scholarly journals The pathogenesis, epidemiology and biomarkers of susceptibility of pulmonary fibrosis in COVID-19 survivors

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrea Vianello ◽  
Gabriella Guarnieri ◽  
Fausto Braccioni ◽  
Sara Lococo ◽  
Beatrice Molena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Fibrosis ◽  
Lung Diseases ◽  
Clinical Course ◽  
Interstitial Lung Diseases ◽  
Long Term Effects ◽  
Acute Case ◽  
Discharge From Hospital

Abstract Pulmonary fibrosis (PF), a pathological outcome of chronic and acute interstitial lung diseases associated to compromised wound healing, is a key component of the “post-acute COVID-19 syndrome” that may severely complicate patients’ clinical course. Although inconclusive, available data suggest that more than a third of hospitalized COVID-19 patients develop lung fibrotic abnormalities after their discharge from hospital. The pathogenesis of PF in patients recovering from a severe acute case of COVID-19 is complex, and several hypotheses have been formulated to explain its development. An analysis of the data that is presently available suggests that biomarkers of susceptibility could help to identify subjects with increased probability of developing PF and may represent a means to personalize the management of COVID-19’s long-term effects. Our review highlights the importance of both patient-related and disease-related contributing risk factors for PF in COVID-19 survivors and makes it definitely clear the possible use of acute phase and follow-up biomarkers for identifying the patients at greatest risk of developing this disease.

scholarly journals The past, present, and future of humidifier disinfectant-associated interstitial lung diseases in children

2020 ◽  
Vol 63 (7) ◽  
pp. 251-258 ◽  
Author(s):  
Eun Lee ◽  
So-Yeon Lee ◽  
Soo-Jong Hong
Keyword(s):  
Health Effects ◽  
Lung Diseases ◽  
Therapeutic Strategies ◽  
Interstitial Lung Diseases ◽  
Toxic Chemicals ◽  
The Past ◽  
Radiologic Findings ◽  
Pathologic Findings

Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%−58.0%. Although 18.1%−31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.

Long-Term Effects of Behavioural Treatment for Panic Disorder with Agoraphobia

1995 ◽  
Vol 166 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Giovanni A. Fava ◽  
Maria Zielezny ◽  
Gianni Savron ◽  
Silvana Grandi
Keyword(s):  
Panic Disorder ◽  
Clinical Course ◽  
Panic Attacks ◽  
Clinical Psychologist ◽  
Long Term Effects ◽  
Behavioural Treatment ◽  
Complete Treatment ◽  
Long Term Follow Up

BackgroundThere are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.Method110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.ResultsThe estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.ConclusionsThe findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

scholarly journals Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Claudia Valenzuela ◽  
Sebastiano Emanuele Torrisi ◽  
Nicolas Kahn ◽  
Manuel Quaresma ◽  
Susanne Stowasser ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Lung Diseases ◽  
Underlying Disease ◽  
Interstitial Lung Diseases ◽  
Future Research ◽  
Function Impairment ◽  
Treatment Paradigm ◽  
Lung Function Impairment ◽  
Improve Patient

AbstractThe approvals of nintedanib and pirfenidone changed the treatment paradigm in idiopathic pulmonary fibrosis (IPF), and increased our understanding of the underlying disease mechanisms. Nonetheless, many challenges and unmet needs remain in the management of patients with IPF and other progressive fibrosing interstitial lung diseases.This review describes how the nintedanib clinical programme has helped to address some of these challenges. Data from this programme have informed changes to the IPF diagnostic guidelines, the timing of treatment initiation, and the assessment of disease progression. The use of nintedanib to treat patients with advanced lung function impairment, concomitant emphysema, patients awaiting lung transplantation and patients with IPF and lung cancer is discussed. The long-term use of nintedanib and an up-to-date summary of nintedanib in clinical practice are discussed. Directions for future research, namely emerging therapeutic options, precision medicine and other progressive fibrosing interstitial lung diseases, are described.Further developments in these areas should continue to improve patient outcomes.

