras, Greece
| | - Demosthenes Bouros
- Medical School, National and Kapodistrian University of Athens, Athens Medical Centre, Athens 15125, Greece.
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Antoniou KM, Raghu G, Tzilas V, Bouros D. Management of Patients with Interstitial Lung Disease in the Midst of the COVID-19 Pandemic. Respiration 2020; 99:625-627. [PMID: 32841954 PMCID: PMC7490496 DOI: 10.1159/000509523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University General Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Vasilios Tzilas
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece,
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Tzilas V, Walsh S, Tzouvelekis A, Bouros D. Radiological honeycombing: pitfalls in idiopathic pulmonary fibrosis diagnosis. Expert Rev Respir Med 2020; 14:1107-1116. [PMID: 32735495 DOI: 10.1080/17476348.2020.1804363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION High-Resolution Computed Tomography (HRCT) plays a pivotal role in the diagnosis of Idiopathic Pulmonary Fibrosis (IPF). First, it establishes the presence of lung fibrosis. Second, it allows the recognition of specific patterns, namely typical and probable Usual Interstitial Pneumonia (UIP) pattern obviating the need for tissue confirmation in the appropriate clinical context. AREAS COVERED Acknowledging the extreme versatility of modern radiology and the heavy burden of knowledge the modern radiologist has to cope with, this review addresses the diagnostic pitfalls of honeycombing in IPF diagnosis. This review focuses on two areas: i) when honeycombing is actually present but there are other findings that should raise suspicion of an alternative diagnosis and ii) when honeycombing is misdiagnosed, focusing on the commonest radiographic patterns that are responsible for this confusion. EXPERT OPINION It is pivotal to establish the actual presence of honeycombing. Even then, the distribution of honeycombing or the presence of other findings could be suggestive of alternative diagnoses. Reviewing older images can be extremely helpful in reaching the correct diagnosis.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College , London, UK
| | | | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens , Athens, Greece
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Tzilas V, Bouros D. Interstitial Lung Abnormalities: A Word of Caution. Chest 2020; 156:1037-1038. [PMID: 31812187 DOI: 10.1016/j.chest.2019.08.2170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 01/18/2023] Open
Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Tzilas V, Sgouros D, Almpanis Z, Bouros D, Tzouvelekis A. Cystic lung disease in Birt-Hogg-Dubé syndrome. A case series. Respir Med Case Rep 2020; 30:101081. [PMID: 32420021 PMCID: PMC7218215 DOI: 10.1016/j.rmcr.2020.101081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Abstract
Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant inherited disease caused by mutations in the folliculin (FLCN) gene. It is characterized by lung cysts, skin fibrofolliculomas and an increased risk for the development of renal cancer, especially chromophobe. Lung cysts in the context of BHDS are typically lower lobe predominant, paramediastinal, in relation to the fissures and often elliptical shaped. Skin manifestations can easily go unnoticed. Respiratory physicians need to have a high degree of vigilance as they can be the first to suspect the disease in the setting of diffuse cystic lung disease. Meticulous skin examination and referral to a dermatologist is of utmost importance as it can establish the diagnosis in the least invasive way. Correct diagnosis is crucial as it may allow for genetic counseling to the affected family and the implementation of a monitoring strategy for early detection of renal cancer.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Respiratory Medicine, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Sgouros
- First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Zannis Almpanis
- Department of Pathology, 251 Hellenic Air Force General Hospital of Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Respiratory Medicine, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Tzouvelekis
- First Academic Department of Respiratory Medicine, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzilas V, Kyriazis P, Tzouvelekis A, Vachlas K, Frangia K, Bouros D. A 63-Year-Old Woman With Pulmonary Micronodules and Chronic Cough. Chest 2020; 156:e47-e50. [PMID: 31395268 DOI: 10.1016/j.chest.2019.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/14/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022] Open
Abstract
CASE PRESENTATION A 63-year-old woman presented with a 2-year history of nonproductive cough. She denied the presence of shortness of breath, chest pain, arthralgia, muscle weakness, weight loss, night sweats, and fatigue. She was a never smoker and had a history of arterial hypertension and diabetes. There was no history of asthma, allergic rhinitis, nasal polyps, or gastroesophageal reflux disease, known malignancy, or collagen tissue disease. She reported exposure to house mold. There was no family history of respiratory diseases. The patient denied alcohol consumption, illicit drug use, occupational exposures, any recent travel, or exposure to TB.
