1
|
Harder EM, Abtin F, Nardelli P, Brownstein A, Channick RN, Washko GR, Goldin J, San José Estépar R, Rahaghi FN, Saggar R. Pulmonary Hypertension in Idiopathic Interstitial Pneumonia Is Associated with Small Vessel Pruning. Am J Respir Crit Care Med 2024; 209:1170-1173. [PMID: 38502314 DOI: 10.1164/rccm.202312-2343le] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | | | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Adam Brownstein
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| | - Richard N Channick
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | | | | | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Rajan Saggar
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
2
|
Calabretta E, Moraleda JM, Iacobelli M, Jara R, Vlodavsky I, O’Gorman P, Pagliuca A, Mo C, Baron RM, Aghemo A, Soiffer R, Fareed J, Carlo‐Stella C, Richardson P. COVID-19-induced endotheliitis: emerging evidence and possible therapeutic strategies. Br J Haematol 2021; 193:43-51. [PMID: 33538335 PMCID: PMC8014053 DOI: 10.1111/bjh.17240] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eleonora Calabretta
- Department of Oncology and HematologyHumanitas Cancer CenterHumanitas Clinical and Research Center ‐ IRCCSRozzanoMilanItaly
- Department of Biomedical SciencesHumanitas UniversityRozzanoMilanItaly
| | - Jose M. Moraleda
- Department of HematologyStem Cell Transplant and Cell Therapy UnitVirgen de la Arrixaca University HospitalIMIB‐ArrixacaUniversity of MurciaMurciaSpain
| | | | - Ruben Jara
- Department of Critical Care MedicineVirgen de la Arrixaca University HospitalIMIB‐ArrixacaUniversity of MurciaMurciaSpain
| | - Israel Vlodavsky
- The Rappaport Faculty of MedicineTechnion Integrated Cancer Center (TICC)HaifaIsrael
| | - Peter O’Gorman
- Haematology DepartmentMater Misericordiae University HospitalDublinIreland
| | - Antonio Pagliuca
- Department of HaematologyKings College Hospital NHS Foundation TrustLondonUK
| | - Clifton Mo
- Department of Medical OncologyDivision of Hematologic MalignanciesDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMAUSA
| | - Rebecca M. Baron
- Division of Pulmonary and Critical Care MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Alessio Aghemo
- Division of Hepatology and Internal MedicineHumanitas Clinical and Research Center ‐ IRCCSMilanItaly
- Department of Biomedical SciencesHumanitas UniversityRozzanoMilanItaly
| | - Robert Soiffer
- Department of Medical OncologyDivision of Hematologic MalignanciesDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMAUSA
| | | | - Carmelo Carlo‐Stella
- Department of Oncology and HematologyHumanitas Cancer CenterHumanitas Clinical and Research Center ‐ IRCCSRozzanoMilanItaly
- Department of Biomedical SciencesHumanitas UniversityRozzanoMilanItaly
| | - Paul Richardson
- Department of Medical OncologyDivision of Hematologic MalignanciesDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMAUSA
| |
Collapse
|
3
|
Fujita T, Hiroishi T, Shikano K, Yanagisawa A, Hayama N, Amano H, Nakamura M, Hirano S, Tabeta H, Nakamura S. The Safety and Efficacy of Treatment with Nab-paclitaxel and Carboplatin for Patients with Advanced Squamous Non-small Cell Lung Cancer Concurrent with Idiopathic Interstitial Pneumonias. Intern Med 2018; 57:1827-1832. [PMID: 29434143 PMCID: PMC6064686 DOI: 10.2169/internalmedicine.0404-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Although lung squamous cell carcinoma (SCC) accounts for 20-30% of lung cancer cases, new treatment options are limited. The CA031 study showed that nanoparticle albumin-bound-paclitaxel (nab-PTX) plus carboplatin produced a significantly higher overall response rate (41%) than solvent-based paclitaxel plus carboplatin in patients with lung SCC. However, the safety and efficacy of combination chemotherapy of nab-PTX and carboplatin