Chronic obstructive pulmonary disease combined with interstitial lung disease

Abstract

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 and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.Additional comparisons of biomarkers between groups revealed four clear categories: biomarkers elevated in emphysema alone (interleukin [IL]-6, CXCL10, CCL2, IL-10, and interferon-γ); biomarkers reduced in emphysema alone (IL-17A, IL-13, matrix metalloproteinase [MMP] 1, MMP13, MMP2, CCL24, and lysyl oxidase); biomarkers that were similar among emphysema, IPF, and CPFE, but different from the healthy control group (sCD14, CCL5, tumor necrosis factor [TNF] RII, SP-D, ST2, IL-1β, IL-4, IL-5, CXCL8, and TNFα); and biomarkers with a mixed pattern that did not fit any other categories. These results suggest that the levels of inflammatory proteins are generally comparable between IPF and CPFE, but distinct features are present in emphysema. These results were also consistent with the findings of previous studies [38][39][40][41] . Therefore, the immunological pathogenesis of CPFE may be more closely associated with IPF development.Klebs von den Lungen-6 (KL-6) is a high-molecular-weight glycoprotein that is strongly expressed on type II alveolar pneumocytes and bronchiolar epithelial cells. It is an important marker of ILD and is associated with disease severity, progression, and survival; notably, it promotes pulmonary fibroblast migration and proliferation [42][43][44][45] . Because of this association with ILD, some studies have investigated relationships with fibrotic changes in patients with COPD. In asthma-COPD overlap, patients with a history of smoking and older age have more frequent ILA 46 . These patients with asthma-COPD overlap and ILA showed higher levels of KL-6, compared with patients with asthma-COPD overlap who lacked ILA.The clinical significance of KL-6 has also bee...

Development and validation of a model for predicting the early occurrence of RF in ICU-admitted AECOPD patients: a retrospective analysis based on the MIMIC-IV database

“…ILD is a collection of diseases and has the characteristics of inflammation and fibrosis infiltration of the interstitium, which significantly alter the alveolar epithelium and capillary endothelium [24]. A study has pointed out that patients with ILD have a higher mortality rate compared with those with isolated COPD [25]. Our investigation is consistent with previous research, revealing that the presence of ILD is a risk factor for the occurrence of RF in people with AECOPD.…”

Sarcopenia in Outcome in Chronic Obstructive Pulmonary Disease: Is the Tip of the Iceberg? - Authors’ Reply

“…We appreciate the insightful comments from Sungurtekin et al 1 on our study that investigated the correlation between low muscle mass and poor clinical outcomes in chronic obstructive pulmonary disease (COPD) patients 2 . They pointed out areas where our research design could be improved and raised valid concerns.…”

Sarcopenia in Outcome in Chronic Obstructive Pulmonary Disease: Is the Tip of the Iceberg?

“…We read with much interest the article by Choi et al 1 , who retrospectively reviewed the records of all patients with chronic obstructive pulmonary disease (COPD) in three hospitals for a 1-year period in Korea. In 24,502 patients with COPD, skeletal muscle mass was significantly correlated with the acute exacerbation of COPD.…”

“…Nutritional intervention is most effective when combined with physical and pulmonary exercise programs. Knowing the nutritional support and exercise status of the patients participating in the study by Choi et al 1 would have made the study more meaningful and detailed.…”

“…The article by Choi et al 1 had a retrospective design and was non-protocolized. They also stated that was a limitation for bioelectrical impedance analysis (BIA) for muscle mass measurements.…”