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Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Vachlas
- Department of Thoracic Surgery, Hospital for Diseases of the Chest, "Sotiria," Athens, Greece
| | | | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest, "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Tzouvelekis A, Karampitsakos T, Kourtidou S, Bouros E, Tzilas V, Katsaras M, Antonou C, Dassiou M, Bouros D. Impact of Depression on Patients With Idiopathic Pulmonary Fibrosis. Front Med (Lausanne) 2020; 7:29. [PMID: 32118014 PMCID: PMC7020231 DOI: 10.3389/fmed.2020.00029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/20/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction: Depression is prevalent in patients with Idiopathic Pulmonary Fibrosis (IPF). The impact of depression on quality of life and its correlation with disease severity in patients with IPF has not been thoroughly evaluated on prospective studies. Patients and Methods: Between 2016 and 2017, we prospectively enrolled 101 patients (80 male, mean age (years) ± SD: 70.8 ± 8.1) with IPF (mean GAP score ± SD: 4.7 ± 1.8) without previous diagnosis of depression. Depressive symptoms were evaluated with Beck's depression inventory-II (BDI-II). Disease severity was evaluated with pulmonary function (FVC, DLCO) and exercise capacity measures. Symptom burden was assessed by cough and dyspnea scales. Health Related Quality of Life (HRQL) was assessed with two questionnaires. Results: Data for analysis was available from 98 patients (97%). Forty two patients (42.9%) presented with depressive symptoms scoring≥14. A significant association between depressive symptoms and measures of: 1) disease severity: a) GAP score: r = 0.32, p = 0.007, b) DLCO: r = -0.28, p = 0.007, c) 6MWD: r = -0.39, p = 0.017, 2) symptom burden: a) cough: r = -0.57, p < 0.001, b) dyspnea (Borg: r = 0.54, p < 0.001, mMRC: r = 0.55, p < 0.001, SOBQ: r = 0.57, p < 0.001 and 3) HRQL: a) SGRQ: (Total score: r = 0.68, p < 0.001, Activity Score: r = 0.60, p < 0.001, Impact score: r = 0.68, p < 0.001, Symptoms score: r = 0.60, p < 0.001, b) K-BILD: r = -0.66, p < 0.001), was identified. There was no statistically significant difference in BDI-II (p = 0.62) and SGRQ (p = 0.64) 1 year after treatment with antifibrotics. Conclusions: Patients with IPF and severe functional impairment tend to have increased risk for depression development and poor quality of life. Further prospective studies should investigate the role of antidepressant drug therapy in patients with IPF and comorbid depression.
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Affiliation(s)
- Argyris Tzouvelekis
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Karampitsakos
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Kourtidou
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthaios Katsaras
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Antonou
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dassiou
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Medical School, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens, Greece
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Antoniou K, Markopoulou K, Tzouvelekis A, Trachalaki A, Vasarmidi E, Organtzis J, Tzilas V, Bouros E, Kounti G, Rampiadou C, Kotoulas SC, Bardaka F, Bibaki E, Fouka E, Meletis G, Tryfon S, Daniil Z, Papakosta D, Bouros D. Efficacy and safety of nintedanib in a Greek multicentre idiopathic pulmonary fibrosis registry: a retrospective, observational, cohort study. ERJ Open Res 2020; 6:00172-2019. [PMID: 32010718 PMCID: PMC6983495 DOI: 10.1183/23120541.00172-2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022] Open
Abstract
Nintedanib is a tyrosine kinase inhibitor approved for the treatment of idiopathic pulmonary fibrosis (IPF). In a retrospective, real-world study across seven Greek hospitals, we evaluated the effectiveness and safety of nintedanib in routine clinical practice. Patients diagnosed with IPF, as per guideline criteria or multidisciplinary diagnosis, received nintedanib between January 2013 and January 2018. We evaluated 244 patients: mean±sd age 71.8±7.5 years, 79.1% male, 45.1% current smokers and 33.1% ex-smokers at treatment initiation. At baseline, predicted forced vital capacity (FVC) was 73.3±20.7% and predicted diffusing capacity of the lungs for carbon monoxide (DLCO) was 42.6±16.7%. On average, patients spent 23.6±15.0 months on nintedanib. At 3 years, 78 patients had died, equating to a 3-year survival rate of 59.4% (unaffected by treatment discontinuation or dose reduction). FVC% pred and DLCO% pred were largely stable at 3 years, with no significant difference from baseline (FVC 