has not yet been established for patients with concurrent lung SCC and idiopathic interstitial pneumonias (IIPs). The aim of this study was to assess the safety and efficacy profiles of nab-PTX and carboplatin in patients with lung SCC and concurrent IIPs. Methods Eight patients with inoperable-stage lung SCC and IIPs were treated with nab-PTX plus carboplatin in a first-line setting between June 2013 and December 2016. One of the eight was a woman, and the median age was 77 (range=72-80) years. Their clinical outcomes, including chemotherapy-associated acute exacerbation of IIPs, were retrospectively investigated. Results The overall response rate was 50%, the median progression-free survival time was 5.6 months, and the median overall survival time was 8.1 months. No patients experienced chemotherapy-related exacerbation of IIPs in the first-line treatment with nab-PTX plus carboplatin. However, IIPs worsened in two of four patients who received second-line chemotherapy. Conclusion Combination chemotherapy of nab-PTX and carboplatin may be an effective and safe treatment option for patients with inoperable lung SCC with IIPs. To confirm this, a large-scale prospective study is needed.
Collapse
Affiliation(s)
- Tetsuo Fujita
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Takuma Hiroishi
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Kohei Shikano
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Asako Yanagisawa
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Noriko Hayama
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Hiroyuki Amano
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Makoto Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Satoshi Hirano
- Department of Medical Oncology, Funabashi Municipal Medical Center, Japan
| | - Hiroshi Tabeta
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Sukeyuki Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| |
Collapse
|
4
|
Tsurugai Y, Takeda A, Sanuki N, Enomoto T, Kaneko T, Hara Y, Mizuno T, Saeki N, Aoki Y, Oku Y, Akiba T, Kunieda E. Stereotactic body radiotherapy for lung cancer patients with idiopathic interstitial pneumonias. Radiother Oncol 2017; 125:310-316. [PMID: 28919004 DOI: 10.1016/j.radonc.2017.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 02/20/2017] [Revised: 05/19/2017] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare toxicity and survival after stereotactic body radiotherapy (SBRT) between lung cancer patients with or without idiopathic interstitial pneumonias (IIPs), and to investigate the potential value of SBRT for the patients. METHODS Among lung cancer patients receiving SBRT between 2005 and 2016, we evaluated those treated with a total dose of 40-60Gy in five fractions with curative intent who either were staged as cT1-4N0M0 or experienced postoperative isolated local recurrence. We analyzed the incidence of radiation pneumonitis (RP) in all patients and local recurrence and overall survival (OS) in T1a-2a patients. RESULTS A total of 508 patients were eligible, including 42 with IIPs. The median follow-up was 32.3 (6.0-120.9) months. Significantly more patients with IIPs had grade ≥3RP than did those without IIPs (12% vs. 3%, p=0.009). The 2-year local recurrence rate was low in both groups (3.4% vs. 5.6%, p=0.38). The 2-year OS rate was significantly lower in the patients with IIPs (42.2% vs. 80.9%, p<0.001), although death from lung cancer was comparable (p=0.74). CONCLUSION SBRT achieved excellent local control with acceptable pulmonary toxicity in lung cancer patients with IIPs. SBRT can be a reasonable option for early lung cancer patients with IIPs.
Collapse
Affiliation(s)
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Tatsuji Enomoto
- Department of Respiratory Medicine, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan.
