Comorbidities in idiopathic pulmonary fibrosis: an underestimated issue

Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive and fibrosing lung disease with a poor prognosis. Between 60% and 70% of IPF patients die of IPF; the remaining causes of death may be due to comorbidities occurring in this ageing population. Interest in the role played by comorbidities in IPF has increased in the past few years. The optimal clinical management of IPF is multifaceted and not only involves antifibrotic treatment, but also vaccinations, oxygen supplementation, evaluation of nutritional status as well as psychological support and patient education. Symptom management, pulmonary rehabilitation, palliative care and treatment of comorbidities represent further areas of clinical intervention. This review analyses the major comorbidities observed in IPF, focusing on those that have the greatest impact on mortality and quality of life (QoL). The identification and treatment of comorbidities may help to improve patients' health-related QoL (i.e. sleep apnoea and depression), while some comorbidities (i.e. lung cancer, cardiovascular diseases and pulmonary hypertension) influence survival. It has been outlined that gathering comorbidities data improves the prediction of survival beyond the clinical and physiological parameters of IPF.

In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs.

“…[35] The in uence of comorbid conditions and interventions on IPF mortality has been increasingly studied over the last decade. [23] Our study supports the ndings of others who have shown age, sex [30,[36][37][38], race and smoking history [36,37,39] to confer differential mortality risk. We found that admission to an academic center was associated with higher mortality risk, which is similar to previous studies [34] and may re ect a higher acuity of illness.…”

“…Variables were selected based on previous studies. [23][24][25] A Bonferroni correction was applied using all eighteen terms in the multivariable logistic regression model resulting in statistical signi cance being accepted when p < 0.003. [26] The area under the curve of the receiver operator characteristic was calculated to assess risk explanation.…”

The efficacy of pulmonary rehabilitation in improving the clinical status in idiopathic pulmonary fibrosis

“…Some studies demonstrated that both diseases share common risk factors such as aging, smoking history and male gender and similar pathogenic mechanisms. Usually lung cancer develops as nodules close to fibrotic areas and the most diagnosed subtypes are the adenocarcinoma and squamous cell carcinoma, worsening the evolution of IPF patients (21,22).…”

“…The restrictive condition can reduce upper airway tone increasing their collapsibility and the nocturnal oxygen desaturation leads to an increased oxidative stress (25), both of these conditions leading to a poor prognosis of IPF. By using therapy with continuous positive air pressure we can see significant improvements in activities of daily living, quality of sleep, survival and ultimately quality of life (15,21,24,25).…”

“…Symptoms like anxiety and depression are commonly observed in patients with IPF. Also they are related to the functional status of patients and can cause an increase in dyspnea, physical disability and mortality and decrease exercise tolerance (21). Given that, comorbidities should be systematically explored in IPF because an appropriate treatment and an early recognition may help in optimizing the management and improving quality of life (15).…”