scholarly journals Ongoing Symptoms, Formation of Interstitial Lung Disease and Follow-up Process in PostCOVID-19

2021 ◽  
Author(s):  
Melike Yüksel Yavuz ◽  
Ceyda Anar
Keyword(s):  
Risk Factors ◽  
Interstitial Lung Disease ◽  
Severe Acute Respiratory Syndrome ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Upper Respiratory Tract ◽  
Acute Respiratory Diseases ◽  
Common Risk Factors

In December 2019, severe acute respiratory diseases due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were reported from Wuhan province of China. The symptoms associated with Coronavirus Disease-2019 (COVID-19) range from mild upper respiratory tract infection to acute respiratory distress syndrome (ARDS). It was observed that symptoms and radiological findings continued in some patients after discharge. Comorbidities such as hypertension and diabetes, risk factors such as male gender and advanced age are common risk factors for severe COVID-19 and idiopathic pulmonary fibrosis (IPF). However, the role of anti fibrotictherapy and the scientific rationale for their continuation or discontinuation in IPF patients infected with SARS-CoV-2 have not been fully defined. Data from the COVID-19 pandemic and previous coronavirus infections such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that there may be significant fibrotic changes following SARS-CoV-2 infection. In this article, the frequency of on going symptoms after COVID-19 pneumonia and the frequency of interstitial lung disease that may ocur were discussed. Inaddition, the prevention of interstitial changes in the lung, especially pulmonary fibrosis, and the decrease in respiratory functions are discussed in the light of the literature.

scholarly journals Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

2018 ◽  
Vol 27 (150) ◽  
pp. 180061 ◽  
Author(s):  
Julio A. Huapaya ◽  
Erin M. Wilfong ◽  
Christopher T. Harden ◽  
Roy G. Brower ◽  
Sonye K. Danoff
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Lung Disease ◽  
Mortality Rates ◽  
Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

scholarly journals Shared genetic predisposition in rheumatoid arthritis-interstitial lung disease and familial pulmonary fibrosis

2017 ◽  
Vol 49 (5) ◽  
pp. 1602314 ◽  
Author(s):  
Pierre-Antoine Juge ◽  
Raphaël Borie ◽  
Caroline Kannengiesser ◽  
Steven Gazal ◽  
Patrick Revy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Interstitial Lung Disease ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
European Ancestry ◽  
Whole Exome ◽  
Burden Test ◽  
Excess Number ◽  
Familial Pulmonary Fibrosis

Despite its high prevalence and mortality, little is known about the pathogenesis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Given that familial pulmonary fibrosis (FPF) and RA-ILD frequently share the usual pattern of interstitial pneumonia and common environmental risk factors, we hypothesised that the two diseases might share additional risk factors, including FPF-linked genes. Our aim was to identify coding mutations of FPF-risk genes associated with RA-ILD.We used whole exome sequencing (WES), followed by restricted analysis of a discrete number of FPF-linked genes and performed a burden test to assess the excess number of mutations in RA-ILD patients compared to controls.Among the 101 RA-ILD patients included, 12 (11.9%) had 13 WES-identified heterozygous mutations in the TERT, RTEL1, PARN or SFTPC coding regions. The burden test, based on 81 RA-ILD patients and 1010 controls of European ancestry, revealed an excess of TERT, RTEL1, PARN or SFTPC mutations in RA-ILD patients (OR 3.17, 95% CI 1.53–6.12; p=9.45×10−4). Telomeres were shorter in RA-ILD patients with a TERT, RTEL1 or PARN mutation than in controls (p=2.87×10−2).Our results support the contribution of FPF-linked genes to RA-ILD susceptibility.

scholarly journals Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction

Heart ◽  
2020 ◽  
Vol 106 (12) ◽  
pp. 916-922 ◽  
Author(s):  
Lorna Elise Clarson ◽  
Ram Bajpai ◽  
Rebecca Whittle ◽  
John Belcher ◽  
Alyshah Abdul Sultan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Ischaemic Heart Disease ◽  
Shared Risk ◽  
The Impact