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan.
| | - Tomikazu Mizuno
- Department of Diagnostic Radiology, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Noriyuki Saeki
- Department of Thoracic Surgery, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Yohei Oku
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan.
| |
Collapse
|
5
|
Yamakawa H, Hagiwara E, Kitamura H, Yamanaka Y, Ikeda S, Sekine A, Baba T, Iso S, Okudela K, Iwasawa T, Takemura T, Kuwano K, Ogura T. Clinical Features of Idiopathic Interstitial Pneumonia with Systemic Sclerosis-Related Autoantibody in Comparison with Interstitial Pneumonia with Systemic Sclerosis. PLoS One 2016; 11:e0161908. [PMID: 27564852 PMCID: PMC5001711 DOI: 10.1371/journal.pone.0161908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/12/2016] [Indexed: 01/23/2023] Open
Abstract
Background Patients with idiopathic interstitial pneumonias sometimes have a few features of connective tissue disease (CTD) and yet do not fulfil the diagnostic criteria for any specific CTD. Objective This study was conducted to elucidate the characteristics, prognosis, and disease behavior in patients with interstitial lung disease (ILD) associated with systemic sclerosis (SSc)-related autoantibodies. Methods We retrospectively analyzed medical records of 72 ILD patients: 40 patients with SSc (SSc-ILD) and 32 patients with SSc-related autoantibody-positive ILD but not with CTD (ScAb-ILD), indicating lung-dominant CTD with SSc-related autoantibody. Results Patients with SSc-ILD were predominantly females and non-smokers, and most had nonspecific interstitial pneumonia confirmed by high-resolution computed tomography (HRCT) and pathological analysis. However, about half of the patients with ScAb-ILD were male and current or ex-smokers. On HRCT analysis, honeycombing was more predominant in patients with ScAb-ILD than with SSc-ILD. Pathological analysis showed the severity of vascular intimal or medial thickening in the SSc-ILD patients to be significantly higher than that in the ScAb-ILD patients. Survival curves showed that the patients with ScAb-ILD had a significantly poorer outcome than those with SSc-ILD. Conclusion Data from this study suggest that lung-dominant CTD with SSc-related autoantibody is a different disease entity from SSc-ILD.
Collapse
Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
- * E-mail:
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
| | - Yumie Yamanaka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Shinichiro Iso
- Department of Radiology, Yokohama Rousai Hospital for Labour Welfare Corporation, Yokohama, Japan
| | - Koji Okudela
- Department of Pathobiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| |
Collapse
|
6
|
De Martino M, Cobuccio R, Bruzzese D, Rea G, Meoli I, Stefanelli F, Canora A, Capaccio A, Sanduzzi A, Matarese A, Bocchino M. Exercise related ventilation dynamics and clinical correlates in patients with fibrotic idiopathic interstitial pneumonias. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:157-165. [PMID: 27537719] [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] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/18/2016] [Indexed: 06/06/2023]
Abstract
Assessment of exercise performance is a key component in the management of interstitial lung diseases, as its limitation may occur very early. Aim of the present study was to assess ventilation dynamics in combination with pulse-oximetry changes in 54 clinically stable patients affected by idiopathic pulmonary fibrosis or idiopathic fibrotic nonspecific interstitial pneumonia. Testing was successfully performed with the Spiropalm 6-MWT Hand-held spirometer by the majority of cases (94%). End test oxygen saturation (SpO2) values <88% were common in most of patients (76%), with a mean distance walked of 403 meters. Ventilation significantly increased due to the contribution of the tidal volume and the respiratory frequency (RF). This finding was associated with a decrease of the end of test respiratory reserve (RR), that was <20% in 9 cases (17.6%). Lung function was inversely related to the end of test RF, while a positive correlation occurred with the end of test RR and the estimated maximal voluntary ventilation (MVV). RR was also a predictive factor of declining forced vital capacity and lung diffusion capacity for carbon monoxide (DLCO) over a 6-month period. Further factors of DLCO impairment were low SpO2 and MVV. Comparison with the cardio-pulmonary exercise test (CPET) showed that the 6-MWT end of test RR was inversely related to the CPET-derived peak RF and VE/VCO2 suggesting RR as pivotal in exercise limitation assessment. Our results open challenging perspectives in an unexplored field. Future research will include management of latent respiratory failure and monitoring of disease progression and therapy response.
