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Calvin Lamas M, Calleja Hernández MÁ, Monte-Boquet E, Rodriguez Sagrado MÁ, Ventayol Bosch P. Checklist for Pharmaceutical Care of the Patient with interstitial lung disease (CheckEPID): A Delphi-based consensus. Farm Hosp 2023; 47:277-284. [PMID: 37516614 DOI: 10.1016/j.farma.2023.06.010] [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: 04/20/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVE To develop a checklist to facilitate pharmaceutical care for patients with interstitial lung disease who require or are undergoing treatment with antifibrotic drugs. METHOD Five hospital pharmacists developed an initial list of 37 items divided into 4 blocks: 1) First visit, which included general patient data and data from the first treatment; 2) Follow-up visits, assessing aspects of the follow-up of the treatment with nintedanib or pirfenidone; 3) Telepharmacy, consisting of the evaluation of the inclusion of patients in a program of this type, course of the disease, and identification of the contact with the pharmacy service; 4) Non-pharmacological treatment and patient information. To decide its potential inclusion in the checklist, two rounds of the Delphi were carried out in which the panelists had to assess the degree of agreement of each proposed item according to its "utility", which was the determining criterion for its inclusion, and its "applicability". RESULTS 48 hospital pharmacists were contacted, 30 (63%) agreed in writing to participate, 28 (58%) completed the first round of the Delphi, and 27 (56%) completed the second round. After the first round of the Delphi the questionnaire was amended and comprised 40 items. Of the 40 items evaluated after the two rounds of the Delphi, there were two that, based on utility, the participants did not reach consensus for inclusion in the checklist: The one referring to "History of surgical intervention, specifically abdominal surgery in the last 4 weeks" (finally kept on the checklist due to its involvement in the indication of nintedanib) and to make recommendations on "Relaxation". No consensus was reached on their applicability for two of the items: "Patient stratification according to the Spanish Society of Hospital Pharmacy (SEFH) chronic patient model" and "Collection of Results Reported by the Patient". CONCLUSIONS The management of patients with ILD and/or pulmonary fibrosis is complex and requires a multidisciplinary approach where the hospital pharmacist plays a key role, especially, although not only, in monitoring drug treatment. We believe that this checklist can contribute from pharmaceutical care to improving the integrated care of patients with ILD who require or are undergoing treatment with antifibrotic drugs.
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Affiliation(s)
- Marta Calvin Lamas
- Servicio de Farmacia, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | | | - Emilio Monte-Boquet
- Servicio de Farmacia, Hospital Universitari i Politècnic La Fe, Valencia, España
| | | | - Pere Ventayol Bosch
- Servicio de Farmacia Hospitalaria, Hospital Universitari Son Espases, Palma de Mallorca, España
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Benegas Urteaga M, Ramírez Ruz J, Sánchez González M. Idiopathic pulmonary fibrosis. Radiologia (Engl Ed) 2022; 64 Suppl 3:227-239. [PMID: 36737162 DOI: 10.1016/j.rxeng.2022.10.009] [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: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 02/05/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease. It is associated with a very poor prognosis. Treatments can delay the progression of IPF, so early diagnosis is fundamental. Radiologists play a fundamental role in the evaluation and accurate diagnosis of IPF. Identifying the characteristic patterns of IPF on high-resolution computed tomography (HRCT) is key in the process of multidisciplinary diagnosis, often obviating the need for surgical lung biopsies. This review describes and illustrates the clinical and imaging findings in IPF in the context of the most recent international guidelines, as well as the differential diagnosis and the role of HRCT in follow-up and assessment of complications.
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Affiliation(s)
- M Benegas Urteaga
- Servicio de Radiodiagnóstico, CDI, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Ramírez Ruz
- Servicio de Anatomía Patológica, CDB, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Sánchez González
- Servicio de Radiodiagnóstico, CDI, Hospital Clínic de Barcelona, Barcelona, Spain.
