Comorbidities of Patients With Idiopathic Pulmonary Fibrosis in Four Latin American Countries. Are There Differences by Country and Altitude?

Abstract

Background: Comorbidities in idiopathic pulmonary fibrosis (IPF) affect quality of life, symptoms, disease progression and survival. It is unknown what are the comorbidities in patients with IPF in Latin America (LA) and if there are differences between countries. Our objective was to compare IPF comorbidities in four countries and analyze possible differences by altitude.Methods: Patients with IPF according 2012 ATS/ERS/JRS/ALAT guidelines, from two cities with an altitude of ≥2,250 m: Mexico City (Mexico) and Bogotá (Colombia) and from three at sea level: Buenos Aires (Argentina) and Lima and Trujillo (Peru). Comorbidities and pulmonary function tests were taken from clinical records. Possible pulmonary hypertension (PH) was defined by findings in the transthoracic echocardiogram of systolic pulmonary arterial pressure (sPAP) >36 mmHg or indirect signs of PH in the absence of other causes of PH. Emphysema as the concomitant finding of IPF criteria on chest tomography plus emphysema in the upper lobes. ANOVA or Kruskal Wallis and χ2-tests were used for comparison.Results: Two hundred and seventy-six patients were included, 50 from Argentina, 86 from Colombia, 91 from Mexico and 49 from Peru. There prevalence of PH was higher in Colombia and Mexico (p < 0.001), systemic arterial hypertension in Argentina (p < 0.015), gastro-esophageal reflux and dyslipidemia in Colombia and Argentina (p < 0.001) and diabetes mellitus in Mexico (p < 0.007). Other comorbidities were obesity (28.4%), coronary artery disease (15.2%) and emphysema (14.9%), with no differences between countries. There was more PH in the altitude cities than those at sea level (51.7 vs. 15.3%, p < 0.001). In patients from Bogotá and Mexico City, arterial oxygen pressure, saturation (p < 0.001) and carbon monoxide diffusing capacity (p = 0.004) were significantly lower than in cities at sea level.Conclusions: In this study with a significant number of patients, we were able to describe and compare the comorbidities of IPF in four LA countries, which contributes to the epidemiological data of this disease in the region. The main results were the differences in comorbidities between the countries and more PH in the subjects residing in the cities of higher altitude, a finding that should be validated in future studies.

Delineating excess comorbidities in idiopathic pulmonary fibrosis: an observational study

“…Estimates of comorbidity prevalence vary widely between studies, but the rates of multiple prevalent comorbidity identified in our study are in line with those documented in prior registry studies [ 9 , 27 ]. Regarding individual comorbidities, previous studies have generated comparable estimates of the prevalence of hypertension [ 9 , 28 ], cardiac disease [ 9 , 27 ], thyroid disease [ 27 ], GERD [ 9 ], cerebrovascular disease [ 10 ], heart failure [ 10 ] in IPF populations (Table 1 ). The prevalence of diabetes was lower in our IPF cohort than prior studies (11% versus 23–45%) [ 9 , 10 , 29 ], but depression was more commonly seen in our study than in prior reports (23% versus 3–15%) [ 9 , 10 , 29 ].…”

Risk factors for persistent tomographic abnormalities at 6 months of follow-up in a cohort of hospitalized patients with moderate and severe COVID-19 living at high altitude

“…These differences in saturation can be explained by altitude. Due to Bogotá’s location at 2,640 m above sea level, PaO 2 is around 60 mmHg and SaO 2 is 90% in normal patients, with significant desaturations during exercise in patients with interstitial lung disease ( 11 ). Despite these lower saturations at altitude, different studies suggest that this does not represent a negative impact on the mortality of patients with COVID-19 residing at high altitudes ( 37 ).…”

“…At altitude, due to lower barometric pressure and lower inspired pressure of oxygen, there are lower levels of arterial oxygen pressure and saturation in both normal subjects and patients with respiratory disease ( 10 , 11 ). More than 80 million people in the world live 2,500 m above sea level, mainly in Latin America and the Andean region ( 12 ).…”