Collapse
|
7
|
Ando M, Miyazaki E, Abe T, Ehara C, Goto A, Masuda T, Nishio S, Fujisaki H, Yamasue M, Ishii T, Mukai Y, Ito T, Nureki SI, Kumamoto T, Kadota J. Angiopoietin-2 expression in patients with an acute exacerbation of idiopathic interstitial pneumonias. Respir Med 2016; 117:27-32. [PMID: 27492510 DOI: 10.1016/j.rmed.2016.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE We hypothesized that increased pulmonary vascular permeability may play a role in the pathogenesis of an acute exacerbation of the idiopathic interstitial pneumonias (AE-IIPs). Angiopoietin-2 (Ang-2) promotes endothelial activation, destabilization, and inflammation. The purpose of this study was to examine whether Ang-2 expression was associated with the pathogenesis of AE-IIPs. METHODS Twenty-three patients with AE-IIP patients, 18 acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients, 37 idiopathic pulmonary fibrosis (IPF) patients, and 33 healthy volunteers (HVs) were enrolled. The serum level of Ang-2 was measured by an enzyme-linked immunosorbent assay. RESULTS The serum levels of Ang-2 were higher in AE-IIPs and ALI/ARDS patients than in IPF patients and HVs; the BALF levels of Ang-2 were also higher than in IPF patients. There was a positive correlation between the serum level of Ang-2 and the CRP in patients with AE-IIP patients, whereas a significant positive correlation was found between the serum Ang-2 level and the CRP or SOFA scores of the ALI/ARDS patients. Although the baseline Ang-2 level was not related to survival, the Ang-2 levels significantly declined in survivors during treatment, while they did not change in non-survivors. CONCLUSIONS Increased pulmonary vascular permeability and inflammation due to Ang-2 may play a role in the pathogenesis of AE-IIPs.
Collapse
Affiliation(s)
- Masaru Ando
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
| | - Eishi Miyazaki
- Center for Community Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Tetsutaro Abe
- Internal Medicine 3, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Chihiro Ehara
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Akihiro Goto
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Taiki Masuda
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Suehiro Nishio
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Hideaki Fujisaki
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Toshihiro Ishii
- Center for Community Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Yutaka Mukai
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Takeo Ito
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Shin-Ich Nureki
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Toshihide Kumamoto
- Internal Medicine 3, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Junichi Kadota
- Department of Respiratory Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| |
Collapse
|
8
|
Abstract
Objective The influence of smoking on the pathogenesis and clinical course of interstitial pneumonia has recently attracted attention. To clarify the influence of smoking on the clinical patient characteristics and therapeutic effects in patients with interstitial pneumonia presenting with a non-specific interstitial pneumonia (NSIP) pattern, we compared the clinical patient characteristics and therapeutic effects in smokers and nonsmokers in this study. Methods We divided 31 NSIP (16 idiopathic nonspecific interstitial pneumonia and 15 collagen vascular disease-associated nonspecific interstitial pneumonia) patients into smoker and non-smoker groups for each case. The patient characteristics, pulmonary function tests, Krebs von den Lungen 6 (KL-6), surfactant protein D (SP-D), bronchoalveolar lavage fluid findings, and clinical courses for two years were compared between the smoker and non-smoker groups. Results The smoking subgroup (n=15) of NSIP patients had a significantly lower % diffusing capacity for carbon monoxide/ alveolar ventilation (DLCO/VA) and tended to have higher SP-D values than the nonsmoking subgroup (n=16). Although no difference was observed regarding the prognosis, 5 of 6 cases with NSIP, which had worsening of lung disease were heavy smokers with a pack-year history of 40 or greater. Conclusion Smoking is thus suggested to negatively influence the diffusing capacity caused by damage to alveolar epithelial cells. In addition, smoking may also be potentially related to resistance to therapy in NSIP cases.