73.3±20.7% pred versus 78±20.1% pred, p=0.074; DLCO 42.6±16.7% pred versus 40.4±18.1% pred, p=0.334). Of the 244 patients, 55.7% reported an adverse event. Gastrointestinal events were the most common (173 (77.2%) out of 224 total events) and 45.0% of patients experienced diarrhoea. Only 32 (13.1%) patients had to permanently discontinue nintedanib due to an adverse event. This real-world study shows a 3-year survival rate of 59.4% and a low discontinuation rate due to adverse events. Our experience is consistent with previous findings in clinical trials of nintedanib in IPF. Findings from the largest registry of Greek patients with IPF receiving nintedanib in routine clinical practice show, over a 3-year period, a low discontinuation rate and efficacy data that support the results of the INPULSIS clinical trialshttp://bit.ly/35a2CS5
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Affiliation(s)
- Katerina Antoniou
- Dept of Thoracic Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,These authors contributed equally
| | - Katerina Markopoulou
- Respiratory Medicine Dept, George Papanikolaou General Hospital, Thessaloniki, Greece.,These authors contributed equally
| | - Argyrios Tzouvelekis
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece.,These authors contributed equally
| | - Athina Trachalaki
- Dept of Thoracic Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,These authors contributed equally
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,These authors contributed equally
| | - Jiannis Organtzis
- Respiratory Medicine Dept, Aristotle University of Thessaloniki, Papanikolaou General Hospital, Thessaloniki, Greece.,These authors contributed equally
| | - Vasilios Tzilas
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Evangelos Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Georgia Kounti
- Respiratory Medicine Dept, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Christina Rampiadou
- Respiratory Medicine Dept, George Papanikolaou General Hospital, Thessaloniki, Greece
| | | | - Fotini Bardaka
- Respiratory Medicine Dept, University General Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Bibaki
- Respiratory Medicine Dept, Venizeleio Pananio General Hospital, Heraklion, Greece
| | - Evangelia Fouka
- Respiratory Medicine Dept, Aristotle University of Thessaloniki, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Georgios Meletis
- Respiratory Medicine Dept, Venizeleio Pananio General Hospital, Heraklion, Greece
| | - Stavros Tryfon
- Respiratory Medicine Dept, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Respiratory Medicine Dept, University General Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Despina Papakosta
- Respiratory Medicine Dept, Aristotle University of Thessaloniki, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
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Tzilas V, Tzouvelekis A, Bouros E, Karampitsakos T, Ntasiou M, Katsaras M, Costabel U, Wells A, Bouros D. Diagnostic value of BAL lymphocytosis in patients with indeterminate for usual interstitial pneumonia imaging pattern. Eur Respir J 2019; 54:13993003.01144-2019. [DOI: 10.1183/13993003.01144-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/07/2019] [Indexed: 11/05/2022]
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Tzilas V, Tzouvelekis A, Bouros D. Safety and Efficacy of Early and Long-Term Use of Pirfenidone in Idiopathic Pulmonary Fibrosis. Respiration 2019; 98:16-18. [PMID: 30947205 DOI: 10.1159/000497391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vasilios Tzilas
- First Academic Department of Pneumonology, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens School of Medicine, Athens, Greece,
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Tzilas V, Bouros E, Barbayianni I, Karampitsakos T, Kourtidou S, Ntassiou M, Ninou I, Aidinis V, Bouros D, Tzouvelekis A. Vitamin D prevents experimental lung fibrosis and predicts survival in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther 2019; 55:17-24. [DOI: 10.1016/j.pupt.2019.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
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Antoniou KM, Tzilas V, Vasarmidi E, Symvoulakis EK, Tzouvelekis A, Bouros D. Interstitial lung abnormalities: ignotum per ignotius. Lancet Respir Med 2019; 7:376-378. [PMID: 30935882 DOI: 10.1016/s2213-2600(19)30052-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Katerina M Antoniou
- Department of Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Eirini Vasarmidi
- Department of Pneumonology, Medical School, University of Crete, Crete, Greece
| | | | - Argyris Tzouvelekis
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece.
