P3 Progression of early fibrotic ILA to established interstitial lung disease and mortality: observations from a regional centre

IF 0.4 Q4 EDUCATION & EDUCATIONAL RESEARCH
A. Achaiah, P. Lyon, E. Fraser, P. Saunders, R. Hoyles, R. Benamore, L. Ho
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Age – – 1.02 1.01 1.04 0.0001* 1.02 1.01 1.04 0.002* Gender – – 1.14 0.95 1.37 0.140 1.08 0.89 1.31 0.420 Nil ILD (ref. category) 355 (13.0%) 43 (12.1%) – – – <0.001* – – – <0.001* GGO only 279 (10.2%) 54 (19.3%) 1.67 1.12 2.50 0.011* 1.63 1.09 2.43 0.017* Reticulation only 603 (22.0%) 68 (11.3%) 1.09 0.74 1.59 0.667 1.01 0.69 1.48 0.966 Reticulation + GGO 373 (13.6%) 55 (14.7%) 1.43 0.96 2.13 0.079 1.39 0.93 2.07 0.108 Reticulation + Emph 133 (4.9%) 28 (2.1%) 2.32 1.45 3.71 <0.001* 2.08 1.29 3.35 0.003* Retic + GGO + Emph 150 (5.5%) 27 (18.0%) 1.74 1.07 2.81 0.025* 1.67 1.03 2.70 0.038* Probable UIP 490 (17.9%) 86 (17.5%) 1.58 1.10 2.28 0.014* 1.45 1.01 2.11 0.047* Definite UIP 272 (9.9%) 87 (32.0%) 2.82 1.95 4.10 <0.001* 2.55 1.76 3.69 <0.001* * P<0.05. GGO; ground glass opacities, UIP; Usual interstitial pneumonia, Emph; Emphysema. Poster sessions A68 Thorax 2021;76(Suppl 2):A1–A205 on N ovem er 3, 2021 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.114 on 8 N ovem er 221. D ow nladed fom Background Early detection and treatment of lung cancer through lowdose computed tomography (LDCT) screening reduces lung cancer mortality. Undiagnosed interstitial lung disease (ILD) can be incidentally detected on LDCT, but whether this leads to improved clinical outcomes is unclear. Methods The West London lung screening pilot invited eversmokers aged 55–75 for a lung health check, and LDCT for those meeting a prespecified lung cancer risk score. LDCTs were reported by 5 consultant thoracic radiologists with 8 years thoracic CT experience. Participants without known ILD and with (i) >10% interstitial lung abnormalities (ILAs) as defined by the Fleischner Society on LDCT (ii) 5–10% ILAs on LDCT and restrictive spirometry (pre-March 2020), (iii) ILAs >5% (without spirometry post-March 2020), (iv) progressive ILAs on serial imaging performed after 12–24 months, were referred for clinical evaluation to the ILD Unit at the Royal Brompton Hospital. Diagnoses were assigned after multidisciplinary team (MDT) discussion. Results ILAs of >5% extent on LDCT were identified in 39/ 1853 (2.1%) subjects screened between August 2018 and April 2021 (table 1). Respiratory symptoms were present in 18/39 (46.1%) and crackles were auscultated in 17 of 22 subjects (77.3%) undergoing physical examination. Past exposure to potential environmental triggers was noted in 21/39 (53.8%). Diagnostic bronchoalveolar lavage was performed in 7/39 (17.9%) and one patient underwent transbronchial lung cryobiopsy. After MDT discussion, ILD was concluded in 31/39 (79.5%) cases, of which 14/31 (45.2%) were diagnosed with IPF. In the IPF subgroup, antifibrotics were initiated in 7/14 (50%) of cases. In those diagnosed with other ILDs, immunomodulatory treatment was initiated in 2/25 (8%) subjects. Conclusion A large proportion of individuals with newly identified ILAs have an abnormal clinical examination and respiratory symptoms, consistent with the widely held suspicion that ILD is underdiagnosed in the community. Lung cancer screening in this demographic provides a unique opportunity to address this unmet health metric. Earlier identification of ILD, specifically IPF, allows institution of antifibrotic therapies proven to modify the natural history of the disease