Collapse
Affiliation(s)
- Tetsuro Sawata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | | | | | | | | | | |
Collapse
|
9
|
Watanabe S, Waseda Y, Takato H, Matsunuma R, Johkoh T, Egashira R, Kawabata Y, Ikeda H, Yasui M, Fujimura M, Kasahara K. Pleuroparenchymal fibroelastosis: Distinct pulmonary physiological features in nine patients. Respir Investig 2015; 53:149-155. [PMID: 26100174 DOI: 10.1016/j.resinv.2015.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 10/16/2014] [Revised: 01/16/2015] [Accepted: 02/08/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia defined by pleural and subpleural parenchymal fibrosis predominantly in the upper lobes. Although the radiological and pathological characteristics of PPFE have become increasingly recognized, its pulmonary physiological features are not well understood. METHODS We reviewed nine patients with radiologically and histologically proven PPFE, and evaluated pulmonary physiological data. RESULTS Of the nine patients, six were male and three were female. The median age at presentation was 61 years. Common symptoms were dyspnea on exertion, weight loss, and nonproductive cough. Recurrent pneumothorax was found in eight patients and pneumonia in four. Median pulmonary function test results were as follows: forced vital capacity, 55.4% predicted; total lung capacity (TLC), 67.1% predicted; residual volume (RV), 102.3% predicted; and RV/TLC, 143.6% predicted. RV/TLC was increased without evidence of small airway disease according to clinico-radiologic-pathologic evaluation. The median partial pressure of oxygen in arterial blood and the alveolar-arterial gradient of oxygen were within normal limits, although there was a slightly elevated partial pressure of carbon dioxide in arterial blood (PaCO2). PPFE progressed in all patients despite treatment with pirfenidone, corticosteroids, and immunosuppressive agents. Seven patients died during the follow-up, five because of hypercapnic respiratory failure. CONCLUSIONS PPFE is characterized by severe mechanical restriction with high RV/TLC, causing increased PaCO2 and eventual hypercapnic respiratory failure. These physiological findings may be useful as an adjunct in the diagnosis of PPFE.
Collapse
Affiliation(s)
- Satoshi Watanabe
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Yuko Waseda
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090 Austria.
| | - Hazuki Takato
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Ryo Matsunuma
- Department of Respiratory Medicine, Komatsu Municipal Hospital, Ho-60, Mukaimoto-ori-machi, Komatsu 923-8560, Japan.
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, 3-1 Kurumazuka, Itami, Hyogo 664-8533, Japan.
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology, Saitama Prefectural Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama 360-0105, Japan.
| | - Hiroko Ikeda
- Section of Diagnostic Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Masahide Yasui
- Department of Respiratory Medicine, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa 921-8105, Japan.
| | - Masaki Fujimura
- Department of Respiratory Medicine, National Hospital Organization Nanao Hospital, 3-1, Mattoumachi-hachibu, Nanao, Ishikawa, Japan.
