Thyroid Disease Is Prevalent and Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis

Oldham, Justin M.; Kumar, Disha; Lee, Cathryn; Patel, Shruti; Takahashi-Manns, Stephenie; Demchuk, Carley; Strek, Mary E.; Noth, Imre

doi:10.1378/chest.14-2714

Cited by 55 publications

(47 citation statements)

References 44 publications

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“…We also showed hyperthyroidism to be associated with mortality in this IPAF cohort, similar to a previous study of patients with IPF at our centre [20], but this association was not maintained after multivariable adjustment. Similarly, a UIP pattern was associated with increased mortality risk in univariate analysis, but not after multivariable adjustment.…”

Section: Discussionsupporting

confidence: 89%

Characterisation of patients with interstitial pneumonia with autoimmune features

et al. 2016

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Patients with interstitial lung disease (ILD) may have features of connective tissue disease (CTD), but lack findings diagnostic of a specific CTD. A recent European Respiratory Society/American Thoracic Society research statement proposed criteria for patients with interstitial pneumonia with autoimmune features (IPAF). We applied IPAF criteria to patients with idiopathic interstitial pneumonia and undifferentiated CTD-ILD (UCTD). We then characterised the clinical, serological and morphological features of the IPAF cohort, compared outcomes to other ILD cohorts and validated individual IPAF domains using survival as an endpoint. Of 422 patients, 144 met IPAF criteria. Mean age was 63.2 years with a slight female predominance. IPAF cohort survival was marginally better than patients with idiopathic pulmonary fibrosis, but worse than CTD-ILD. A non-usual interstitial pneumonia pattern was associated with improved survival, as was presence of the clinical domain. A modified IPAF cohort of those meeting the clinical domain and a radiographic or histological feature within the morphological domain displayed survival similar to those with CTD-ILD. IPAF is common among patients with idiopathic interstitial pneumonia and UCTD. Specific IPAF features can identify subgroups with differential survival. Further research is needed to replicate these findings and determine whether patients meeting IPAF criteria benefit from immunosuppressive therapy.

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Section: Discussionsupporting

confidence: 89%

Characterisation of patients with interstitial pneumonia with autoimmune features

et al. 2016

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“…IPF patients with CAD have been reported to have worse outcomes [ 12 ]. If CVDs were diagnosed after the diagnosis of IPF, this was associated with increased mortality in IPF as was also the presence of either diabetes or thyroid disease [ 11 ]. In contrast, in our study, diabetes, thyroid medication and CAD alone did not influence survival, and furthermore, the CVDs and CAD had been most often diagnosed before the diagnosis of IPF.…”

Section: Discussionmentioning

confidence: 99%

Effect of smoking and comorbidities on survival in idiopathic pulmonary fibrosis

et al. 2017

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BackgroundCigarette smoking has been associated with the risk of idiopathic pulmonary fibrosis (IPF). Certain comorbidities have been associated with reduced survival although some studies have indicated that current smokers have a longer survival than ex-smokers. Comorbidities in relation to smoking history have not been previously analyzed.MethodsRetrospective data was collected and patients were categorized according to gender and smoking habits. Comorbidities and medications were collected. Predictive values for mortality were identified by COX proportional hazard analyses.ResultsWe examined 45 non-smokers (53.3% female), 66 ex-smokers (9.1% female) and 17 current smokers (17.6% female) with IPF. Current smokers were younger at baseline (58.1 ± 8.74 years) compared to non-smokers (71.4 ± 8.74, p < 0.001) and ex-smokers (72.5 ±7.95, p <0.001). Median survival of non-smokers and current smokers was longer (55.0 and 52.0 months, respectively) than that of ex-smokers (36.0 months) (p=0.028 and 0.034, respectively). In age and severity adjusted analyses, smoking was not related to survival. Cardiovascular diseases (CVD) (72.7 %) were the most common comorbidities, current smokers had more chronic obstructive pulmonary disease (COPD) and lung cancer compared to ex-smokers (p<0.001). CVD, COPD and use of insulin were related to poorer survival in adjusted analyses.ConclusionsSmoking seems to influence the course of disease in IPF since current smokers developed the disease at a younger age in comparison to non-smokers and ex-smokers. No significant differences in the major comorbidities were detected between IPF patients with different smoking histories. The mechanism through which smoking influences IPF progression requires further investigation.

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“…Roughly 70–80% of individuals with IPF endorse a history of cigarette smoking, which has long been an established IPF risk factor ( 17 – 20 ). Not surprisingly, about 30% of IPF patients have concurrent pulmonary emphysema ( 21 , 22 ), including 8–27% with ≥10% emphysematous involvement throughout the lungs (Figure 1 ) ( 22 , 23 ).…”

Section: Pulmonary Comorbiditiesmentioning

confidence: 99%

“…While 1–2% of men and 5–9% of women in the general population carry a diagnosis of hypothyroidism ( 110 – 112 ), a recent case–control analysis demonstrated a substantially higher prevalence among individuals with IPF, with 13% of men and 28% of women affected ( 20 ). Furthermore, those with combined IPF and hypothyroidism had reduced survival compared to those with IPF alone.…”

Section: Endocrine/metabolic Comorbiditiesmentioning

confidence: 99%

Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management

Oldham

Collard²

2017

Front. Med.

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Idiopathic pulmonary fibrosis (IPF), a fibrosing interstitial pneumonia of unknown etiology, primarily affects older adults and leads to a progressive decline in lung function and quality of life. With a median survival of 3–5 years, IPF is the most common and deadly of the idiopathic interstitial pneumonias. Despite the poor survivorship, there exists substantial variation in disease progression, making accurate prognostication difficult. Lung transplantation remains the sole curative intervention in IPF, but two anti-fibrotic therapies were recently shown to slow pulmonary function decline and are now approved for the treatment of IPF in many countries around the world. While the approval of these therapies represents an important first step in combatting of this devastating disease, a comprehensive approach to diagnosing and treating patients with IPF remains critically important. Included in this comprehensive assessment is the recognition and appropriate management of comorbid conditions. Though IPF is characterized by single organ involvement, many comorbid conditions occur within other organ systems. Common cardiovascular processes include coronary artery disease and pulmonary hypertension (PH), while gastroesophageal reflux and hiatal hernia are the most commonly encountered gastrointestinal disorders. Hematologic abnormalities appear to place patients with IPF at increased risk of venous thromboembolism, while diabetes mellitus (DM) and hypothyroidism are prevalent metabolic disorders. Several pulmonary comorbidities have also been linked to IPF, and include emphysema, lung cancer, and obstructive sleep apnea. While the treatment of some comorbid conditions, such as CAD, DM, and hypothyroidism is recommended irrespective of IPF, the benefit of treating others, such as gastroesophageal reflux and PH, remains unclear. In this review, we highlight common comorbid conditions encountered in IPF, discuss disease-specific diagnostic modalities, and review the current state of treatment data for several key comorbidities.

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Thyroid Disease Is Prevalent and Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis

Cited by 55 publications

References 44 publications

Characterisation of patients with interstitial pneumonia with autoimmune features

Characterisation of patients with interstitial pneumonia with autoimmune features

Effect of smoking and comorbidities on survival in idiopathic pulmonary fibrosis

Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management

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