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León-Román F, Valenzuela C, Molina-Molina M. Idiopathic pulmonary fibrosis. Med Clin (Barc) 2022; 159:189-194. [PMID: 35659420 DOI: 10.1016/j.medcli.2022.02.020] [Citation(s) in RCA: 5] [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: 01/20/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
Idiopathic pulmonary fibrosis is defined as a chronic progressive fibrosing interstitial pneumonia of unknown etiology. There are intrinsic and extrinsic risk factors that could favor the development of the disease in individuals with a genetic predisposition. The diagnosis is made by characteristic radiological and/or histological findings on high-resolution computed tomography and lung biopsy, respectively, in the absence of a specific identifiable cause. The median survival of the disease for patients without treatment is 3-5years from the onset of symptoms, although its natural history is variable and unpredictable. Currently, there are two antifibrotic drugs that reduce disease progression. The multidisciplinary approach will consider the nutritional and emotional status, physical conditioning, and treatment of comorbidities, as well as lung transplantation and palliative care in advanced stages. The following article reviews the fundamental aspects for the diagnosis and treatment of idiopathic pulmonary fibrosis.
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Affiliation(s)
| | - Claudia Valenzuela
- Unidad de Enfermedades Pulmonares Intersticiales Difusas, Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - María Molina-Molina
- Unidad Funcional de Intersticio Pulmonar (UFIP), Servicio de Neumología, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, España
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Bermudo G, Suarez-Cuartin G, Rivera-Ortega P, Rodriguez-Portal JA, Sauleda J, Nuñez B, Castillo D, Aburto M, Portillo K, Balcells E, Badenes-Bonet D, Valenzuela C, Fernandez-Fabrellas E, González-Budiño T, Cano E, Acosta O, Leiro-Fernández V, Romero A, Planas-Cerezales L, Villar A, Moreno A, Laporta R, Vicens-Zygmunt V, Shull J, Franquet T, Luburich P, Molina-Molina M. Different Faces of Idiopathic Pulmonary Fibrosis With Preserved Forced Vital Capacity. Arch Bronconeumol 2021; 58:135-141. [PMID: 33895005 DOI: 10.1016/j.arbres.2021.03.018] [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: 12/14/2020] [Revised: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is progressive and irreversible. Some discrepancies about IPF staging exists, especially in mild phases. Forced vital capacity (FVC) higher than 80% has been considered early or mild IPF even for the design of clinical trials. METHODS Spanish multicentre, observational, retrospective study of IPF patients diagnosed between 2012 and 2016, based on the ATS/ERS criteria, which presented FVC greater or equal 80% at diagnosis. Clinical and demographic characteristics, lung function, radiological pattern, treatment, and follow-up were analyzed. RESULTS 225 IPF patients were included, 72.9% were men. The mean age was 69.5 years. The predominant high-resolution computed tomography (HRCT) pattern was consistent usual interstitial pneumonia (UIP) (51.6%). 84.7% of patients presented respiratory symptoms (exertional dyspnea and/or cough) and 33.33% showed oxygen desaturation below 90% in the 6min walking test (6MWT). Anti-fibrotic treatment was initiated at diagnosis in 55.11% of patients. Median FVC was 89.6% (IQR 17) and 58.7% of patients had a decrease of diffusion lung capacity for carbon monoxide (DLCO) below 60% of theoretical value; most of them presented functional progression (61.4%) and higher mortality at 3 years (20.45%). A statistically significant correlation with the 3-years mortality was observed between DLCO <60% and consistent UIP radiological pattern. CONCLUSIONS Patients with preserved FVC but presenting UIP radiological pattern and moderate-severe DLCO decrease at diagnosis associate an increased risk of progression, death or lung transplantation. Therefore, in these cases, preserved FVC would not be representative of early or mild IPF.