ObjectivesDespite many shared risk factors and pathophysiological pathways, the risk of ischaemic heart disease (IHD) and myocardial infarction (MI) in interstitial lung disease (ILD) remains poorly understood. This lack of data could be preventing patients who may benefit from screening for these cardiovascular diseases from receiving it.MethodsA population-based cohort study used electronic patient records from the Clinical Practice Research Datalink and linked Hospital Episode Statistics to identify 68 572 patients (11 688 ILD exposed (mean follow-up: 3.8 years); 56 884 unexposed controls (mean follow-up: 4.0 years), with 349 067 person-years of follow-up. ILD-exposed patients (pulmonary sarcoidosis (PS) or idiopathic pulmonary fibrosis (PF)) were matched (by age, sex, registered general practice and available follow-up time) to patients without ILD or IHD/MI. Rates of incident MI and IHD were estimated. HRs were modelled using multivariable Cox proportional hazards regression accounting for potential confounders.ResultsILD was independently associated with IHD (HR 1.85, 95% CI 1.56 to 2.18) and MI (HR 1.74, 95% CI 1.44 to 2.11). In all disease categories, risk of both IHD and MI peaked between ages 60 and 69 years, except for the risk of MI in PS which was greatest <50 years. Men with PF were at greatest risk of IHD, while women with PF were at greatest risk of MI.ConclusionsILD, particularly PF, is independently associated with MI and IHD after adjustment for established cardiovascular risk factors. Our results suggest clinicians should prioritise targeted assessment of cardiovascular risk in patients with ILD, particularly those aged 60–69 years. Further research is needed to understand the impact of such an approach to risk management.

scholarly journals SAT0040 RISK FACTORS FOR DEVELOPING AND MORTALITY FOR ACUTE EXACERBATION OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 950.2-951
Author(s):  
S. Izuka ◽  
H. Yamashita ◽  
Y. Takahashi ◽  
H. Kaneko
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Interstitial Lung Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Acute Exacerbation ◽  
Vascular Diseases ◽  
Collagen Vascular Diseases ◽  
Survivor Group

Background:Among collagen vascular diseases, rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is the most commonly associated with ILD with acute exacerbation (AE) [1]. One study reported that ILD diagnosis at an older age, the usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography, and methotrexate (MTX) use were associated with AE in patients with RA-ILD [2]. However, because these studies included few patients, the risk factors and prognosis of AE in patients with RA-ILD remain unclear. Therefore, this study examined the characteristics of RA-ILD patients with AE, and the variables associated with mortality due to AE of RA-ILD.Objectives:To investigate the risk factors for AE and mortality of RA-ILD.Methods:We retrospectively collected the clinical data of 165 RA-ILD patients admitted to our hospital between July 2010 and October 2019. We compared clinical characteristics between patients who developed AE (AE group) and those who did not (non-AE group), and identified the variables significantly associated with AE occurrence. We also compared the admission characteristics of those who survived (survivor group) and those who died (non-survivor group) after admission for AE. AE was defined using previously proposed criteria [3], which were modified slightly for application to RA-ILD.Results:The mean patient age was 73.6 ± 9.7 years and 97 (71.9%) patients were female. Thirty (22.2%) patients developed AE, of whom thirteen (43.3%) died (mean follow-up, 64.9 months). In univariate analyses UIP pattern and MTX were not associated with AE. However, in multivariate analyses, UIP pattern was associated with AE (OR 2.68, 95% CI 1.10–6.52,p=0.03). Median age (70vs. 80 years,p=0.003), non-use of MTX (70.6%vs. 23.1%,p=0.025), and C reactive protein level (median 9.38vs. 18.12 mg/dL,p=0.02) on admission were significantly higher in patients who died of AE. In the Cox proportional hazard model, UIP pattern (HR 4.67, 95% CI 1.02–21.5,p=0.048) and non-use of MTX (HR 0.16, 95% CI 0.04–0.72,p=0.016) were associated with death.Conclusion:Our data suggest that the UIP pattern is related to AE, and non-use of MTX and UIP pattern are related to death due to AE of RA-ILD.References:[1] Suda T, Kaida Y, Nakamura Y et al. Acute exacerbation of interstitial pneumonia associated with collagen vascular diseases.Respir Med2009;103:846-53.[2] Hozumi H, Nakamura Y, Johkoh T et al. Acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: a retrospective case control study.BMJ Open2013;3:e003132.[3] Collard HR, Moore BB, Flaherty KR et al. Idiopathic pulmonary fibrosis clinical research network investigators. Acute exacerbations of idiopathic pulmonary fibrosis.Am J Respir Crit Care Med2007;176:636-43.Disclosure of Interests:None declared

scholarly journals The Role of Radiology in Progressive Fibrosing Interstitial Lung Disease

2022 ◽  
Vol 8 ◽  
Author(s):  
Ahmad Abu Qubo ◽  
K. M. Capaccione ◽  
Elana J. Bernstein ◽  
Maria Padilla ◽  
Mary Salvatore
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Clinical Diagnosis ◽  
Early Death ◽  
Radiographic Diagnosis ◽  
Increased Risk

In this article, we describe the role of radiology for diagnosis and follow-up of progressive fibrosing interstitial lung disease (PF-ILD). Patients with PF-ILD are at increased risk for early death without treatment. Clinical diagnosis of PF-ILD has been described in the literature. This manuscript reviews the radiographic diagnosis of PF-ILD and the unique CT characteristics associated with specific types of fibrosis. Ultimately, we believe that radiology has the potential to recognize progression early and thus make an important contribution to the multidisciplinary discussion for this important diagnosis.

