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      Comorbidities in interstitial lung diseases

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          Abstract

          Fibrosing lung disorders include a large number of diseases with diverse behaviour. Patients can die because of the progression of their illness, remain stable or even improve after appropriate treatment has been instituted. Comorbidities, such as acute and chronic infection, gastro-oesophageal reflux, pulmonary hypertension, lung cancer, cardiovascular diseases, and obstructive sleep apnoea, can pre-exist or develop at any time during the course of the disease and, if unidentified and untreated, may impair quality of life, impact upon the respiratory status of the patients, and ultimately lead to disease progression and death. Therefore, early identification and accurate treatment of comorbidities is essential.

          Abstract

          Early detection and accurate management of comorbidity have benefits in reducing ILD morbidity and mortality http://ow.ly/4nmYie

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          Most cited references157

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          An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline.

          Ganesh Raghu, Bram Rochwerg, Yuan Zhang … (2015)
          This document updates the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association guideline on idiopathic pulmonary fibrosis treatment.
          Article 0 comments Cited 417 times – based on 0 reviews     Review now
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            Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis.

            Kevin J Anstrom, B. T. King, Ganesh Raghu … (2012)
            A combination of prednisone, azathioprine, and N-acetylcysteine (NAC) has been widely used as a treatment for idiopathic pulmonary fibrosis. The safety and efficacy of this three-drug regimen is unknown. In this randomized, double-blind, placebo-controlled trial, we assigned patients with idiopathic pulmonary fibrosis who had mild-to-moderate lung-function impairment to one of three groups -- receiving a combination of prednisone, azathioprine, and NAC (combination therapy), NAC alone, or placebo -- in a 1:1:1 ratio. The primary outcome was the change in longitudinal measurements of forced vital capacity during a 60-week treatment period. When approximately 50% of data had been collected (with 77 patients in the combination-therapy group and 78 in the placebo group), a planned interim analysis revealed that patients in the combination-therapy group, as compared with the placebo group, had an increased rate of death (8 vs. 1, P=0.01) and hospitalization (23 vs. 7, P<0.001). These observations, coupled with no evidence of physiological or clinical benefit for combination therapy, prompted the independent data and safety monitoring board to recommend termination of the combination-therapy group at a mean follow-up of 32 weeks. Data from the ongoing comparison of the NAC-only group and the placebo group are not reported here. Increased risks of death and hospitalization were observed in patients with idiopathic pulmonary fibrosis who were treated with a combination of prednisone, azathioprine, and NAC, as compared with placebo. These findings provide evidence against the use of this combination in such patients. (Funded by the National Heart, Lung, and Blood Institute and the Cowlin Family Fund; ClinicalTrials.gov number, NCT00650091.).
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              Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome.

              J. W. Song, S-B. Hong, C.-M. Lim … (2011)
              Although acute exacerbation of idiopathic pulmonary fibrosis (IPF) has become well recognised, the reported incidence and outcomes are highly variable, and risk factors are unknown. The aim of this study was to estimate the incidence, risk factors and impact of acute exacerbations, and other known causes of rapid deterioration. This was a retrospective review of 461 patients with IPF (269 cases were biopsy-proven). The median follow-up period was 22.9 months. Rapid deterioration requiring hospitalisation occurred in 163 (35.4%) patients, with multiple episodes in 42 patients. Acute exacerbation was the most frequent cause (55.2%), followed by infection. The 1- and 3-yr incidences of acute exacerbation were 14.2 and 20.7%, respectively. Never having smoked and low forced vital capacity (FVC) were significant risk factors. The in-hospital mortality rate was 50.0%, and the 1- and 5-yr survival rates from the initial diagnosis were 56.2 and 18.4%, respectively. Acute exacerbation was a significant predictor of poor survival after the initial diagnosis, along with increased age, low FVC and diffusing capacity of the lung for carbon monoxide, and steroid use with or without cytotoxic therapy. 1- and 3-yr incidences of acute exacerbation were 14.2 and 20.7%, respectively. Never having smoked and low FVC were risk factors. Acute exacerbation had a serious impact on the overall survival of the patients with IPF.
              Article 0 comments Cited 284 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Respir Rev
                Journal ID (iso-abbrev): Eur Respir Rev
                Journal ID (publisher-id): ERR
                Journal ID (hwp): errev
                Title: European Respiratory Review
                Publisher: European Respiratory Society
                ISSN (Print): 0905-9180
                ISSN (Electronic): 1600-0617
                Publication date Collection: 31 March 2017
                Publication date (Electronic): 03 January 2017
                Volume: 26
                Issue: 143
                Electronic Location Identifier: 160027
                Affiliations
                [1 ]Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
                [2 ]Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
                Author notes
                Athol U. Wells, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, SW3 6LP, UK. E-mail: RBHILD@ 123456rbht.nhs.uk
                Article
                Publisher ID: ERR-0027-2016
                DOI: 10.1183/16000617.0027-2016
                PMC ID: 9488735
                PubMed ID: 28049126
                SO-VID: 3b8386e7-772c-4f1c-a22b-f9aca22b78f5
                Copyright © Copyright ©ERS 2017.
                License:

                ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 22 February 2016
                Date accepted : 16 April 2016
                Categories
                Subject: Reviews
                Subject: 13
                Subject: 18

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