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Affiliation(s)
- Guadalupe Bermudo
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain
| | - Guillermo Suarez-Cuartin
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain
| | - Pilar Rivera-Ortega
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain; ILD Unit, Respiratory Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK
| | | | - Jaume Sauleda
- Respiratory Department, University Hospital Son Espases, Mallorca, Spain
| | - Belen Nuñez
- Respiratory Department, University Hospital Son Espases, Mallorca, Spain
| | - Diego Castillo
- Respiratory Department, University Hospital De la Santa Creu i Sant Pau, Barcelona, Spain
| | - Myriam Aburto
- Respiratory Department, Hospital de Galdakao, Bizkaia, Spain
| | - Karina Portillo
- Respiratory Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Eva Balcells
- Respiratory Department, University Hospital del Mar, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Diana Badenes-Bonet
- Respiratory Department, University Hospital del Mar, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Claudia Valenzuela
- Respiratory Department, University Hospital de la Princesa, Madrid, Spain
| | | | | | - Esteban Cano
- Respiratory Department, University Hospital Lucus Agusti, Lugo, Spain
| | - Orlando Acosta
- Respiratory Department, University Hospital of Canarias, Santa Cruz de Tenerife, Spain
| | | | - Ana Romero
- Respiratory Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - Lurdes Planas-Cerezales
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain; Respiratory Department, Hospital de Viladecans, Barcelona, Spain
| | - Ana Villar
- Respiratory Department, University Hospital Vall d'Hebrón, Barcelona, Spain
| | - Amalia Moreno
- Respiratory Department, University Hospital Parc Taulí, Sabadell, Spain
| | - Rosalia Laporta
- Respiratory Department, University Hospital Puerta del Hierro, Majadahonda, Spain
| | - Vanesa Vicens-Zygmunt
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain
| | - Jessica Shull
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain
| | - Tomàs Franquet
- Respiratory Department, University Hospital De la Santa Creu i Sant Pau, Barcelona, Spain
| | - Patricio Luburich
- ILD Unit. Radiology Department. University Hospital of Bellvitge, Barcelona, Spain
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Asensio-Sánchez VM. Unilateral pattern of macular dystrophy and associated systemic pathology. ACTA ACUST UNITED AC 2020; 95:603-6. [PMID: 32653315 DOI: 10.1016/j.oftal.2020.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022]
Abstract
Retinal pattern dystrophies are a heterogeneous group of generally bilateral and symmetrical maculopathies that, curiously, can be associated with different systemic diseases. This article describes a patient with unilateral pattern dystrophies, as well as associated McArdle disease and idiopathic pulmonary fibrosis.
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Guo L, Yang Y, Liu F, Jiang C, Yang Y, Pu H, Li W, Zhong Z. Clinical Research on Prognostic Evaluation of Subjects With IPF by Peripheral Blood Biomarkers, Quantitative Imaging Characteristics and Pulmonary Function Parameters. Arch Bronconeumol 2019; 56:365-372. [PMID: 31740085 DOI: 10.1016/j.arbres.2019.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/14/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is an irreversible and progressive fatal interstitial lung disease with a poor prognosis. The aim of this study is to investigate the predictive value of combined blood biomarkers, pulmonary function and quantitative monitoring by computer-aided diagnosis (CAD) system in IPF patients. METHODS Pulmonary baseline function and pathological features of 126 patients with IPF were analyzed using spirometry and chest X-ray. Patients were divided into survival group and non-survival group after 5 years follow-up. The relationships the levels of peripheral blood biomarkers, quantitative imaging characteristics and pulmonary function were analyzed between the two groups. RESULTS The baseline level of serum Krebs von den Lungen-6 (KL-6) and C-X-C motif chemokine 13 (CXCL13) were moderately or highly correlated with annual changes in forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO), total lung capacity (TLC), total interstitial lung disease (ILD) lesions, and the volume changes of reticular. The baseline level of serum KL-6 was higher than the cut-off value of 800.0U/ml and baseline level of serum CXCL13 was higher than the cut-off value of 62.0pg/ml. IPF patients with baseline levels of serum KL-6 and CXCL13 lower than the cut-off value had longer median survival time. CONCLUSIONS Serum KL-6 and CXCL13 may be predictive biomarkers for the outcomes of patients with IPF patients and their baseline levels were related to the progression of pulmonary function and quantitative monitoring by CAD system.
