Interstitial Lung Abnormalities and the Clinical Course in Patients With COPD

Interstitial lung abnormalities: new insights between theory and clinical practice

“…It must be acknowledged that most data on ILAs were obtained from studies involving research participants from general population cohorts, and from populations of smokers enriched for the presence of chronic-obstructive pulmonary disease (COPD), cardiovascular and lung cancer screening cohorts [ 9 , 11 , 12 , 24 , 33 – 37 ]. Indeed, those cohorts mostly included either elderly [ 9 , 38 , 39 ] or smokers [ 14 , 34 ], thus subjects at greater risk of ILAs.…”

“…This approach might be easier and more relevant in patients with other comorbidities (e.g., COPD). Noteworthy, patients with history of ILA and COPD are at a higher risk of pulmonary fibrosis and COPD exacerbations [ 33 ].…”

Interstitial lung abnormalities – current knowledge and future directions

“…Smokers with ILA also have increased odds of a restrictive lung deficit, decreased lung volumes, and decreased emphysema compared to their peers [ 5 ]. Still, COPD patients with ILA have higher rate of COPD exacerbations and accelerated lung function decline compared to others [ 21 ]. Measures of airway thickness are increased in both ILA and IPF [ 22 ] and CT detected vascular pruning, an indicator of decreased volume of pulmonary blood vessels, is associated with increased odds of ILA [ 23 ].…”

Interstitial Lung Abnormality Incidentally Detected on CT

“…The most important finding from the study by Lee et al 9 was that the presence of equivocal or definite ILA on CT scans was associated with increased risk of frequent exacerbations (defined as two or more acute moderateto-severe exacerbations per year), even after adjustment for other risk factors. On longitudinal follow up over a mean of 4.5 years, nonfibrotic ILA persisted in 63% of cases, while fibrotic ILA persisted in 60%; 30% of those with fibrotic ILA at baseline were classified as nonfibrotic at follow up, likely reflecting the subjective challenges of the identification ofsubtle signs of fibrosis in these individuals, Despite the differences in definition of ILA, the article by Lee et al 9 underscores the importance of ILA as a marker of increased respiratory morbidity. ILA are an important clinically relevant finding.…”

“…8 However, this article did not subcategorize subjects by the presence or absence of COPD. The article by Lee et al 9 in this issue of CHEST focuses on individuals with COPD and evaluates the relationship between ILA and COPD exacerbation. The authors found that 103 of 363 subjects (28%) had findings of definite ILA and that a further 44 patients (12%) had findings equivocal for ILA.…”