scholarly journals POS0403 RISK FACTORS FOR PROGRESSION OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE: REASSURING IMPACT OF METHOTREXATE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 431.2-431
Author(s):  
C. Lucas ◽  
A. Tremblay ◽  
S. Jouneau ◽  
A. Perdriger
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Logistic Regression ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Respiratory Function Tests ◽  
Multivariable Logistic Regression Analysis ◽  
High Resolution Computed Tomography ◽  
The Impact

Background:Factors associated with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) progression and prognosis are not well identified, especially the impact of methotrexate.Objectives:Identify risk factors of ILD progression in RA-ILD patients in a longitudinal study.Methods:RA patients with ILD confirmed in 2 high resolution computed tomography (HRCT) chest scans spaced at least 6 months apart (T0: date of the first HRCT chest scan describing ILD; Tx: date of the last HRCT chest scan available) were consecutively included in this retrospective multi-centric study from 2010 to 2020. HRCT chest scans were analyzed for each patient at T0 and Tx by 2 independent radiologists to determinate ILD pattern (definite UIP, probable UIP, indeterminate UIP, non-UIP) and progression during the follow-up including variation of the fibrosis score (aggravated or non-aggravated). Characteristics of patients (demographic-clinical-biological findings, respiratory function tests, and treatments exposure) at ILD diagnosis and during the follow-up (T0-Tx) were analyzed as potential determinants of ILD progression through multivariable logistic regression analysis. Overall survival was analyzed using Kaplan-Meier method.Results:74 RA-ILD patients were included. During a mean duration between T0-Tx of 2.8 years ± 2.4, 26 patients (35%) had ILD progression. Thirty-three patients (45%) were treated by methotrexate at ILD diagnosis (T0) and 29 of them (39%) continued methotrexate during T0-Tx. Logistic regression in multivariate analysis revealed that a treatment by methotrexate at ILD diagnosis was protective against ILD progression (OR=0.14 [0.04-0.52]; p=0.0031). Non-UIP pattern at ILD diagnosis was also protective against ILD progression (OR=0.09 [0.02-0.36]; p=0.0005). The follow-up for survival analysis was 5.1 years ± 2.9. Thirty-three patients (31%) died, and the 3-year survival rate was 80%. Survival was better for non-aggravated ILD patients (HR=3.5 [1.46-8.4]; p=0.004) and for patients treated by methotrexate during T0-Tx (HR= 0.36 [0.15-0.84]; p=0.018) and worse for definite UIP patterns (HR=2.570 [1.078-6.128]; p=0.0332).Conclusion:In RA-ILD patients, non-UIP pattern and methotrexate treatment are associated with better ILD evolution and prognosis.Disclosure of Interests:None declared

scholarly journals Post-COVID-19 Pulmonary Fibrosis: An Update

2021 ◽  
Vol 08 (02) ◽  
pp. 16-26
Author(s):  
Naresh Kumar ◽  
Keyword(s):  
Natural History ◽  
Severe Acute Respiratory Syndrome ◽  
Pulmonary Fibrosis ◽  
Severity Of Illness ◽  
Pulmonary Vascular Disease ◽  
History Of ◽  
Prolonged Icu Stay

Coronavirus disease 2019 (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most common cause of hospitalisation for COVID-19 is interstitial pneumonia that may be complicated by Acute Respiratory Distress Syndrome (ARDS). With an increasing magnitude of COVID-19 survivors, post-COVID interstitial lung disease and pulmonary vascular disease are likely to be the most important long term respiratory complications. Data from previous coronavirus infections such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), as well as emerging data from the COVID-19 pandemic, suggest that there could be substantial pulmonary fibrotic consequences following SARS-CoV-2 infection. Thus, the long-term consequences of COVID-19 appear crucial. Here, we have discussed the pathogenesis, natural history, and radiological aspects of such patients and the possible predictors which might lead to the development of lung fibrosis. Older age, severity of illness, prolonged ICU stay, history of smoking and alcoholism are few of the risk factors for the development of post-COVID-19 pulmonary fibrosis. Therapeutic options like antifibrotic drugs such as pirfenidone, nintedanib, pulmonary rehabilitation, SARS-COV-2 vaccine etc. have been described. The role of steroids and antifibrotics in the prevention of post-COVID fibrosis is still controversial. Careful longitudinal follow-up of multiple cohorts of post-COVID-19 survivors with serial lung function testing and imaging is required to complete the knowledge about natural history of the disease and the response to various therapies.

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