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Affiliation(s)
- Lu Guo
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Yan Yang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Feng Liu
- Thoracic surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Chengdu, PR China
| | - Caiyu Jiang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Yang Yang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Hong Pu
- Radiology Department, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Weimin Li
- Division of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Zhendong Zhong
- Institute for Laboratory Animal Research, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, PR China.
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7
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Castillo D, Sánchez-Font A, Pajares V, Franquet T, Llatjós R, Sansano I, Sellarés J, Centeno C, Fibla JJ, Sánchez M, Ramírez J, Moreno A, Trujillo-Reyes JC, Barbeta E, Molina-Molina M, Torrego A. A Multidisciplinary Proposal for a Diagnostic Algorithm in Idiopathic Pulmonary Fibrosis: The Role of Transbronchial Cryobiopsy. Arch Bronconeumol 2019; 56:99-105. [PMID: 31420183 DOI: 10.1016/j.arbres.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/09/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
The diagnosis of idiopathic pulmonary fibrosis (IPF) is a complex process that requires the multidisciplinary integration of clinical, radiological, and histological variables. Due to its diagnostic yield, surgical lung biopsy has been the recommended procedure for obtaining samples of lung parenchyma, when required. However, given the morbidity and mortality of this technique, alternative techniques which carry a lower risk have been explored. The most important of these is transbronchial cryobiopsy -transbronchial biopsy with a cryoprobe- which is useful for obtaining lung tissue with less comorbidity. Yield may be lower than surgical biopsy, but it is higher than with transbronchial biopsy with standard forceps. This option has been discussed in the recent clinical guidelines for the diagnosis of IPF, but the authors do not go so far as recommend it. The aim of this article, the result of a multidisciplinary discussion forum, is to review current evidence and make proposals for the use of transbronchial cryobiopsy in the diagnosis of IPF.
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Affiliation(s)
- Diego Castillo
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Albert Sánchez-Font
- Servicio de Neumología, Hospital del Mar-Parc de Salut Mar, UAB-UPF, IMIM, Barcelona, España
| | - Virginia Pajares
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Tomás Franquet
- CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - Roger Llatjós
- Servicio de Anatomía Patológica, Hospital de Bellvitge, L'Hospitalet de Llobregat, España
| | - Irene Sansano
- Servicio de Anatomía Patológica, Hospital Vall d'Hebron, Barcelona, España
| | - Jacobo Sellarés
- Servicio de Neumología, Hospital Clínic, IDIBAPS, Barcelona, España
| | - Carmen Centeno
- Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, España
| | - Juan J Fibla
- Servicio de Cirugía Torácica, Hospital del Sagrat Cor, Barcelona, España
| | | | - José Ramírez
- Servicio de Anatomía Patológica, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Amalia Moreno
- Servicio de Neumología, Hospital Parc Taulí, Sabadell, España
| | | | - Enric Barbeta
- Unitat de Pneumologia, Hospital Universitari General de Granollers, Granollers, España
| | - María Molina-Molina
- Servicio de Neumología, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - Alfons Torrego
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Molina-Molina M. The Future of Pharmacological Treatment in Idiopathic Pulmonary Fibrosis. Arch Bronconeumol 2019; 55:642-7. [PMID: 31253376 DOI: 10.1016/j.arbres.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 01/15/2023]
Abstract
The therapeutic approach in idiopathic pulmonary fibrosis has changed substantially over the past 5 years. National and international guidelines for the pharmacological treatment of IPF recommend 2antifibrotic drugs, nintedanib and pirfenidone. The use of both these drugs is supported by high-level evidence, with benefits including not only slower disease progression but also a reduction in the annual risk of death. Currently, the therapeutic management of these patients prioritizes both the use of drugs that act on the pathogenic mechanisms of the disease, and the positive effect of improving quality of life with integrated multidisciplinary support, including nutrition, physical activity, education, emotional support, and palliation of symptoms. The overall aim is to ensure that the patient remains as well as possible for as long as possible after diagnosis. However, the goal of the new antifibrotic combinations that are currently under evaluation in clinical trials is to use the potential antifibrotic synergy to enhance the therapeutic benefit or completely halt disease progression, by acting simultaneously on different pathogenic pathways. Another line of investigation involves markers that might be useful for identifying patients who may benefit more from certain antifibrotics than from others, which would make it possible to optimize resources and take the first steps toward precision medicine in pulmonary fibrosis. Below, we review the main potential areas for improvement in the pharmacological treatment of idiopathic pulmonary fibrosis in the short, medium, and long term.
