Patients With Fibrotic Interstitial Lung Disease Hospitalized for Acute Respiratory Worsening

Moua, Teng; Westerly, Blair; Dulohery, Megan M.; Daniels, Craig; Ryu, Jay H.; Lim, Kaiser G.

doi:10.1016/j.chest.2015.12.026

Cited by 88 publications

(125 citation statements)

References 18 publications

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“…Non-elective hospitalisations are associated with considerable cost [63], and respiratory-related hospitalisations in particular have prognostic significance in IPF [64][65][66]. BROWN et al [65] have reported that most hospitalisations in IPF are respiratory-related, and associated with high in-hospital mortality and limited survival beyond discharge.…”

Section: Importance Of Non-elective Hospitalisationmentioning

confidence: 99%

“…Even in the setting of a respiratory-related hospitalisation, the presence of AE is associated with a worse prognosis. MOUA et al [66] reviewed consecutive patients with a fibrosing interstitial lung disease hospitalised with acute respiratory worsening and found that those diagnosed with an AE had a worse prognosis than those without (OR 4.06, 95% CI 1.32-13.8; p=0.014). These studies emphasise the prognostic importance of both non-elective and respiratory hospitalisation as well as AE in IPF.…”

Section: Importance Of Non-elective Hospitalisationmentioning

confidence: 99%

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Recent lessons learned in the management of acute exacerbation of idiopathic pulmonary fibrosis

2017

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Recognising recent advances, the definition and diagnostic criteria for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) have been updated by an international working group. The new definition describes any acute, clinically significant respiratory deterioration (both idiopathic and triggered events) characterised by evidence of new widespread alveolar abnormality. The new criteria require a previous or concurrent diagnosis of IPF, an acute worsening or development of dyspnoea typically less than 1 month in duration, chest imaging evidence on computed tomography (CT) of new bilateral ground-glass opacity and/or consolidation superimposed on a background imaging pattern of usual interstitial pneumonia not fully explained by cardiac failure or fluid overload. Due to high in-hospital mortality rates, current treatment guidelines say that the majority of patients with AE-IPF should not receive mechanical ventilation. However, new data suggest that the prognosis may have improved. This modest improvement in overall survival seen in more recent studies may be the result of differences in the diagnostic criteria, study design, baseline clinical risk factors and/or improvements in management. Based on our updated knowledge of possible preventive and therapeutic measures, including mechanical ventilation and pharmacological therapies, the current approach to the treatment of AE-IPF requires careful decision-making.

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Section: Importance Of Non-elective Hospitalisationmentioning

confidence: 99%

Section: Importance Of Non-elective Hospitalisationmentioning

confidence: 99%

Recent lessons learned in the management of acute exacerbation of idiopathic pulmonary fibrosis

2017

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“…Besides, Moua et al recently reported an extremely high mortality of 55%, in a cohort of 100 IPF patients hospitalised for acute respiratory worsening of whom 60% have a suspected acute exacerbation [28], suggesting that our population of patients experiencing acute respiratory worsening contains fewer acute exacerbations. As not all acute respiratory worsening are idiopathic acute exacerbation costs associated seem underestimated (€3,224).…”

Section: Discussionmentioning

confidence: 99%

Burden of Idiopathic Pulmonary Fibrosis Progression: A 5-Year Longitudinal Follow-Up Study

Cottin

Schmidt²,

Laura³

et al. 2017

PLoS ONE

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Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with an unpredictable course. An observational study was set up using the French hospital discharge database to describe the reasons, outcomes and costs of hospitalisations related to this disease. Patients newly hospitalised for idiopathic pulmonary fibrosis (ICD-10 code: J84.1) in 2008 were identified and followed for 5 years. As J84.1 includes other fibrotic pulmonary diseases, an algorithm excluding age<50 years and presence of a differential diagnosis in the following year was defined. Overall, 6,476 patients were identified; of whom 30% were admitted through the emergency unit and 12% died during their first hospitalisation. Most of patients were hospitalised at least once for one or several acute events (n = 5,635; 87.0% of patients), of whom 36.5% of patients with an acute respiratory worsening (in-hospital mortality of 17.0% and median cost of €3,224; interquartile range (IQR €889–6,092)), 43.7% of patients with a respiratory infection (in-hospital mortality of 29.5% and median cost of €5,432 (IQR, €3,620–9,115)) and 51.7% of patients with a cardiac event (in-hospital mortality of 35.7% and median cost of €4,584 (IQR, €2,803–6,399)); 30.2% of these events occurred during the first hospitalisation. Finally, the 3-year in-hospital mortality crude rate was 36.8%. This study is the first providing extensive data on hospitalisations in patients with pulmonary fibrosis, mostly idiopathic, in France, demonstrating high burden and hospital cost.

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“…The reported 1-month mortality rate is approximately 60% [3], and the reported in-hospital mortality rate ranges from 50 to 60% [1, 4]. …”

Section: Introductionmentioning

confidence: 99%

Azithromycin for idiopathic acute exacerbation of idiopathic pulmonary fibrosis: a retrospective single-center study

et al. 2017

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BackgroundAcute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a fatal condition without an established pharmaceutical treatment. Most patients are treated with high-dose corticosteroids and broad-spectrum antibiotics. Azithromycin is a macrolide with immunomodulatory activity and may be beneficial for treatment of acute lung injury. The objective of this study was to determine the effect of azithromycin on survival of patients with idiopathic AE of IPF.MethodsWe evaluated 85 consecutive patients hospitalized in our department for idiopathic AE of IPF from April 2005 to August 2016. The initial 47 patients were treated with a fluoroquinolone-based regimen (control group), and the following 38 consecutive patients were treated with azithromycin (500 mg/day) for 5 days. Idiopathic AE of IPF was defined using the criteria established by the 2016 International Working Group.ResultsMortality in patients treated with azithromycin was significantly lower than in those treated with fluoroquinolones (azithromycin, 26% vs. control, 70%; p < 0.001). Multivariate analysis revealed that the two variables were independently correlated with 60-day mortality as determined by the Acute Physiology and Chronic Health Evaluation II score (p = 0.002) and azithromycin use (p < 0.001).ConclusionAzithromycin may improve survival in patients with idiopathic AE of IPF.

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Patients With Fibrotic Interstitial Lung Disease Hospitalized for Acute Respiratory Worsening

Cited by 88 publications

References 18 publications

Recent lessons learned in the management of acute exacerbation of idiopathic pulmonary fibrosis

Recent lessons learned in the management of acute exacerbation of idiopathic pulmonary fibrosis

Burden of Idiopathic Pulmonary Fibrosis Progression: A 5-Year Longitudinal Follow-Up Study

Azithromycin for idiopathic acute exacerbation of idiopathic pulmonary fibrosis: a retrospective single-center study

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