| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Division of Pulmonary and Critical Care Medicine and Depts of 4 Radiology and 6 Pathology, University of Michigan Health System, Ann Arbor, MI, 2 Armed Forces Institute of Pathology, Washington DC, 3 Mayo Clinic, Scottsdale, AZ, and 5 Dept of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
CORRESPONDENCE: F.J. Martinez, Taubman Center 3916, 1500 E. Medical Center Dr. Ann Arbor, MI, 48109-0360, USA. Fax: 1 734 9365048. E-mail: fmartine@umich.edu
Keywords: idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, usual interstitial pneumonia
Received: February 23, 2001
Accepted September 6, 2001
This study was supported in part by National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) Grant #P50HL46487, NIH/NCRR 3 MO1 RR00042-33S3, NIH/NIA P60 AG08808-06 and NHLBI, 1 K24 HL04212-01.
Patients with idiopathic interstitial pneumonias (IIPs) can be subdivided into groups based on the histological appearance of lung tissue obtained by surgical biopsy. The quantitative impact of histological diagnosis, baseline factors and response to therapy on survival has not been evaluated.
Surgical lung biopsy specimens from 168 patients with suspected IIP were reviewed according to the latest diagnostic criteria. The impact of baseline clinical, physiological, radiographic and histological features on survival was evaluated using Cox regression analysis. The predictive value of honeycombing on high-resolution computed tomography (HRCT) as a surrogate marker for usual interstitial pneumonia (UIP) was examined. The response to therapy and survival of 39 patients treated prospectively with high-dose prednisone was evaluated.
The presence of UIP was the most important factor influencing mortality. The risk ratio of mortality when UIP was present was 28.46 (95% confidence interval (CI) 5.5–148.0; p=0.0001) after controlling for patient age, duration of symptoms, radiographic appearance, pulmonary physiology, smoking history and sex. Honeycombing on HRCT indicated the presence of UIP with a sensitivity of 90% and specificity of 86%. Patients with nonspecific interstitial pneumonia were more likely to respond or remain stable (9 of 10) compared to patients with UIP (14 of 29) after treatment with prednisone. Patients remaining stable had the best prognosis. The risk ratio of mortality for stable patients compared to nonresponders was 0.32 (95% CI 0.11–0.93; p=0.04) in all patients and 0.33 (95% CI 0.12–0.96; p=0.04) in patients with UIP.
The histological diagnosis of usual interstitial pneumonia is the most important factor determining survival in patients with suspected idiopathic interstitial pneumonia. The presence of honeycombing on high-resolution computed tomography is a good surrogate for usual interstitial pneumonia and could be utilized in patients unable to undergo surgical lung biopsy. Patients with nonspecific interstitial pneumonia are more likely to respond or remain stable following a course of prednisone. Patients remaining stable following prednisone therapy have the best prognosis.