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Caro FM, Alberti ML, Campins F, Enghelmayer JI, Fernández ME, Lancellotti D, Papucci T, Sebastiani JA, Paulin F. Real-Life Experience with Pirfenidone in Idiopathic Pulmonary Fibrosis in Argentina. A Retrospective Multicenter Study. Arch Bronconeumol 2018; 55:75-80. [PMID: 30049557 DOI: 10.1016/j.arbres.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/08/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pirfenidone was the first antifibrotic drug approved in Argentina for idiopathic pulmonary fibrosis (IPF). Outcomes in real life may differ from the results of clinical trials. The primary endpoint was to study the tolerance of pirfenidone in real life. Secondary endpoints were to analyze effectiveness and reasons for discontinuation. MATERIALS AND METHODS Retrospective observational study conducted in 4 specialized centers in Argentina. We analyzed the medical records of patients with IPF who received pirfenidone between June 2013 and September 2016. Adverse events (AE) and the variables that could influence these results were analyzed. Forced vital capacity (FVC%) parameters were also compared between the pre-pirfenidone and post-pirfenidone periods. RESULTS Fifty patients were included, 38 (76%) men, with mean age (SD) 67.8 (8.36) years. Mean (SD) exposure to pirfenidone was 645.68 (428.19) days, with a mean daily dose (SD) of 2,064.56mg (301.49). Nineteen AEs in 15 patients (30%) were reported: nausea (14%), asthenia (10%) and skin rash (8%). A total of 18 patients (36%) interrupted treatment, only 1 definitively. The most frequent reason for discontinuation was failure of suppliers to provide the drug (9 subjects; 18%). We compared the evolution of FVC% between the pre-pirfenidone and post-pirfenidone periods, and found a mean (SD) FVC% decline of 4.03% (7.63) pre-pirfenidone and 2.64% (7.1) post-pirfenidone (P=.534). CONCLUSIONS In our study, pirfenidone was well tolerated and associated with a reduction in FVC decline, although without reaching statistical significance.
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Affiliation(s)
- Fabián Matías Caro
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina.
| | - María Laura Alberti
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | | | - Martín Eduardo Fernández
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | - Tulio Papucci
- Laboratorio de Función Pulmonar de Alta Complejidad, Bahía Blanca, Argentina
| | | | - Francisco Paulin
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
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10
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Abstract
Idiopathic pulmonary fibrosis is a fibrosing interstitial pneumonia associated with the radiological and/or histological pattern of usual interstitial pneumonia. Its aetiology is unknown, but probably comprises the action of endogenous and exogenous micro-environmental factors in subjects with genetic predisposition. Its diagnosis is based on the presence of characteristic findings of high-resolution computed tomography scans and pulmonary biopsies in absence of interstitial lung diseases of other aetiologies. Its clinical evolution is variable, although the mean survival rate is 2-5 years as of its clinical presentation. Patients with idiopathic pulmonary fibrosis may present complications and comorbidities which modify the disease's clinical course and prognosis. In the mild-moderate disease, the treatment consists of the administration of anti-fibrotic drugs. In severe disease, the best therapeutic option is pulmonary transplantation. In this paper we review the diagnostic and therapeutic aspects of the disease.
