Effects of inflammation and fibrosis on pulmonary function in diffuse lung fibrosis.

Chinet, Thierry; Jaubert, Françis; Dusser, Daniel; Danel, Claire; Chrétien, J; Huchon, G

doi:10.1136/thx.45.9.675

Cited by 60 publications

(41 citation statements)

References 18 publications

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“…Although spirometry, lung volumes, and Dl CO correlated poorly with histologic abnormality, exercise gas exchange (Pa O 2 and P[a-a] O 2 ), corrected for achieved V o 2 , exhibited the best correlation with both histologic fibrosis and, to a lesser extent, cellularity. In 14 untreated patients with IPF, gas transfer and lung volumes correlated with the extent of fibrosis and cellular infiltration; both of these correlated more strongly than gas exchange with exercise (27). Cherniack and coworkers, using a more extensive semiquantitative histologic scoring system in 96 patients with IPF, noted no significant correlation between histologic fibrosis and any physiologic parameter (10).…”

Section: Can Pulmonary Function Testing Establish Disease Severity?mentioning

confidence: 99%

Pulmonary Function Testing in Idiopathic Interstitial Pneumonias

Martínez

Flaherty

2006

Proceedings of the American Thoracic Society

139

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Diffuse parenchymal lung diseases are a group of disorders that involve the space between the epithelial and endothelial basement membranes and are generally segregated into four major categories. These include the idiopathic interstitial pneumonias, which are further categorized into seven clinical/radiologic/pathologic subsets. These disorders generally share a common pattern of physiologic abnormality characterized by a restrictive ventilatory defect and reduced diffusing capacity (DL CO ). Pulmonary function testing is often used and recommended in their assessment and management. The potential clinical application of physiologic testing includes to aid in diagnosis, although its value in differential diagnosis is limited. Pulmonary function testing also aids in establishing disease severity and in defining prognosis. In nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis, severely decreased DL CO has proven valuable in this regard. Similarly, exertional desaturation to less than 88% at baseline testing and a decrease in FVC (greater than 10%) over the course of short-term follow-up identify patients at particular risk of mortality. Finally, physiologic testing, especially spirometry and DL CO , have demonstrated value in monitoring response to therapy and identifying disease progression.

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Section: Can Pulmonary Function Testing Establish Disease Severity?mentioning

confidence: 99%

Pulmonary Function Testing in Idiopathic Interstitial Pneumonias

Martínez

Flaherty

2006

Proceedings of the American Thoracic Society

139

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“…Conceptually, a loss of DL,CO that is much less than a loss of volume (low DL,CO but high DL,CO/VA) might suggest an extraparenchymal abnormality, such as a pneumonectomy or chest wall restriction, whereas a loss of DL,CO that is much greater than a loss of volume (low DL,CO and low DL,CO/VA) might suggest parenchymal abnormalities. The relationship between DL,CO and lung volume, however, is not linear and markedly less than 1:1, so these simple ratios as traditionally reported do not provide an appropriate way to normalise DL,CO for lung volume [154][155][156][157][158][159]. Nonlinear adjustments may be considered, but their clinical utility must be established before they can be recommended.…”

Section: Dlco Interpretationmentioning

confidence: 99%

Interpretative strategies for lung function tests

Pellegrino¹

2005

Eur Respir J

5,004

4,636

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“…The extent of inflammation, (which is potentially reversible) and fibrosis (which is not) may be assessed either directly by open lung biopsy [6][7][8][9][10], or indirectly by bronchoalveolar lavage (BAL), which provides information on luminal alveolitis [4,[11][12][13][14][15][16]. Pulmonary function tests (PFT) do not differentiate between the relative contributions of cellular infiltration and fibrosis to functional impairment [5]. The epithelial lung clearance of aerosolized 99m Tcdiethylenetriamine penta-acetate (RC-DTPA), which is mainly an assessment of the permeability of the epithelium of the terminal respiratory units to solutes [17], has been found to be increased in various conditions characterized by the presence of inflammation and/or changes in lung volumes, including mediator release [18,19], increase in lung volumes [20,21], and DFA [20,22,23].…”

mentioning

confidence: 99%

“…Diffuse fibrosing alveolitis (DFA) is characterized by the infiltration of alveolar structures by inflammatory cells, that leads to progressive fibrosis [1][2][3][4][5]. The extent of inflammation, (which is potentially reversible) and fibrosis (which is not) may be assessed either directly by open lung biopsy [6][7][8][9][10], or indirectly by bronchoalveolar lavage (BAL), which provides information on luminal alveolitis [4,[11][12][13][14][15][16].…”

mentioning

confidence: 99%

Mechanisms of increased epithelial lung clearance of DTPA in diffuse fibrosing alveolitis

Labrune

Chinet²,

Collignon³

et al. 1994

Eur Respir J

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The aim of this study was to elucidate possible mechanisms of increased epithelial lung clearance in diffuse fibrosing alveolitis (DFA). We investigated the relationships between epithelial lung clearance as assessed by the clearance of aerosolized 99mTc-diethylene-triamine-penta-acetic acid (RC-DTPA), luminal alveolitis as assessed by bronchoalveolar lavage, and pulmonary function, in 30 nonsmokers with DFA. In 14 of these patients, RC-DTPA and lung function were determined before and during therapy with prednisolone (0.5 mg.kg-1 daily). RC-DTPA was higher in patients with DFA (4.45 +/- 2.50%.min-1) than in normal subjects (1.18 +/- 0.31%.min-1). RC-DTPA did not correlate with the number of alveolar neutrophils, but correlated positively with the number of alveolar lymphocytes, and negatively with vital capacity (VC). RC-DTPA decreased from 6.1 +/- 2.8 to 3.8 +/- 1.9%.min-1 with prednisolone. RC-DTPA before prednisolone correlated positively with the prednisolone-associated improvement in VC. We conclude that in patient with DFA, RC-DTPA is increased, and decreases but does not return to normal with corticosteroid therapy. Our data suggest that in DFA the increase in RC-DTPA could be related to the recoil-induced stretch of the respiratory epithelium and to alveolar lymphocytic inflammation.

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Effects of inflammation and fibrosis on pulmonary function in diffuse lung fibrosis.

Abstract: To investigate the relation between lung

Cited by 60 publications

References 18 publications

Pulmonary Function Testing in Idiopathic Interstitial Pneumonias

Pulmonary Function Testing in Idiopathic Interstitial Pneumonias

Interpretative strategies for lung function tests

Mechanisms of increased epithelial lung clearance of DTPA in diffuse fibrosing alveolitis

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