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| |
Collapse
|
10
|
Kreuter M, Ehlers-Tenenbaum S, Schaaf M, Oltmanns U, Palmowski K, Hoffmann H, Schnabel PA, Heußel CP, Puderbach M, Herth FJF, Warth A. Treatment and outcome of lung cancer in idiopathic interstitial pneumonias. Sarcoidosis Vasc Diffuse Lung Dis 2015; 31:266-274. [PMID: 25591137] [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] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/18/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Idiopathic interstitial pneumonias (IIP) are associated with an increased lung cancer (LC) risk. However, data on the prognostic and therapeutic impact are limited. We therefore aimed to analyze the outcome of IIP patients with LC under different treatment modalities. METHODS Patients with IIPs diagnosed in a tertiary interstitial lung diseases (ILD) center were reviewed for LC diagnosis. RESULTS Of 265 patients with idiopathic pulmonary fibrosis (IPF), 142 with non-specific interstitial pneumonia (NSIP), and 71 with cryptogenic organizing pneumonia (COP), 16%, 4%, and 6% were affected byLC, respectively. Patient characteristics were: IPF: 93% male, median age 67 years, forced vital capacity (FVC) 82%, diffusion capacity for Carbon monoxide (DLCO) 41%, mean survival 20 months. NSIP: 67% male, median age 70 years, FVC 72%, DLCO 43%, mean survival 35 months. COP: 50% male, median age 66 years, FVC 93%, DLCO 77%, mean survival 88 months. Significant treatment-related toxicities occurred in 55% IPF, 20% NSIP und 0% COP patients. 30-days postoperative mortality was 25% in IPF, and 0% in NSIP/COP while rate of radiation pneumonitis was 24% in IPF. CONCLUSIONS LC is a frequent comorbidity in IIP, with a higher incidence and reduced survival in IPF compared to other IIPs. LC treatment is associated with significant toxicity, specifically in IPF. Interdisciplinary evaluation of therapeutic options in IIP patients diagnosed with LC is therefore mandatory.
Collapse
|
11
|
Shiraishi M, Kodama M, Hirano R, Takeda S, Yoshida Y, Fujita M, Watanabe K. [Relationship between combined emphysema, pulmonary hypertension and %FEV1 in patients with idiopathic interstitial pneumonia]. Nihon Kokyuki Gakkai Zasshi 2011; 49:810-815. [PMID: 22171483] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The prognosis of idiopathic pulmonary fibrosis (IPF) is poor, and it deteriorates when it is complicated with pulmonary hypertension (PH). Forced vital capacity (FVC) is a useful parameter for evaluating the disease status of interstitial pneumonia (IP). However, in patients with IP complicated with emphysema, the disease severity can be overlooked because of relatively well preserved FVC. We investigated the correlation between the maximum pressure gradient (PG) in the tricuspid valve using echocardiographic measurements and pulmonary function tests in patients with IP without emphysema and in those with IP with emphysema. There was an inverse correlation between PG and %FVC in patients with IP without emphysema. However, the above inverse correlation between PG and %FVC mentioned above disappeared when analyzed in the whole cohort of patients (n = 42) consisting of IP without emphysema (n = 35) and IP with emphysema (n = 7). Patients with IP without emphysema did not show a correlation between PG and %FEV1, but when analyzed using the whole cohort of patients an inverse correlation between PG and %FEV1 was observed (p<0.05). In clinical practice, not only FVC, but also %FEV1 is a valuable parameter in investigating the complication of emphysema and PH in patients with chronic idiopathic interstitial pneumonia.
Collapse
Affiliation(s)
- Motokimi Shiraishi
- Department of Respiratory Medicine, Fukuoka University School of Medicine
| | | | | | | | | | | | | |
Collapse
|
12
|
Carbone R, Bottino G, Paredi P, Shah P, Meyer KC. Predictors of survival in idiopathic interstitial pneumonia. Eur Rev Med Pharmacol Sci 2010; 14:695-704. [PMID: 20707290] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM To evaluate the ability of newly identified clinical factors to predict prognosis and survival in idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP). METHODS Seventy-eight patients referred to the University of Genoa and the Regional Hospital of Aosta between January 1995 and December 2006 were evaluated prospectively. Fifty-nine patients were diagnosed with IPF and 19 with NSIP on the basis of surgical lung biopsy specimens. Gender, age at diagnosis, smoking, New York Heart Association class (NYHA), systolic pulmonary artery pressure (sPAP), Octreoscan uptake index (UI), and therapy were the chosen variables. Primary end-point was survival. RESULTS With the exception of gender and smoking history, all baseline patient characteristics correlated significantly with the diagnosis (IPF vs. NSIP). Median survival for the entire study group was 52.7 months. Univariate analysis showed poorer survival for the IPF group versus the NSIP group, and survival was significantly lower for older patients (p < 0.001). Multivariate analysis confirmed the negative prognostic effect of age (p < 0.001) on survival with a risk of death for older patients ( > OR =66 years old) being more than 4 times higher than that for younger patients (<58 yr.). NYHA class and pulmonary artery pressure were also significant predictors of survival, and all patients with a sPAP < OR = 35-mm Hg were alive at the end of the follow-up period. There was a good correlation between Octreoscan uptake index and the diagnosis. CONCLUSION Diagnosis (IPF vs. NSIP), NYHA class, sPAP, and especially age appear to represent important prognostic indicators in the two most prevalent forms of idiopathic pulmonary fibrosis (IPF and NSIP). Lower Octreoscan uptake values were found in all patients with IPF, suggesting that this test may have a role as a new predictor of survival for differentiating IPF from NSIP.