Diabetische Pneumopathie

2019 ◽  
Vol 14 (05) ◽  
pp. 370-378
Author(s):  
Stefan Kopf
Keyword(s):  
Type 2 Diabetes ◽  
Pulmonary Fibrosis ◽  
Lung Diseases ◽  
Epidemiological Studies ◽  
Interstitial Lung Diseases ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Sports And Physical Activity

AbstractBreathlessness or dyspnea is a frequent symptom in patients with diabetes and the first disease which has to be excluded is the coronary heart disease. However, previous epidemiological studies have shown that patients with diabetes mellitus have an increased risk for fibrotic pulmonary diseases, such as the idiopathic pulmonary fibrosis (IPF). Recent studies were able to show that patients with newly diagnosed type 2 diabetes have impaired pulmonary oxygen consumption and over 26 % of patients with long-term type 2 diabetes showed restrictive lung function with fibrotic interstitial lung diseases. Especially patients with type 2 diabetes and nephropathy had an 8-fold higher risk for lung diseases. This is not surprising since the pathomechanisms of pulmonary fibrosis and diabetic complications have much in common: reactive oxygen species induce DNA-damage with consecutive activation of inflammatory cytokines which induce fibrotic remodeling of the tissue. This leads us to the suggestion that patients with diabetes, albuminuria and breathlessness should be examined for interstitial lung disease on regular basis. However, data regarding the natural course of diabetic pneumopathy and therapeutic approaches are still missing. Small intervention studies with IPF-patients could show that sports and physical activity were able to stabilize the disease progression.

scholarly journals Longitudinal comparison of anxiety and depression between idiopathic pulmonary fibrosis and other interstitial lung diseases: a prospective cohort study

2020 ◽  
Author(s):  
Won Bae ◽  
Jaeyoung Cho ◽  
Jinwoo Lee ◽  
Young Sik Park ◽  
Chang-Hoon Lee ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Odds Ratio ◽  
Lung Diseases ◽  
Depression Scale ◽  
Interstitial Lung Diseases ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
St George's Respiratory Questionnaire

Abstract Background and objective: Few studies have investigated the differences in the incidence of anxiety and depression among the interstitial lung diseases (ILDs). We evaluated the differences in the incidence of anxiety and depression between idiopathic pulmonary fibrosis (IPF) and non-IPF ILD, and the changes after a 1-year follow-up period. Methods The study participants were patients included in a prospective ILD cohort of Seoul National University Hospital between March 2013 and August 2018. Clinical variables were recorded at baseline and at 1 year. The Hospital Anxiety and Depression Scale was used to assess patient anxiety and depression at baseline and at 1-year follow-up. Results A total of 224 patients in the cohort participated in the study (154 [68.8%] with IPF and 70 [31.2%] with non-IPF ILD). Among them, 111 patients completed a follow-up Hospital Anxiety and Depression Scale questionnaire 1 year later (77 in the IPF group, 34 in the non-IPF group). In the IPF group, 20.8% and 27.3% of patients suffered from anxiety and 29.9% and 31.2% suffered from depression at baseline and 1-year follow-up, respectively. In the non-IPF group, 14.3% and 23.5% of patients suffered from anxiety and 24.3% and 17.6% suffered from depression at baseline and 1-year follow-up, respectively. Total score on the St. George’s Respiratory Questionnaire at baseline was associated with depression both at baseline (odds ratio 1.05; 95% confidence interval 1.02–1.08) and at 1-year follow-up (odds ratio 1.03; 95% confidence interval 1.00-1.05), even after adjusting other factors. The interaction of prevalence change of anxiety and depression at baseline and 1-year follow-up between the IPF group and the non-IPF ILD group were not statistically significant (p-value 0.878 for anxiety and 0.376 for depression, respectively). Conclusion The prevalence of anxiety and depression at baseline and at 1-year follow-up were not significantly different between patients with IPF and non-IPF ILD. St. George’s Respiratory Questionnaire total score at baseline was associated with depression at baseline and at 1-year follow-up.

scholarly journals Sex- and Gender-specific Risk Factors of Post-COVID-19 Syndrome: A Population-based Cohort Study in Switzerland

2021 ◽  
Author(s):  
Caroline E Gebhard ◽  
Claudia Suetsch ◽  
Susan Bengs ◽  
Manja Deforth ◽  
Karl Philipp Buehler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Sex And Gender ◽  
Long Term Effects ◽  
Feminine Gender ◽  
Specific Risk ◽  
And Gender ◽  
Gender Specific

