Increased respiratory morbidity in individuals with interstitial lung abnormalities

Abstract

Background: Interstitial lung abnormalities (ILA) are common in participants of lung cancer screening trials and broad population-based cohorts. They are associated with increased mortality, but less is known about disease specific morbidity and healthcare utilisation in individuals with ILA. Methods: We included all participants from the screening arm of the Danish Lung Cancer Screening Trial with available baseline CT scan data (n = 1990) in this cohort study. The baseline scan was scored for the presence of ILA and patients were followed for up to 12 years. Data about all hospital admissions, primary healthcare visits and medicine prescriptions were collected from the Danish National Health Registries and used to determine the participants' disease specific morbidity and healthcare utilisation using Cox proportional hazards models. Results: The 332 (16.7%) participants with ILA were more likely to be diagnosed with one of several respiratory diseases, including interstitial lung disease (HR: 4.9, 95% CI: 1.8-13.3, p = 0.008), COPD (HR: 1.7, 95% CI: 1.2-2.3, p = 0.01), pneumonia (HR: 2.0, 95% CI: 1.4-2.7, p < 0.001), lung cancer (HR: 2.7, 95% CI: 1.8-4.0, p < 0.001) and respiratory failure (HR: 1.8, 95% CI: 1.1-3.0, p = 0.03) compared with participants without ILA. These findings were confirmed by increased hospital admission rates with these diagnoses and more frequent prescriptions for inhalation medicine and antibiotics in participants with ILA. Conclusions: Individuals with ILA are more likely to receive a diagnosis and treatment for several respiratory diseases, including interstitial lung disease, COPD, pneumonia, lung cancer and respiratory failure during long-term follow-up.

Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study

“…It includes men and women born from 1907 to 1935; the average age of participants enrolled in this study amounted to seventy-six. Hoyer et al [ 35 ] reported that ILA subjects were subject to respiratory disease such as chronic obstructive pulmonary disease, lung cancer and pneumonia. However, the cause of death of participants was not identified in our study.…”

Spectrum of Pulmonary Fibrosis from Interstitial Lung Abnormality to Usual Interstitial Pneumonia: Importance of Identification and Quantification of Traction Bronchiectasis in Patient Management

“…However, early diagnosis or more careful follow-up of ILAs may be required with the possibility of progression in mind. Increased comorbidities, such as lung cancer and other respiratory diseases, should also be considered during follow-up ( Table 5 ) [ 72 81 82 83 84 ].…”

Interstitial lung abnormalities – current knowledge and future directions

“…In addition to mortality, ILA have been associated with several disease processes. A lung cancer screening study has found an increased risk of ILD diagnosis among participants with ILA [ 19 ]. Patients with ILA have been found to have decreased odds of COPD and decreased COPD severity in a cohort study [ 5 ].…”

“…Patients with ILA have been found to have decreased odds of COPD and decreased COPD severity in a cohort study [ 5 ]. Still, a later case-control study among smokers failed to show a significant association with COPD and a lung cancer screening study has suggested increased risk of COPD diagnoses among participants with ILA [ 19 , 52 ]. Another study has associated ILA with Group B of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of COPD [ 53 ].…”

“…Lung cancer screening studies or retrospective studies of lung cancer patients have consistently found participants with ILA to be at increased risk of lung cancer and lung cancer mortality [ 10 , 19 , 20 , 59–64 ]. Findings from a general-population cohort support these findings [ 65 ].…”