Clinical characteristics of Japanese patients with chronic obstructive pulmonary disease (COPD) with comorbid interstitial lung abnormalities: A cross-sectional study

Ono, Manabu; Kobayashi, Seiichi; Hanagama, Masakazu; Ishida, Masatsugu; Sato, Hikari; Makiguchi, Tomonori; Yanai, Masaru

doi:10.1371/journal.pone.0239764

“…The impact of emphysema spatial capacity in mortality was higher in patients with ILA, compared with patients who had emphysema alone (p=0.04). Although previous mentioned studies indicate poor prognosis of ILA in COPD patients, a previous study showed that the presence of ILA was associated with a lower exacerbation rate in patients with COPD [ 84 ].…”

Section: Prognosismentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Choi

¹

,

Song

²

,

Rhee

³

2022

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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.

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“…By contrast, LEE et al [60] evaluated 363 patients with COPD, 44 and 103 having respectively equivocal and definite ILA, and showed an association between ILA and the annual incidence of moderate to severe acute exacerbations (adjusted OR 2.03; p=0.45). In summary, low-dose CT signs of lung fibrosis can also be observed in COPD, but their clinical relevance remains to be determined and recent data on associations between COPD exacerbations and the presence of ILA are conflicting [59][60][61].…”

Section: Clinical Features Of Ilamentioning

confidence: 99%

Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives

Tomassetti

¹

,

Poletti²,

Ravaglia³

et al. 2022

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The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity defined as the incidental finding of computed tomography (CT) abnormalities affecting more than 5% of any lung zone. Two recent documents have redefined the borders of this entity and made the recommendation to monitor patients with ILA at risk of progression. In this narrative review, we will focus on some of the limits of the current approach, underlying the potential for progression to full-blown ILD of some patients with ILA and the numerous links between subpleural fibrotic ILA and idiopathic pulmonary fibrosis (IPF). Considering the large prevalence of ILA in the general population (7%), restricting monitoring only to cases considered at risk of progression appears a reasonable approach. However, this suggestion should not prevent pulmonary physicians from pursuing an early diagnosis of ILD and timely treatment where appropriate. In cases of suspected ILD, whether found incidentally or not, the pulmonary physician is still required to make a correct ILD diagnosis according to current guidelines, and eventually treat the patient accordingly.

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“…The impact of emphysema spatial capacity in mortality was higher in patients with ILA, compared with patients who had emphysema alone (p = 0.04). Although previous mentioned studies indicate poor prognosis of ILA in COPD patients, a previous study showed that the presence of ILA was associated with a lower exacerbation rate in patients with COPD 89 .…”

Section: Putman Et Al Analyzed the Data Of Four Major Cohort Studies Including The Framinghammentioning

confidence: 81%

Chronic obstructive pulmonary disease combined with interstitial lung disease

Choi¹,

Song²,

Rhee³

2022

Tuberc Respir Dis

3

0

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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...

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Clinical characteristics of Japanese patients with chronic obstructive pulmonary disease (COPD) with comorbid interstitial lung abnormalities: A cross-sectional study

Cited by 10 publications

References 30 publications

Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives

Chronic obstructive pulmonary disease combined with interstitial lung disease

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