This article has been cited by other articles:
|
|
 |
|
  A U Wells, N Hirani, and on behalf of the British Thoracic Society Intersti Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society Thorax, September 1, 2008; 63(Suppl_V): v1 - v58. [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Shin, K. S. Lee, M. P. Chung, J. Han, Y. A Bae, T. S. Kim, and M. J. Chung Prognostic Determinants among Clinical, Thin-Section CT, and Histopathologic Findings for Fibrotic Idiopathic Interstitial Pneumonias: Tertiary Hospital Study Radiology, August 5, 2008; (2008) 2483071378. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. D. Travis, G. Hunninghake, T. E. King Jr., D. A. Lynch, T. V. Colby, J. R. Galvin, K. K. Brown, M. P. Chung, J.-F. Cordier, R. M. du Bois, et al. Idiopathic Nonspecific Interstitial Pneumonia: Report of an American Thoracic Society Project Am. J. Respir. Crit. Care Med., June 15, 2008; 177(12): 1338 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Han, S. Murray, C. D. Fell, K. R. Flaherty, G. B. Toews, J. Myers, T. V. Colby, W. D. Travis, E. A. Kazerooni, B. H. Gross, et al. Sex differences in physiological progression of idiopathic pulmonary fibrosis Eur. Respir. J., June 1, 2008; 31(6): 1183 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thomeer, M. Demedts, J. Behr, R. Buhl, U. Costabel, C. D. R. Flower, J. Verschakelen, F. Laurent, A. G. Nicholson, E. K. Verbeken, et al. Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis Eur. Respir. J., March 1, 2008; 31(3): 585 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Huang, S. H. Wettlaufer, C. M. Hogaboam, K. R. Flaherty, F. J. Martinez, J. L. Myers, T. V. Colby, W. D. Travis, G. B. Toews, and M. Peters-Golden Variable Prostaglandin E2 Resistance in Fibroblasts from Patients with Usual Interstitial Pneumonia Am. J. Respir. Crit. Care Med., January 1, 2008; 177(1): 66 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Noth and F. J. Martinez Recent Advances in Idiopathic Pulmonary Fibrosis Chest, August 1, 2007; 132(2): 637 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B Gotway, M. M Freemer, and T. E King Jr Challenges in pulmonary fibrosis {middle dot} 1: Use of high resolution CT scanning of the lung for the evaluation of patients with idiopathic interstitial pneumonias Thorax, June 1, 2007; 62(6): 546 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Flaherty, A.-C. Andrei, T. E. King Jr., G. Raghu, T. V. Colby, A. Wells, N. Bassily, K. Brown, R. du Bois, A. Flint, et al. Idiopathic Interstitial Pneumonia: Do Community and Academic Physicians Agree on Diagnosis? Am. J. Respir. Crit. Care Med., May 15, 2007; 175(10): 1054 - 1060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M Rudd, R. J Prescott, J C Chalmers, I. D A Johnston, and for the Fibrosing Alveolitis Subcommittee of the R British Thoracic Society Study on cryptogenic fibrosing alveolitis: response to treatment and survival Thorax, January 1, 2007; 62(1): 62 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Raghu, D. Weycker, J. Edelsberg, W. Z. Bradford, and G. Oster Incidence and Prevalence of Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., October 1, 2006; 174(7): 810 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Flaherty, A.-C. Andrei, S. Murray, C. Fraley, T. V. Colby, W. D. Travis, V. Lama, E. A. Kazerooni, B. H. Gross, G. B. Toews, et al. Idiopathic Pulmonary Fibrosis: Prognostic Value of Changes in Physiology and Six-Minute-Walk Test Am. J. Respir. Crit. Care Med., October 1, 2006; 174(7): 803 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. J. Thannickal and A. U. Wells Classification of Interstitial Pneumonias: What Do Gene Expression Profiles Tell Us? Am. J. Respir. Crit. Care Med., January 15, 2006; 173(2): 141 - 142. [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Martinez Idiopathic Interstitial Pneumonias: Usual Interstitial Pneumonia versus Nonspecific Interstitial Pneumonia. Proceedings of the ATS, January 1, 2006; 3(1): 81 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Misumi and D. A. Lynch Idiopathic pulmonary fibrosis/usual interstitial pneumonia: imaging diagnosis, spectrum of abnormalities, and temporal progression. Proceedings of the ATS, January 1, 2006; 3(4): 307 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Martinez and K. Flaherty