Correlated Studies of Interstitial Pulmonary Disease

Functional impairment in fibrosing alveolitis: relationship to reversible disease on thin section computed tomography

“…Recently, CHERNIACK et al [10] evaluated a large group of patients with CFA and found correlations between the alveolar desquamation score and TL,CO, and between interstitial cellularity and both FVC and TLC. By contrast, FULMER et al [8] TL,CO % pred on exercise and the degree of cell infiltration; whereas GREEN et al [9] found interstitial inflammation to correlate poorly with functional indices. In these studies, the severity of fibrosis correlated with change in arterial oxygen tension (Pa,O 2 ) on exercise, adjusted for respiratory work [8], resting Pa,O 2 [9], or bore no relationship to functional impairment [10].…”

“…By contrast, FULMER et al [8] TL,CO % pred on exercise and the degree of cell infiltration; whereas GREEN et al [9] found interstitial inflammation to correlate poorly with functional indices. In these studies, the severity of fibrosis correlated with change in arterial oxygen tension (Pa,O 2 ) on exercise, adjusted for respiratory work [8], resting Pa,O 2 [9], or bore no relationship to functional impairment [10]. CHINET et al [11] reported relationships between the severity both of fibrosis and inflammation, and a large number of functional measures, including lung volumes, TL,CO and oxygen desaturation on exercise; however, pulmonary function tests did not indicate the relative contributions made by inflammation and fibrosis to histological disease severity.…”

“…Previous studies evaluating the functional consequences of inflammation and fibrosis in fibrosing alveolitis have been based upon histological findings at open-lung biopsy [8][9][10][11]. Discrepant findings can be ascribed to low numbers of patients studied [8,9,11], the inclusion of heterogeneous groups of interstitial lung diseases [9,11], and the non-exclusion of patients with concurrent emphysema [8,9,11].…”

“…Discrepant findings can be ascribed to low numbers of patients studied [8,9,11], the inclusion of heterogeneous groups of interstitial lung diseases [9,11], and the non-exclusion of patients with concurrent emphysema [8,9,11]. Recently, CHERNIACK et al [10] evaluated a large group of patients with CFA and found correlations between the alveolar desquamation score and TL,CO, and between interstitial cellularity and both FVC and TLC.…”

“…If a routine pulmonary function variable was found to correlate selectively with the severity of inflammation, it would be an invaluable aid to management. Up to the present time, studies of relationships between functional indices and the severity of inflammation and fibrosis in interstitial lung disease have been based on histological findings at open lung biopsy and have yielded conflicting results [8][9][10][11]. However, functional-histopathological correlations suffer from a major flaw: regional disease severity varies greatly in fibrosing alveolitis, and thus the choice of biopsy site introduces major variability.…”