by preserving lung function and extending life. The cost-effectiveness of this approach for ILD screening warrants detailed evaluation. P5 HOW SHOULD PATIENTS WITH INTERSTITIAL LUNG ABNORMALITIES BE EVALUATED AND MONITORED? EXPERIENCE FROM A SECONDARY CARE INTERSTITIAL LUNG DISEASE CLINIC SL Liew, J Shaw, C Hayton, Z Borrill, G Ng Man Kwong. Royal Oldham Hospital, Manchester, UK; Wythenshawe Hospital, Manchester, UK; North Manchester General Hospital, Manchester, UK 10.1136/thorax-2021-BTSabstracts.115 Introduction Interstitial lung abnormalities (ILA) have been defined as incidental radiological parenchymal abnormalities without clinical suspicion of interstitial lung disease (ILD). It is recognised that they are clinically important due to increased risk of pulmonary fibrosis, exercise impairments and mortality. A recently published Fleischner Society position paper described three subcategories of ILA; non-subpleural, subpleural non-fibrotic and subpleural fibrotic. Little is known about the real world management of these patients. Methods We performed a retrospective analysis of an ILD database containing 1298 patients covering a population of 820,000. Results 55 patients with ILA were identified (61.8% male, median age 75 (IQR 69.5–79), current or ex-smokers 70.9%). 33/55(60%) were categorized as subpleural fibrotic, 15/55 (27.2%) as subpleural non-fibrotic and 7/55(12.7%) as nonsubpleural. Baseline pulmonary function showed a mean (S.D.) FVC% predicted of 98.76% (±19.94) and TLCO% predicted of 59.45%(±23.45). 42/55(76.3%) patients were followed up and 13/55(23.7%) were discharged with safety netting after initial consultation. A further 26 were discharged after a period of follow up (mean (S.D) 18.5(26.3) months). 16/55(29.1%) remain under active follow up, mean duration 22.3 months. 1 patient was rereferred after discharge. 11 (20%) patients died within 3 years of ILA identification. In those who died, there was no significant difference in age, co-morbidities or baseline pulmonary function compared to survivors. Cause of death was known in 7/11, one caused by lung cancer, none by ILD. 6/42(14.3%) reported worsening respiratory symptoms during the follow-up period. 27/42 patients had serial pulmonary function available at 12 months, of which 3(11.1%) had >10% decline in FVC. 23 had repeat Abstract P4 Table 1 Characteristics of the subjects Characteristics Subjects with ILAs","PeriodicalId":43460,"journal":{"name":"How-A Colombian Journal for Teachers of English","volume":null,"pages":null},"PeriodicalIF":0.4000,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"How-A Colombian Journal for Teachers of English","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/thorax-2021-btsabstracts.113","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"EDUCATION & EDUCATIONAL RESEARCH","Score":null,"Total":0}
引用次数: 0

Abstract

P3 Table 1 Univariate and multivariate cox regression analysis for outcome of mortality. Hazard ratios of ILD categories are expressed relative to Nil ILD group Table 1. Outcome = Mortality Univariate Multivariate Covariate n Death HR Lower Upper Sig. HR Lower Upper Sig. Age – – 1.02 1.01 1.04 0.0001* 1.02 1.01 1.04 0.002* Gender – – 1.14 0.95 1.37 0.140 1.08 0.89 1.31 0.420 Nil ILD (ref. category) 355 (13.0%) 43 (12.1%) – – – <0.001* – – – <0.001* GGO only 279 (10.2%) 54 (19.3%) 1.67 1.12 2.50 0.011* 1.63 1.09 2.43 0.017* Reticulation only 603 (22.0%) 68 (11.3%) 1.09 0.74 1.59 0.667 1.01 0.69 1.48 0.966 Reticulation + GGO 373 (13.6%) 55 (14.7%) 1.43 0.96 2.13 0.079 1.39 0.93 2.07 0.108 