Understanding cough in interstitial lung disease: a cross-sectional study on the adequacy of treatment.
- 作者列表："Lan NSH","Moore I","Lake F
BACKGROUND:Cough is a common symptom in interstitial lung disease (ILD) often with treatment dissatisfaction for patients and physicians. AIM:The objective of this study was to identify the prevalence and subjective adequacy of control of cough in patients with ILD. METHODS:A cross-sectional study of patients with ILD attending a tertiary ILD clinic in Perth was undertaken by a pre-designed questionnaire that patients were invited to complete when attending clinic. Cough severity and impact on quality of life was assessed using a visual analogue scale and validated Leicester cough questionnaire. Participants were asked to list triggers to their cough and strategies or medications trialled to control cough. RESULTS:Of 164 respondents, 118 (72%) had cough with prevalence common in all ILD subtypes. A lower FVC was found in the cough versus non-cough group (74.6 ± 18.7 vs 87.0 ± 15.9, p-value<0.0001). Common reported triggers were lung irritants, exertion and doing routine daily activities. Avoidance of triggers was a common strategy to control cough. A high prevalence of non-ILD causes of cough was recorded in both groups. A variety of medications had been trialled, including anti-fibrotics, immunosuppression drugs, inhalers and proton pump inhibitors, with moderate benefit reported by 18% of participants. CONCLUSIONS:Cough is prevalent in ILD but is not adequately suppressed. Cough has significant impact on quality of life leading patients to adopt their own strategies to control their cough. More study is needed to understand cough mechanisms in ILD and the interplay of other potential co-pathologies. This article is protected by copyright. All rights reserved.
背景: 咳嗽是间质性肺病 (ILD) 的常见症状，患者和医生往往对治疗不满意。 目的: 本研究的目的是确定 ILD 患者咳嗽控制的患病率和主观充分性。 方法: 通过预先设计的问卷对珀斯一家三级 ILD 诊所就诊的 ILD 患者进行横断面研究，邀请患者在就诊时完成。使用视觉模拟量表评估咳嗽严重程度和对生活质量的影响，并验证莱斯特咳嗽问卷。参与者被要求列出咳嗽的触发因素和控制咳嗽的试验策略或药物。 结果: 在 164 名受访者中，118 名 (72%) 有咳嗽，患病率在所有 ILD 亚型中很常见。咳嗽组 FVC 低于非咳嗽组 (74.6 ± 18.7 vs 87.0 ± 15.9，p 值 <0.0001)。常见的报告触发因素是肺部刺激物、劳累和日常活动。避免触发是控制咳嗽的常见策略。两组均记录到咳嗽的非 ILD 原因的高患病率。已经试验了多种药物，包括抗纤维化药物、免疫抑制药物、吸入器和质子泵抑制剂，18% 的参与者报告了中度获益。 结论: 咳嗽在 ILD 中普遍存在，但未得到充分抑制。咳嗽对生活质量有显著影响，导致患者采取自己的策略来控制咳嗽。需要更多的研究来了解 ILD 的咳嗽机制和其他潜在共同病理的相互作用。本文受版权保护。保留所有权利。
METHODS:OBJECTIVES:To asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated. METHODS:A longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6-12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI. RESULTS:A total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI. CONCLUSION:RA-ILD patients deteriorate over time, with the median time free of impairment being <2 years. Patients exposed to RTX had a higher probability of remaining free of FI compared with other therapies. Other factors have also been identified. Key words: rheumatoid arthritis, interstitial lung disease, observational study, rituximab and prognosis
METHODS:The safety of anti-programmed cell death 1 (PD-1) antibody for patients with preexisting interstitial lung disease (ILD) remains unknown. The aim of this study was to evaluate the dependence of preexisting ILD on anti-PD-1 antibody-induced pneumonitis in non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed the association of preexisting ILD with the incidence, radiographic pattern, and outcome of pneumonitis in NSCLC patients receiving anti-PD-1 antibody. A total of 331 patients were included in this study. Of these patients, 17 had preexisting ILD. The incidence of pneumonitis was higher among the patients with preexisting ILD than among those without preexisting ILD (29% vs. 10%, P = 0.027). The distributions of the CT appearances at the onset of anti-PD-1 antibody-induced pneumonitis were as follows: for the patients with preexisting ILD, two patients (40%) had diffuse alveolar damage (DAD), one patient each with organizing pneumonia-like (OP), hypersensitivity pneumonitis (HP), and other patterns (20% each); for the patients without preexisting ILD, 19 patients (61%) had OP, 8 (26%) had HP, 3 (10%) had DAD, and 1 (3.2%) had other patterns. The median onset time from the initiation of anti-PD-1 antibody treatment until the development of pneumonitis was 1.3 months (range 0.3–2.1 months) for the patients with preexisting ILD and 2.3 months (range 0.2–14.6 months) for the patients without preexisting ILD. Careful attention to the development of pneumonitis is needed, especially within the first 3 months after the start of anti-PD-1 antibody treatment, when using anti-PD-1 antibody to treat patients with preexisting ILD.
METHODS::Bacteria of the Burkholderia cepacia complex (Bcc) are ubiquitous multidrug resistant organisms and opportunistic pathogens capable of causing life threatening lung infections among cystic fibrosis (CF) patients. No effective therapies are currently available to eradicate Bcc bacteria from CF patients, as these organisms are inherently resistant to the majority of clinically available antimicrobials. An immunoproteomics approach was used to identify Bcc proteins that stimulate the humoral immune response of the CF host, using bacterial cells grown under conditions mimicking the CF lung environment and serum samples from CF patients with a clinical record of Bcc infection. 24 proteins of the Bcc strain B. cenocepacia J2315 were identified as immunoreactive, 19 here reported as immunogenic for the first time. Ten proteins were predicted as extracytoplasmic, 9 of them being conserved in Bcc genomes. The immunogenic Bcc extracytoplasmic proteins are potential targets for development of novel therapeutic strategies and diagnostic tools to protect patients against the onset of chronic Bcc lung infections.