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Portillo K, Perez-Rodas N, García-Olivé I, Guasch-Arriaga I, Centeno C, Serra P, Becker-Lejuez C, Sanz-Santos J, Andreo García F, Ruiz-Manzano J. Lung Cancer in Patients With Combined Pulmonary Fibrosis and Emphysema and Idiopathic Pulmonary Fibrosis. A Descriptive Study in a Spanish Series. Arch Bronconeumol 2016; 53:304-310. [PMID: 27986408 DOI: 10.1016/j.arbres.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/13/2016] [Revised: 09/15/2016] [Accepted: 10/08/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Information on the association of lung cancer (LC) and combined pulmonary fibrosis and emphysema (CPFE) is limited and derived almost exclusively from series in Asian populations. The main objective of the study was to assess the impact of LC on survival in CPFE patients and in patients with idiopathic pulmonary fibrosis (IPF). METHODS A retrospective study was performed with data from patients with CFPE and IPF diagnosed in our hospital over a period of 5 years. RESULTS Sixty-six patients were included, 29 with CPFE and 37 with IPF. Nine had a diagnosis of LC (6 with CPFE and 3 with IPF). Six patients (67%) received palliative treatment even though 3 of them were diagnosed atstage i-ii. Overall mortality did not differ significantly between groups; however, in patients with LC, survival was significantly lower compared to those without LC (P=.044). The most frequent cause of death was respiratory failure secondary to pulmonary fibrosis exacerbation (44%). In a multivariate analysis, the odds ratio of death among patients with LC compared to patients without LC was 6.20 (P=.037, 95% confidence interval: 1.11 to 34.48). CONCLUSIONS Lung cancer reduces survival in both entities. The diagnostic and therapeutic management of LC is hampered by the increased risk of complications after any treatment modality, even after palliative treatment.
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Affiliation(s)
- Karina Portillo
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Barcelona Research Network (BRN), Barcelona, España.
| | - Nancy Perez-Rodas
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Ignasi García-Olivé
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - Ignasi Guasch-Arriaga
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Carmen Centeno
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Pere Serra
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Caroline Becker-Lejuez
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - José Sanz-Santos
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Felip Andreo García
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Barcelona Research Network (BRN), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, España
| | - Juan Ruiz-Manzano
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Barcelona Research Network (BRN), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España; Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, España
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Casas Maldonado F, Alfageme Michavila I, Barchilón Cohen VS, Peis Redondo JI, Vargas Ortega DA. [Pneumococcal vaccine recommendations in chronic respiratory diseases]. Semergen 2014; 40:313-25. [PMID: 25107494 DOI: 10.1016/j.semerg.2014.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Abstract
Community-acquired pneumonia is an acute respiratory infectious disease which has an incidence of 3-8 cases/1,000 inhabitants, and increases with age and comorbidities. The pneumococcus is the organism most frequently involved in community-acquired pneumonia in the adult (30-35%). Around 40% of patients with community-acquired pneumonia require hospital admission, and around 10% need to be admitted to an intensive care unit. The most serious forms of pneumococcal infection include invasive pneumococcal disease (IPD), which covers cases of bacteremia (associated or not to pneumonia), meningitis, pleuritis, arthritis, primary peritonitis and pericarditis. Currently, the biggest problem with the pneumococcus is the emergence of resistance to antimicrobial agents, and its high morbimortality, despite the use of appropriate antibiotics and proper medical treatment. Certain underlying medical conditions increase the risk of IPD and its complications, especially, from the respiratory diseases point of view, smoking and chronic respiratory diseases. Pneumococcal disease, according to the WHO, is the first preventable cause of death worldwide in children and adults. Among the strategies to prevent IPD is vaccination. WHO considers that its universal introduction and implementation against pneumococcus is essential and a priority in all countries. There are currently 2 pneumococcal vaccines for adults: the 23 serotypes polysaccharide and conjugate 13 serotypes. The scientific societies represented here have worked to develop some recommendations, based on the current scientific evidence, regarding the pneumococcal vaccination in the immunocompetent adult with chronic respiratory disease and smokers at risk of suffering from IPD.
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Affiliation(s)
- F Casas Maldonado
- Asociación de Neumología y Cirugía Torácica del Sur (NEUMOSUR), España.
| | | | | | - J I Peis Redondo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN-Andalucía), España
| | - D A Vargas Ortega
- Sociedad Española de Médicos Generales y de Familia (SEMG-Andalucía), España
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