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Bouros D, Tzilas V, Tzouvelekis A. Diagnostic guidelines for IPF: when art meets science. The Lancet Respiratory Medicine 2018; 6:812-814. [DOI: 10.1016/s2213-2600(18)30430-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
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Gomatou G, Tzilas V, Kourti G, Lagou S, Bouros D, Syrigos K. Crazy paving pattern as a rare radiological manifestation of peripheral T-cell lymphoma (PTCL) with lung involvement: A case report. Respir Med Case Rep 2018; 25:253-256. [PMID: 30596008 PMCID: PMC6308371 DOI: 10.1016/j.rmcr.2018.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 01/15/2023] Open
Abstract
We report on a 70-year old woman with dyspnea, systemic lymphadenopathy and abnormal chest computed tomography (CT) findings. A complete laboratory testing as well as mediastinal tissue sampling via Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Biopsy (TBNB) did not reveal a definite diagnosis. After experiencing acute respiratory failure which led to intensive care unit, the patient underwent a cervical lymph node biopsy which revealed peripheral T-cell lymphoma not otherwise specified (PTCL-NOS). A CT-guided trans-thoracic lung biopsy was performed that showed involvement of the lung parenchyma in the context of PTCL-NOS. Lung involvement is a rare extra-nodal manifestation of PTCL. The imaging patterns of this lymphoma have not been well described. We conclude that the finding of crazy paving pattern is a rare manifestation of this disease. In patients with pre-existing lymphoma, lung involvement should be included in the differential due to high pre-test probability.
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Affiliation(s)
- Georgia Gomatou
- 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kourti
- 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Lagou
- 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzouvelekis A, Tzilas V, Dassiou M, Bouros D. Metformin in Idiopathic Pulmonary Fibrosis "Seeking the Holy-Grail through Drug-Repositioning". Respiration 2018; 96:305-307. [PMID: 30007987 DOI: 10.1159/000490917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dassiou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzilas V, Tzouvelekis A, Bouros E, Bouros D. Prognosis of Interstitial Lung Disease Associated with Anti-Aminoacyl-tRNA Synthetase Antibodies: Look in the Middle. Respiration 2018; 96:207-209. [PMID: 29920503 DOI: 10.1159/000489936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
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Tzouvelekis A, Karampitsakos T, Kontou M, Granitsas A, Malliou I, Anagnostopoulos A, Ntolios P, Tzilas V, Bouros E, Steiropoulos P, Chrysikos S, Dimakou K, Koulouris N, Bouros D. Safety and efficacy of nintedanib in idiopathic pulmonary fibrosis: A real-life observational study in Greece. Pulm Pharmacol Ther 2018; 49:61-66. [PMID: 29366978 DOI: 10.1016/j.pupt.2018.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nintedanib represents an antifibrotic compound able to slow down disease progression of patients with idiopathic pulmonary fibrosis (IPF). OBJECTIVE To investigate the safety and efficacy of nintedanib in patients with IPF in a real-life setting. METHODS This was a multicentre, retrospective, observational, real-life study for patients with IPF receiving nintedanib between October 2014 and October 2016. RESULTS We identified 94 patients with IPF receiving nintedanib (72 males, mean age±SD: 73.8 ± 7.5, mean%FVC±SD = 68.1 ± 18.3, mean%DLCo±SD = 44.4 ± 14.5). Diarrhea (n = 52, 55.3%) was the most commonly reported adverse event. Twenty patients (21.2%) had to permanently discontinue nintedanib due to severe adverse events. In the 6-months follow-up, median decline in %FVC predicted and %DLCO predicted were 1.36 (95%Cl: 0 to 2.97) and 4.00 (95%Cl: 2.01 to 6.20), respectively, when deaths were censored and excluded from the analysis. At 12 months, mean%FVC±SD and mean%DLCo±SD were 64.5 ± 19.1 and 43.7 ± 15.4, respectively. With regards to mortality, 17 patients (18.1%) died over a study period of 730 days. CONCLUSION Nintedanib demonstrated an acceptable safety and efficacy profile in our real-world observational study. Prospective observational studies in the context of registries that collect well-defined supporting data over time are sorely needed to answer residual questions on drug's performance.
