2022 update on clinical practice guidelines for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis

Tzilas, Vasilios; Tzouvelekis, Argyrios; Ryu, Jay H.; Bouros, Demosthenes

doi:10.1016/s2213-2600(22)00223-5

Cited by 22 publications

(18 citation statements)

References 10 publications

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“…The diagnosis of IPF in older patients should be based on multiple medical information sources without invasive procedures [ 4 ]. The patient's chest CT showed diffuse frosted shadows in both lungs and findings suspicious of cellulite lung with traction bronchiectasis at the base of the lower lobe of the left lung.…”

Section: Discussionmentioning

confidence: 99%

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Deciding a Treatment Plan for an Older Patient With Severe Idiopathic Pulmonary Fibrosis: A Case Report

Akashi¹,

Horinishi²,

Sano³

et al. 2023

Cureus

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Idiopathic pulmonary fibrosis (IPF) is a group of diseases in which the main loci of lesions, mainly inflammatory and fibrotic, are within the interstitium of the alveolar and bronchiolar regions. Steroid therapy is the standard treatment for acute exacerbation of IPF, whereas antifibrotic agents are the standard treatment for chronic IPF. However, the vulnerability of older patients indicates that these treatments may be discontinued. Here, we report the case of an 86-year-old woman who had a dry cough for over a year and was subsequently diagnosed with IPF based on imaging studies. After using steroid pulses to treat acute exacerbations, the patient was transitioned to the chronic management phase, and time was allowed to plan the patient's advanced care with her family. The use of high-dose steroids in older patients with frailty is contraindicated. This case emphasizes the importance of considering initial intensive treatment for IPF in older patients for better palliative care.

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Section: Discussionmentioning

confidence: 99%

“…IPF diagnosis is based on the exclusion of interstitial pneumonia and other diseases with diffuse pulmonary shadows, such as collagen disease and drug-induced interstitial pneumonia of known etiology [ 4 ]. A definitive diagnosis should be based on the histopathological diagnosis after a surgical lung biopsy.…”

Section: Introductionmentioning

confidence: 99%

Deciding a Treatment Plan for an Older Patient With Severe Idiopathic Pulmonary Fibrosis: A Case Report

Akashi¹,

Horinishi²,

Sano³

et al. 2023

Cureus

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“…In CTD-related UIP, such as RA-ILD and PM/DM-ILD, moderate or higher doses of steroids and immunosuppressive drugs are the most effective treatments 5,6) . In contrast, in the case of progressive IPF, antifibrotic drugs are recommended and steroids are generally not administered except for acute exacerbations 31) .…”

Section: Discussionmentioning

confidence: 99%

Serum Levels of Caspase-Cleaved Cytokeratin-18 in Interstitial Lung Disease Associated with Rheumatoid Arthritis, Dermatomyositis, and Polymyositis

Kawasaki

Imamura

Nagafuchi

et al. 2022

J St. Marianna Univ

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Although the detailed pathogenesis of interstitial lung disease (ILD) is unknown, the involvement of apoptosis has been suggested. We investigated whether the apoptosis marker of epithelial cells in serum can be a marker of disease activity, to examine the involvement of apoptosis in the pathology of ILD associated with connective tissue disease (CTD). Methods: We analyzed serum levels of caspase-cleaved cytokeratin-18 (M30) in 87 patients, consisting of 52 patients with rheumatoid arthritis (RA) and 35 with polymyositis or dermatomyositis (PM/DM), using enzyme-linked immunosorbent assays. Of the 87 patients, 39 (17 with RA and 22 with PM/DM) had ILD. Results: The median (interquartile range) serum level of M30 was 283.2 (153.9-340.6) U/L in the patients with ILD associated with RA and PM/DM (RA-ILD, and PM/DM-ILD), and 143.4 (108.5-176.2) U/L in the patient without ILD. Serum level of M30 was significantly higher in patients with RA-ILD than those with RA without ILD (P<0.001). Furthermore, serum level of M30 was significantly higher in patients with PM/DM-ILD than those with PM/DM without ILD (P<0.001). Serum M30 levels were negatively correlated with percent-predicted forced vital capacity (r s =-0.37). The cutoff value of serum M30 to detect CTD-ILD, revealed by receiver-operating characteristic curve analysis, was 211.7 U/L, with a sensitivity of 85.4% and specificity of 66.7%. Conclusion: Lung apoptosis is suggested to be involved in the fibrosis of CTD-ILD. The serum M30 level can be useful as a detection and activity marker for CTD-ILD.

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“…In addition, GGOs may not only be a sign of an inflammatory condition, but also an indication of ongoing contact with a triggering factor that may advance the disease. Finally, the treatment of GGOs in typical IP patients is not certain [17,18]. Therefore, stating the role of anti-inflammatory therapy…”

Section: Ethical and Clinical Implications Of The Hypothesismentioning

confidence: 99%

Ground Glass Opacities: Sign of Caution in Typical Interstitial Pneumonia

Tezcan

Kasman

2023

CAJMHE

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Typical interstitial pneumonia (IP) is mainly the fibrotic form of interstitial lung disease. In some cases with typical IP, a certain amount of ground-glass opacity (GGO) can be detected on high-resolution computed tomography, however, some important issues, such as the co-existence of GGO and typical IP, still require further investigation by biopsy. After the diagnosis of typical IP, anti-fibrosis treatment is usually considered. Here, we hypothesized that GGO in typical IP could be a manifestation of an acute inflammatory attack requiring immunosuppressive therapy or an indicator of ongoing contact with trigger factors that initiate pathological reactions in typical IP.

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2022 update on clinical practice guidelines for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis

Cited by 22 publications

References 10 publications

Deciding a Treatment Plan for an Older Patient With Severe Idiopathic Pulmonary Fibrosis: A Case Report

Deciding a Treatment Plan for an Older Patient With Severe Idiopathic Pulmonary Fibrosis: A Case Report

Serum Levels of Caspase-Cleaved Cytokeratin-18 in Interstitial Lung Disease Associated with Rheumatoid Arthritis, Dermatomyositis, and Polymyositis

Ground Glass Opacities: Sign of Caution in Typical Interstitial Pneumonia

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