Background: Evidence to date indicates that mortality of acute coronavirus disease (COVID-19) is higher in men than in women. Conversely, women seem more likely to suffer from long-term consequences of the disease and pronounced negative social and economic impacts. Sex- and gender-specific risk factors of COVID-19-related long-term effects are unknown. Methods: We conducted a multicentre prospective observational cohort study of 5838 (44.6% women) individuals in Switzerland who were tested positive for SARS-CoV-2 RNA between February and December 2020. Of all surviving individuals who met the inclusion criteria, 2799 (1285 [45.9%] women) completed a follow-up questionnaire. Findings: After a mean follow-up time of 197±77 days, women more often reported at least one persistent symptom (43.0% vs 31.5%, p<0.001) with reduced exercise tolerance and reduced resilience being the most frequently reported symptom in both sexes. Critical illness (intermediate or intensive care unit admission) during acute SARS-CoV-2 infection (odds ratio[95%CI]: 4.00[2.66-6.02], p<0.0001 was a risk factor of post-COVID-19 syndrome in both women and men. Women with pre-existing mental illness (1.81[1.00-3.26], p=0.049), cardiovascular risk factors (1.39[1.03-1.89], p=0.033), higher self-reported domestic stress levels (1.15[1.08-1.22], p<0.0001), and feminine gender identity (1.12[1.02-1.24], p=0.02) increased the odds of experiencing post-COVID syndrome. Conversely, obesity (1.44[1.03-2.02], p=0.034) increased the odds of post-COVID-19 syndrome in men, but not in women. Being responsible for household work (men, OR 0.82[0.69-0.97], p=0.021), taking care of children/relatives (women, 0.90[0.84-0.96], p=0.002) or being pregnant at the time of acute COVID-19 illness (OR 0.48[0.23-1.01], p=0.054) was associated with lower odds of post-COVID syndrome. Interpretation: Predictors of post-COVID syndrome differ between men and women. Our data reinforce the importance to include sex and gender to identify patients at risk for post-COVID syndrome so that access to care and early intervention can be tailored to their different needs.

scholarly journals Long-term effects of radiotherapy on cardiovascular risk factors in acromegaly

2011 ◽  
Vol 164 (5) ◽  
pp. 675-684 ◽  
Author(s):  
Cristina L Ronchi ◽  
Elisa Verrua ◽  
Emanuele Ferrante ◽  
Gwendolyn Bender ◽  
Elisa Sala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Control Group ◽  
Oral Glucose ◽  
Long Term Effects ◽  
End Point ◽  
Cerebrovascular Events

ObjectiveRadiation therapy (RT) is a useful adjuvant tool for acromegalic patients not cured by surgery and/or not responding to pharmacotherapy. However, its specific effects on cardio- and cerebrovascular morbidity are still on debate.DesignRetrospective analysis of 42 acromegalic patients cured after conventional radiotherapy (CRT, n=31) or radiosurgery by gamma-knife (GKRS, n=11) followed for a median period of 16.5 years (range: 2–40). Totally, 56 patients cured by surgery alone, with similar GH/IGF1 levels and duration of disease remission, served as control group.MethodsChanges in cardiovascular risk factors, such as body mass index, glucose metabolism, insulin resistance, blood pressure, and lipid profile (pre-defined primary end point) and occurrence of new major cardio- and cerebrovascular events (secondary end point) during follow-up.ResultsThe number of obese, hypertensive, and dyslipidemic subjects increased over time only in patients cured with RT. In contrast, the glucose response to the oral glucose tolerance test and the percentage of subjects with glucose alterations improved only in controls. As expected, the percentage of patients with pituitary failure was deeply higher among RT patients than among controls (86 vs 30%, P<0.0005). Despite these findings, a similar number of RT patients and controls developed major cardio- or cerebrovascular events (4/42 vs 3/56, P: NS). No differences were found between CRT and GKRS subgroups.ConclusionsPrevious RT seems to be associated with a worse metabolic profile in acromegalic patients studied after a long-term follow-up. Nevertheless, a direct link between RT and cardiovascular events remains to be proven.

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