Reticulation + Emph 133 (4.9%) 28 (2.1%) 2.32 1.45 3.71 <0.001* 2.08 1.29 3.35 0.003* Retic + GGO + Emph 150 (5.5%) 27 (18.0%) 1.74 1.07 2.81 0.025* 1.67 1.03 2.70 0.038* Probable UIP 490 (17.9%) 86 (17.5%) 1.58 1.10 2.28 0.014* 1.45 1.01 2.11 0.047* Definite UIP 272 (9.9%) 87 (32.0%) 2.82 1.95 4.10 <0.001* 2.55 1.76 3.69 <0.001* * P<0.05. GGO; ground glass opacities, UIP; Usual interstitial pneumonia, Emph; Emphysema. Poster sessions A68 Thorax 2021;76(Suppl 2):A1–A205 on N ovem er 3, 2021 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.114 on 8 N ovem er 221. D ow nladed fom Background Early detection and treatment of lung cancer through lowdose computed tomography (LDCT) screening reduces lung cancer mortality. Undiagnosed interstitial lung disease (ILD) can be incidentally detected on LDCT, but whether this leads to improved clinical outcomes is unclear. Methods The West London lung screening pilot invited eversmokers aged 55–75 for a lung health check, and LDCT for those meeting a prespecified lung cancer risk score. LDCTs were reported by 5 consultant thoracic radiologists with 8 years thoracic CT experience. Participants without known ILD and with (i) >10% interstitial lung abnormalities (ILAs) as defined by the Fleischner Society on LDCT (ii) 5–10% ILAs on LDCT and restrictive spirometry (pre-March 2020), (iii) ILAs >5% (without spirometry post-March 2020), (iv) progressive ILAs on serial imaging performed after 12–24 months, were referred for clinical evaluation to the ILD Unit at the Royal Brompton Hospital. Diagnoses were assigned after multidisciplinary team (MDT) discussion. Results ILAs of >5% extent on LDCT were identified in 39/ 1853 (2.1%) subjects screened between August 2018 and April 2021 (table 1). Respiratory symptoms were present in 18/39 (46.1%) and crackles were auscultated in 17 of 22 subjects (77.3%) undergoing physical examination. Past exposure to potential environmental triggers was noted in 21/39 (53.8%). Diagnostic bronchoalveolar lavage was performed in 7/39 (17.9%) and one patient underwent transbronchial lung cryobiopsy. After MDT discussion, ILD was concluded in 31/39 (79.5%) cases, of which 14/31 (45.2%) were diagnosed with IPF. In the IPF subgroup, antifibrotics were initiated in 7/14 (50%) of cases. In those diagnosed with other ILDs, immunomodulatory treatment was initiated in 2/25 (8%) subjects. Conclusion A large proportion of individuals with newly identified ILAs have an abnormal clinical examination and respiratory symptoms, consistent with the widely held suspicion that ILD is underdiagnosed in the community. Lung cancer screening in this demographic provides a unique opportunity to address this unmet health metric. Earlier identification of ILD, specifically IPF, allows institution of antifibrotic therapies proven to modify the natural history of the disease by preserving lung function and extending life. The cost-effectiveness of this approach for ILD screening warrants detailed evaluation. P5 HOW SHOULD PATIENTS WITH INTERSTITIAL LUNG ABNORMALITIES BE EVALUATED AND MONITORED? EXPERIENCE FROM A SECONDARY CARE INTERSTITIAL LUNG DISEASE CLINIC SL Liew, J Shaw, C Hayton, Z Borrill, G Ng Man Kwong. Royal Oldham Hospital, Manchester, UK; Wythenshawe Hospital, Manchester, UK; North Manchester General Hospital, Manchester, UK 10.1136/thorax-2021-BTSabstracts.115 Introduction Interstitial lung abnormalities (ILA) have been defined as incidental radiological parenchymal abnormalities without clinical suspicion of interstitial lung disease (ILD). It is recognised that they are clinically