Collapse
Affiliation(s)
- R Carbone
- Department of Medicine, Respiratory Unit, Regional Hospital Aosta, Aosta, Italy
| | | | | | | | | |
Collapse
|
13
|
Yoshida M, Sasaki M, Nakabayashi I, Akashi M, Tomiyasu T, Yoshikawa N, Kojima T, Ohno N, Yamada M. Two types of myeloperoxidase-antineutrophil cytoplasmic autoantibodies with a high affinity and a low affinity in small vessel vasculitis. Clin Exp Rheumatol 2009; 27:S28-S32. [PMID: 19646343] [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] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Myeloperoxidase (MPO) -anti-neutrophil cytoplasmic autoantibodies (ANCAs) are detected at a high rate in microscopic polyangiitis and renal-limited vasculitis. MPO-ANCA titers are not always reflected in the disease activity. We studied the titer and affinity of MPO-ANCA in sera from patients in relation to vasculitis activity. METHODS Blood samples were collected from 27 newly diagnosed or relapsed patients with MPO-ANCA-associated vasculitides. The MPO-ANCA titer was determined by a direct enzyme-linked immunosorbent assay (ELISA) using homogeneously purified human MPO of leukocytes. The MPO-ANCA affinity was expressed as IC50 that was determined by a competitive inhibition method using the ELISA. RESULTS The MPO-ANCA affinity of 27 sera from 27 patients could be classified into a high-affinity type (14 sera) and a low-affinity type (13 sera). The mean values for IC50 in the two types were 0.15+/-0.06 microg/ml and 0.54+/-0.15 microg/ml, and the difference was statistically significant (p<0.0000000684). Between the two groups of patients divided by the affinity, there were differences in the Birmingham Vasculitis Activity Score (BVAS): and in C-reactive protein (CRP): (p<0.00093 and p<0.00129, respectively). However, the difference in titer was not statistically significant (p<0.0265). The affinity remained steady from the disease onset to remission or relapse. CONCLUSIONS The affinity of MPO-ANCA from patients with MPO-ANCA-associated vasculitides were largely distinguished into a high and a low affinity, irrespective of the level of MPO-ANCA titers, and may be helpful for assessment of vasculitis activity affecting mainly the kidney and the lung.
Collapse
Affiliation(s)
- M Yoshida
- Renal Unit of Internal Medicine, Hachioji Medical Center, Tokyo Medical University, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Stepanian IE, Shergina EA, Shmelev EI. [Impaired bronchial patency in patients with idiopathic interstitial pneumonias]. Probl Tuberk Bolezn Legk 2008:39-41. [PMID: 19069192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Idiopathic interstitial pneumonias are well-known to be mainly characterized by restrictive ventilation dysfunctions and a diminished lung diffuse capacity. No separate significance is generally attached to bronchial obstructive disorders that may be detected along with restrictive ones in some patients. The made analysis of the ventilation capacity of the lung in 53 patients with idiopathic interstitial pneumonias has revealed impaired bronchial patency in 47.2% of the cases, which gives grounds to study this problem in future.
Collapse
|