Shortness of Breath in Patients with Progressive Fibrous Interstitial Lung Disease Associated with Cardio Ischemia

Abstract

Study Objective: To compare the quantitative aspects of shortness of breath in patients with fibrous interstitial lung disease (ILD) associated with cardio ischemia; to compare analysis results of the data obtained during functional and instrumental examinations. Study Design: Open comparative study in parallel groups. Materials and Methods. The study included 47 patients with fibrous ILD: 8 patients had idiopathic pulmonary fibrosis; 25 patients had chronic hypersensitive pneumonitis, and 14 patients had fibrous non-specific interstitial pneumonia. The patients were divided into two groups: study group of 24 patients with fibrous ILD associated with cardio ischemia, and 23 controls with fibrous ILD without cardio ischemia. We analysed clinical symptoms, instrumental examination results, changes in patients’ functional status with and without cardiac pathology. Study Results. In patients with fibrous ILD and cardio ischemia, respiratory symptoms were more intensive than in patients without cardio ischemia. Patients with fibrous ILD and cardio ischemia experienced worsening of their shortness of breath statistically earlier (in 3.15 days) vs patients with isolated fibrous ILD, who had shortness of breath in 7.29 days (p < 0.05). Patients with fibrous ILD and cardio ischemia demonstrated mixed functional changes: restrictive (reduced lung capacity and FVRC) and obstructive disorders (reduced FEV1 and instantaneous exhalation rate, МСВ25); statistically significant reduction in diffusing lung capacity, p < 0.05. A shorter 6-minute walking distance, more marked desaturation (SрO2 reduction by 8.31% in the study group and by 2.12% in controls, p < 0.05), higher scores of Borg Dyspnoea Scale and CRP scale (Clinical, Radiographic, and Physiologic scoring system) demonstrated statistically reduced tolerance to physical exercises in patients with cardio ischemia. CT scans did not reveal any differences in the intensity of interstitial changes in patients of both groups; “ground glass” areas were significantly more intense in patients with cardio ischemia, p < 0.05. Pulmonary hypertension and structural changes in right compartments of heart were recorded in patients in both groups; however, left ventricular hypertrophy and dysfunction were noted only in patients with cardio ischemia. Conclusion. In patients with fibrous ILD associated with cardio ischemia, intensification of shortness of breath can be a sign of a progressive respiratory disease or a new event: coronary event, atrial fibrillation attack, cardiac failure, chronic cor pulmonale. Assessment of the functional status using Borg Dyspnoea Scale, CRP, Medical Research Council Scale is a tool to identify the reasons of dyspnoea in primary care settings, to develop an algorithm for instrumental differential diagnosis of shortness of breath. Keywords: progressive fibrous interstitial lung diseases, quantification of shortness of breath, cardio ischemia.