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Affiliation(s)
- Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece; Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece.
| | | | - Maria Kontou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Andreas Granitsas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Ioanna Malliou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Aris Anagnostopoulos
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Paschalis Ntolios
- University Hospital of Alexandroupolis, Department of Pneumonology, Democritus University of Thrace, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Paschalis Steiropoulos
- University Hospital of Alexandroupolis, Department of Pneumonology, Democritus University of Thrace, Greece
| | - Serafeim Chrysikos
- 5th Respiratory Department, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Department, Hospital for Diseases of the Chest, "Sotiria", Athens, Greece
| | - Nikolaos Koulouris
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, University of Athens, Greece
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Tzouvelekis A, Karampitsakos T, Ntolios P, Tzilas V, Bouros E, Markozannes E, Malliou I, Anagnostopoulos A, Granitsas A, Steiropoulos P, Dimakou K, Chrysikos S, Koulouris N, Bouros D. Corrigendum: Longitudinal "Real-World" Outcomes of Pirfenidone in Idiopathic Pulmonary Fibrosis in Greece. Front Med (Lausanne) 2018; 4:257. [PMID: 29393931 PMCID: PMC5787691 DOI: 10.3389/fmed.2017.00257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article on p. 213 in vol. 4, PMID: 29238708.].
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Affiliation(s)
- Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | | | - Paschalis Ntolios
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Markozannes
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Malliou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Anagnostopoulos
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Granitsas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paschalis Steiropoulos
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Department, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Serafeim Chrysikos
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Nikolaos Koulouris
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzouvelekis A, Spagnolo P, Bonella F, Vancheri C, Tzilas V, Crestani B, Kreuter M, Bouros D. Patients with IPF and lung cancer: diagnosis and management. Lancet Respir Med 2017; 6:86-88. [PMID: 29241977 DOI: 10.1016/s2213-2600(17)30478-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Argyris Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece; Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens 16672, Greece.
| | - Paolo Spagnolo
- Section of Respiratory Diseases, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, University Hospital "Policlinico", Department of Clinical and Respiratory Medicine, University of Catania, Catania, Italy
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Bruno Crestani
- Service de Pneumologie A, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, Heidelberg University Hospital, Member of the German Center for Lung Research, Germany
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzouvelekis A, Karampitsakos T, Ntolios P, Tzilas V, Bouros E, Markozannes E, Malliou I, Anagnostopoulos A, Granitsas A, Steiropoulos P, Dimakou K, Chrysikos S, Koulouris N, Bouros D. Longitudinal "Real-World" Outcomes of Pirfenidone in Idiopathic Pulmonary Fibrosis in Greece. Front Med (Lausanne) 2017; 4:213. [PMID: 29238708 PMCID: PMC5712559 DOI: 10.3389/fmed.2017.00213] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022] Open
Abstract
Background Pirfenidone is an antifibrotic compound able to slow down disease progression in patients with idiopathic pulmonary fibrosis (IPF). Objective To investigate the safety and efficacy of pirfenidone in patients with IPF in a real-life setting. Methods This was a multicenter, retrospective, real-life, observational study for patients with IPF receiving pirfenidone. Results We identified 92 patients with IPF receiving pirfenidone. Eighty patients (70 males and 10 females, mean age ± SD: 68.1 + 7.5, mean %FVC ± SD = 74.9 ± 17.2, mean %DLCO ± SD = 48.1 ± 16.9) were included in the analysis. Skin-related (25%) and gastrointestinal (17.5%) adverse events were the most common and led to drug discontinuation in 22.5% of cases. The majority (87%) of patients experienced side effects during the first 6 months of treatment. At 36 months, changes in %FVC and %DLCO were -9.25 ± 16.34 and -9.26 ± 15.26, respectively. At 6, 12, and 24 months after treatment initiation (n = 80, 60, and 26), 18, 15, and 5 patients (22.5, 25, and 19.2%) experienced significant (>10%) and 11, 3, and 3 patients (13.8, 5, and 11.5%) experienced marginal (5-10%) %FVC improvement; and 13, 6, and 1 patient (16.2, 10, and 3.9%) experienced marginal (-5 to -10%) and 20, 21, and 8 patients (25, 35, and 30.8%) experienced significant decline (<-10%) in %FVCpred. Median survival was 851 days, and 41 patients died during the study period. Conclusion Pirfenidone demonstrated an acceptable safety and therapeutic profile in patients with IPF on a longitudinal basis. Prospective observational registries are urgently needed to provide a real-world view of outcomes of pirfenidone in clinical practice.
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Affiliation(s)
- Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | | | - Paschalis Ntolios
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Markozannes
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Malliou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Anagnostopoulos
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Granitsas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paschalis Steiropoulos
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Department, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Serafeim Chrysikos
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Nikolaos Koulouris
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tzilas V, Tzouvelekis A, Bouros D. Metsovo Lung: A Story of Episteme, Techne, and Phronesis. Respiration 2017; 94:491-492. [PMID: 29024926 DOI: 10.1159/000481291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vasilios Tzilas
- 1st Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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