Pulmonary function testing in idiopathic interstitial pneumonias. Proceedings of the ATS, January 1, 2006; 3(4): 315 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Visscher and J. L. Myers Histologic spectrum of idiopathic interstitial pneumonias. Proceedings of the ATS, January 1, 2006; 3(4): 322 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A Pacanowski and G. W Amsden Interferon Gamma-1b in the Treatment of Idiopathic Pulmonary Fibrosis Ann. Pharmacother., October 1, 2005; 39(10): 1678 - 1686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Kinnula, C. L. Fattman, R. J. Tan, and T. D. Oury Oxidative Stress in Pulmonary Fibrosis: A Possible Role for Redox Modulatory Therapy Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 417 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Ito, S. Nagai, M. Kitaichi, A. G. Nicholson, T. Johkoh, S. Noma, D. S. Kim, T. Handa, T. Izumi, and M. Mishima Pulmonary Manifestations of Primary Sjogren's Syndrome: A Clinical, Radiologic, and Pathologic Study Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 632 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Flaherty, T. E. King Jr., G. Raghu, J. P. Lynch III, T. V. Colby, W. D. Travis, B. H. Gross, E. A. Kazerooni, G. B. Toews, Q. Long, et al. Idiopathic Interstitial Pneumonia: What Is the Effect of a Multidisciplinary Approach to Diagnosis? Am. J. Respir. Crit. Care Med., October 15, 2004; 170(8): 904 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Khalil and R. O'Connor Idiopathic pulmonary fibrosis: current understanding of the pathogenesis and the status of treatment Can. Med. Assoc. J., July 20, 2004; 171(2): 153 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A G Nicholson, B J Addis, H Bharucha, C A Clelland, B Corrin, A R Gibbs, P S Hasleton, K M Kerr, N B N Ibrahim, S Stewart, et al. Inter-observer variation between pathologists in diffuse parenchymal lung disease Thorax, June 1, 2004; 59(6): 500 - 505. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Jakubzick, E S Choi, S L Kunkel, H Evanoff, F J Martinez, R K Puri, K R Flaherty, G B Toews, T V Colby, E A Kazerooni, et al. Augmented pulmonary IL-4 and IL-13 receptor subunit expression in idiopathic interstitial pneumonia J. Clin. Pathol., May 1, 2004; 57(5): 477 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Monaghan, A. U. Wells, T. V. Colby, R. M. du Bois, D. M. Hansell, and A. G. Nicholson Prognostic Implications of Histologic Patterns in Multiple Surgical Lung Biopsies From Patients With Idiopathic Interstitial Pneumonias Chest, February 1, 2004; 125(2): 522 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Costabel Idiopathic pulmonary fibrosis: a treatable disease? Eur. Respir. J., December 1, 2003; 22(6): 872 - 873. [Full Text] [PDF]
|
|
|
|
|
|
V. N. Lama, K. R. Flaherty, G. B. Toews, T. V. Colby, W. D. Travis, Q. Long, S. Murray, E. A. Kazerooni, B. H. Gross, J. P. Lynch III, et al. Prognostic Value of Desaturation during a 6-Minute Walk Test in Idiopathic Interstitial Pneumonia Am. J. Respir. Crit. Care Med., November 1, 2003; 168(9): 1084 - 1090. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Kaminski, J. A. Belperio, P. B. Bitterman, L. Chen, S. W. Chensue, A. M.K. Choi, S. Dacic, J. H. Dauber, R. M. du Bois, J. J. Enghild, et al. Idiopathic Pulmonary Fibrosis Am. J. Respir. Cell Mol. Biol., September 1, 2003; 29(3): S1 - 105. [Full Text] [PDF]
|
|
|
|
|
|
K. R. Flaherty, J. A. Mumford, S. Murray, E. A. Kazerooni, B. H. Gross, T. V. Colby, W. D. Travis, A. Flint, G. B. Toews, J. P. Lynch III, et al. Prognostic Implications of Physiologic and Radiographic Changes in Idiopathic Interstitial Pneumonia Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 543 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Flaherty, T. V. Colby, W. D. Travis, G. B. Toews, J. Mumford, S. Murray, V. J. Thannickal, E. A. Kazerooni, B. H. Gross, J. P. Lynch III, et al. Fibroblastic Foci in Usual Interstitial Pneumonia: Idiopathic versus Collagen Vascular Disease Am. J. Respir. Crit. Care Med., May 15, 2003; 167(10): 1410 - 1415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. E. King Jr. Nonspecific Interstitial Pneumonia and Systemic Sclerosis Am. J. Respir. Crit. Care Med., June 15, 2002; 165(12): 1578 - 1579. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