important due to increased risk of pulmonary fibrosis, exercise impairments and mortality. A recently published Fleischner Society position paper described three subcategories of ILA; non-subpleural, subpleural non-fibrotic and subpleural fibrotic. Little is known about the real world management of these patients. Methods We performed a retrospective analysis of an ILD database containing 1298 patients covering a population of 820,000. Results 55 patients with ILA were identified (61.8% male, median age 75 (IQR 69.5–79), current or ex-smokers 70.9%). 33/55(60%) were categorized as subpleural fibrotic, 15/55 (27.2%) as subpleural non-fibrotic and 7/55(12.7%) as nonsubpleural. Baseline pulmonary function showed a mean (S.D.) FVC% predicted of 98.76% (±19.94) and TLCO% predicted of 59.45%(±23.45). 42/55(76.3%) patients were followed up and 13/55(23.7%) were discharged with safety netting after initial consultation. A further 26 were discharged after a period of follow up (mean (S.D) 18.5(26.3) months). 16/55(29.1%) remain under active follow up, mean duration 22.3 months. 1 patient was rereferred after discharge. 11 (20%) patients died within 3 years of ILA identification. In those who died, there was no significant difference in age, co-morbidities or baseline pulmonary function compared to survivors. Cause of death was known in 7/11, one caused by lung cancer, none by ILD. 6/42(14.3%) reported worsening respiratory symptoms during the follow-up period. 27/42 patients had serial pulmonary function available at 12 months, of which 3(11.1%) had >10% decline in FVC. 23 had repeat Abstract P4 Table 1 Characteristics of the subjects Characteristics Subjects with ILAs
P3早期纤维化性ILA发展为间质性肺病和死亡率:来自一个区域中心的观察
P3表1死亡率结局的单因素和多因素cox回归分析。表1表示ILD类别相对于无ILD组的风险比。结果=死亡率单因素多因素协变量n死亡HR上下限Sig. HR上下限Sig.年龄- - 1.02 1.01 1.04 0.0001* 1.02 1.01 1.04 0.002*性别- - 1.14 0.95 1.37 0.140 1.08 0.89 1.31 0.420无ILD(参考分类)355(13.0%)43(12.1%)- - 10%肺间质性异常(ILAs),由Fleischner协会在LDCT上定义(ii) 5-10%的ILAs和限制性肺活量测定(2020年3月前),(iii) ILAs >5%(2020年3月后无肺活量测定),(iv)在12-24个月后进行连续成像的进行性ILAs,被转介到皇家布朗普顿医院的ILD部门进行临床评估。多学科小组(MDT)讨论后分配诊断。结果2018年8月至2021年4月期间,筛查的39/ 1853名受试者(2.1%)在LDCT上发现ILAs >5%(表1)。18/39名受试者(46.1%)出现呼吸道症状,22名接受体检的受试者中有17名(77.3%)有听音。有21/39(53.8%)指出过去暴露于潜在的环境触发因素。诊断性支气管肺泡灌洗7例(17.9%),1例经支气管肺低温活检。经MDT讨论后,31/39(79.5%)例确诊为ILD,其中14/31(45.2%)诊断为IPF。在IPF亚组中,7/14(50%)的病例开始使用抗纤维化药物。在诊断为其他ild的患者中,有2/25(8%)的受试者接受了免疫调节治疗。结论大部分新确诊的ILD患者临床检查异常,伴有呼吸道症状,这与社区普遍认为ILD未被充分诊断的观点一致。在这一人群中进行肺癌筛查为解决这一未满足的健康指标提供了独特的机会。早期发现ILD,特别是IPF,使得抗纤维化治疗能够通过保持肺功能和延长生命来改变疾病的自然史。这种ILD筛查方法的成本效益值得详细评估。如何评估和监测间质性肺异常患者?二级护理间质性肺疾病诊所的经验:刘秀莲,邵俊杰,海顿,博瑞尔,黄文光。英国曼彻斯特皇家奥尔德姆医院;威森肖医院,曼彻斯特,英国;北曼彻斯特总医院,曼彻斯特,英国10.1136/thorax-2021- btsabstract .115间质性肺异常(ILA)被定义为没有临床怀疑为间质性肺疾病(ILD)的偶然放射学实质异常。由于肺纤维化、运动障碍和死亡率的增加,它们在临床上具有重要意义。最近发表的弗莱施纳学会立场文件描述了ILA的三个子类别;非胸膜下纤维化,胸膜下非纤维化和胸膜下纤维化。人们对这些病人的实际治疗知之甚少。方法:我们对一个ILD数据库进行回顾性分析,该数据库包含1298例患者,覆盖82万人口。结果55例ILA患者(男性61.8%,中位年龄75岁(IQR 69.5-79),当前或已戒烟者70.9%)。33/55(60%)为胸膜下纤维化,15/55(27.2%)为胸膜下非纤维化,7/55(12.7%)为非胸膜下纤维化。基线肺功能显示平均值(sd)。FVC%预测98.76%(±19.94),TLCO%预测59.45%(±23.45)。42/55例(76.3%)患者随访,13/55例(23.7%)患者在初次会诊后使用安全网出院。随访26例,平均(S.D) 18.5(26.3)个月后出院。16/55(29.1%)仍在积极随访,平均持续时间22.3个月。1例患者出院后转诊。11例(20%)患者在确诊后3年内死亡。在死亡患者中,与幸存者相比,在年龄、合并症或基线肺功能方面没有显著差异。在7/11事件中,死亡原因已知,一个是肺癌,没有一个是ILD。6/42(14.3%)报告在随访期间呼吸道症状恶化。42例患者中有27例在12个月时有连续肺功能,其中3例(11.1%)FVC下降>10%。摘要P4表1被试特征ILAs被试特征
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How-A Colombian Journal for Teachers of English
How-A Colombian Journal for Teachers of English EDUCATION & EDUCATIONAL RESEARCH-
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