P5 How should patients with interstitial lung abnormalities be evaluated and monitored? Experience from a secondary care interstitial lung disease clinic

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents may be beneficial in patients with CPFE, but further studies are needed.

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Increased Respiratory Morbidity in Individuals with Interstitial Lung Abnormalities

10.21203/rs.2.17784/v3 ◽

2020 ◽

Author(s):

Nils Hoyer ◽

Laura H. Thomsen ◽

Mathilde M.W. Wille ◽

Torgny Wilcke ◽

Asger Dirksen ◽

...

Keyword(s):

Lung Cancer ◽

Respiratory Failure ◽

Cancer Screening ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Respiratory Diseases ◽

Lung Cancer Screening ◽

Healthcare Utilisation ◽

Lung Abnormalities ◽

Disease Specific

Abstract Background Interstitial lung abnormalities (ILA) are common in participants of lung cancer screening trials and broad population-based cohorts. They are associated with increased mortality, but less is known about disease specific morbidity and healthcare utilisation in individuals with ILA. Methods We included all participants from the screening arm of the Danish Lung Cancer Screening Trial with available baseline CT scan data (n=1990) in this cohort study. The baseline scan was scored for the presence of ILA and patients were followed for up to 12 years. Data about all hospital admissions, primary healthcare visits and medicine prescriptions were collected from the Danish National Health Registries and used to determine the participants’ disease specific morbidity and healthcare utilisation using Cox proportional hazards models. Results The 332 (16.7%) participants with ILA were more likely to be diagnosed with one of several respiratory diseases, including interstitial lung disease (HR: 4.9, 95% CI: 1.8–13.3, p=0.008), COPD (HR: 1.7, 95% CI: 1.2–2.3, p = 0.01), pneumonia (HR: 2.0, 95% CI: 1.4–2.7, p<0.001), lung cancer (HR: 2.7, 95% CI: 1.8–4.0, p<0.001) and respiratory failure (HR: 1.8, 95% CI: 1.1–3.0, p=0.03) compared with participants without ILA. These findings were confirmed by increased hospital admission rates with these diagnoses and more frequent prescriptions for inhalation medicine and antibiotics in participants with ILA. Conclusions Individuals with ILA are more likely to receive a diagnosis and treatment for several respiratory diseases, including interstitial lung disease, COPD, pneumonia, lung cancer and respiratory failure during long-term follow-up.

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Essential Components of an Interstitial Lung Disease Clinic

CHEST Journal ◽

10.1016/j.chest.2020.09.256 ◽

2020 ◽

Author(s):

Bridget A. Graney ◽

Christophe He ◽

Michael Marll ◽

Scott Matson ◽

Pauline Bianchi ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Disease Clinic ◽

Essential Components

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Interstitial Lung Abnormalities in People With HIV Infection and Uninfected Controls

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa047 ◽

2020 ◽

Vol 221 (12) ◽

pp. 1973-1977 ◽

Cited By ~ 1

Author(s):

Andreas Ronit ◽

Thomas Benfield ◽

Jens Lundgren ◽

Jørgen Vestbo ◽

Shoaib Afzal ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Hiv Infection ◽

Lung Disease ◽

Chest Ct ◽

Cross Sectional ◽

Disease States ◽

Ct Findings ◽

Lung Abnormalities ◽

Sectional Analysis ◽

Over Time

Abstract Background Chest computed tomography (CT) findings in well-treated people with HIV infection (PWH) remain poorly characterized. Methods Cross-sectional analysis examining interstitial chest CT findings in PWH (n = 754) and uninfected controls (n = 470). Results HIV infection was independently associated with 1.82 (95% CI, 1.18–2.88) and 5.15 (95% CI, 1.72–22.2) higher adjusted odds of any interstitial lung abnormality and findings suspicious for interstitial lung disease, respectively. Conclusions HIV infection was independently associated with interstitial lung abnormalities and findings suspicious for interstitial lung disease. Whether these abnormalities develop into more recognizable disease states over time is unknown but warrants further investigation.

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