Pulmonary Rehabilitation in Patients With Advanced Idiopathic Pulmonary Fibrosis Referred for Lung Transplantation

Fontoura, Fabrício Farias da; Berton, Danilo Cortozi; Watte, Guilherme; Florian, Juliessa; Schio, Sadi Marcelo; Camargo, José de Jesus Peixoto; Teixeira, Paulo José Zimermann; Moreira, José da Silva

doi:10.1097/hcr.0000000000000315

Cited by 25 publications

(34 citation statements)

References 12 publications

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“…Female patients have also been shown to discontinue treatment more frequently,23 which could suggest that physicians feel less compelled to keep patients on medication when the diagnosis is less certain. This gender-based treatment gap extends to non-pharmacological therapies such as exercise rehabilitation, where male patients make up a greater proportion of the study population in pulmonary rehabilitation studies 24 25. A similar disparity was found among lung transplant recipients, with male patients receiving more transplants than female patients with IPF, despite male gender being associated with a higher risk of death 26 27…”

Section: Discussionmentioning

confidence: 87%

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Assayag

Morisset

Johannson

et al. 2020

Thorax

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BackgroundPatient sex has clinical and prognostic implications in idiopathic pulmonary fibrosis (IPF). It is not known if sex-related and gender-related discrepancies exist when establishing a diagnosis of IPF. The aim was to determine how patient gender influences the diagnosis of IPF and the physician’s diagnostic confidence.MethodsThis study was performed using clinical cases compiled from a single centre, then scored by respiratory physicians for a prior study. Using clinical information, physicians were asked to provide up to five diagnoses, together with their diagnostic confidence. Logistic regression was used to assess the odds of receiving a diagnosis of IPF based on patient gender. Prognostic discrimination between IPF and non-IPF was used to assess diagnostic accuracy with Cox proportional hazards modelling.ResultsSixty cases were scored by 404 physicians. IPF was diagnosed more frequently in men compared with women (37.8% vs 10.6%; p<0.0001), and with greater mean diagnostic confidence (p<0.001). The odds of a male patient receiving an IPF diagnosis was greater than that of female patients, after adjusting for confounders (OR=3.05, 95% CI: 2.81 to 3.31), especially if the scan was not definite for the usual interstitial pneumonia pattern. Mortality was higher in women (HR=2.21, 95% CI: 2.02 to 2.41) than in men with an IPF diagnosis (HR=1.26, 95% CI: 1.20 to 1.33), suggesting that men were more often misclassified as having IPF.ConclusionPatient gender influences diagnosis of IPF: women may be underdiagnosed and men overdiagnosed with IPF.

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Section: Discussionmentioning

confidence: 87%

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Assayag

Morisset

Johannson

et al. 2020

Thorax

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“…Out of this group, 31 participants successfully completed the PR, and the rest of the respondents did not show any significant differences in the parameters assessed before the start of PR. 36 In a meta-analysis of 9 PR programs for ILD patients, 8 programs were on an outpatient basis. The average duration was 10 weeks, with 2 sessions per week.…”

Section: Pulmonary Diseases Accompanying Ildsmentioning

confidence: 99%

Pulmonary rehabilitation in interstitial lung diseases: A review of the literature

Wytrychowski¹,

Hans-Wytrychowska²,

Piesiak³

et al. 2020

Adv Clin Exp Med

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There are more than 200 different diseases classed as interstitial lung diseases (ILDs). For epidemiological and practical purposes, ILDs are classified into diseases of known and unknown etiology. The aim of this review is to evaluate our current knowledge about the efficacy and safety of pulmonary rehabilitation (PR) in patients with ILDs. Other issues, such as ILD pathogenesis, prevalence and comorbidity, are also elaborated in the review. Pulmonary rehabilitation is an important part of comprehensive care for patients with ILDs. In comparison to PR for patients with chronic pulmonary obstructive disease (COPD), the number of clinical studies concerning PR for patients with ILDs is small. The majority of trials have been performed in relatively small groups of patients. The principles of PR in this group of patients are the same as for patients with COPD. Exercise-induced desaturation is frequently observed during PR, which is the main source of complications in patients with ILDs. Major differences between ILD and COPD patients include poorer exercise tolerance and faster development of respiratory failure in patients with ILDs.

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“…Current evidence on pulmonary rehabilitation in IPF shows significant short-term effects on improving exercise capacity (6MWD) and HRQL, while long-term effects are not maintained [157]. In addition, pulmonary rehabilitation has been shown to be useful in patients referred to lung transplantation [158]. Pulmonary rehabilitation should also include nutritional support [1], non-exercise components such as education [159], psychological [160] and symptom management [161], which are all of great importance in IPF.…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

The therapy of idiopathic pulmonary fibrosis: what is next?

et al. 2019

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease, characterised by progressive scarring of the lung and associated with a high burden of disease and early death. The pathophysiological understanding, clinical diagnostics and therapy of IPF have significantly evolved in recent years. While the recent introduction of the two antifibrotic drugs pirfenidone and nintedanib led to a significant reduction in lung function decline, there is still no cure for IPF; thus, new therapeutic approaches are needed. Currently, several clinical phase I–III trials are focusing on novel therapeutic targets. Furthermore, new approaches in nonpharmacological treatments in palliative care, pulmonary rehabilitation, lung transplantation, management of comorbidities and acute exacerbations aim to improve symptom control and quality of life. Here we summarise new therapeutic attempts and potential future approaches to treat this devastating disease.

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Pulmonary Rehabilitation in Patients With Advanced Idiopathic Pulmonary Fibrosis Referred for Lung Transplantation

Cited by 25 publications

References 12 publications

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Pulmonary rehabilitation in interstitial lung diseases: A review of the literature

The therapy of idiopathic pulmonary fibrosis: what is next?

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