2019年5月19日
A Single-Center Prospective Cohort Study of Diagnostic Procedure of Interstitial Pneumonia in Clinical Setting; The Importance of Distinguishing Chronic Hypersensitivity Pneumonitis from Idiopathic Pulmonary Fibrosis
ATS 2019 INTERNATIONAL CONFERENCE
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- 記述言語
- 英語
- 会議種別
- ポスター発表
- 主催者
- AMERICAN THORACIC SOCIETY
- 開催地
- Dallas, Texas, US
RATIONALE:
The diagnostic process of identifying the etiology of interstitial pneumonia (IP), in particular distinguishing between idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP), is clinically important but challenging. The aim of this study is to clarify the diagnostic process of interstitial pneumonia in clinical settings.
METHODS:
Single-centered prospective cohort study was performed to describe the identification process of the etiology of IP. This study was approved by the Tokyo Medical and Dental University Institutional Review Board (no. G2000-217). This study included untreated outpatients with IP diagnosed by chest high-resolution computed tomography (HRCT) at Tokyo Medical and Dental University Hospital between December 2015 and June 2018. The etiology of IP was determined by multidisciplinary discussion using clinical manifestations, radiologic findings and blood examinations.
RESULTS:
Of the 95 patients were enrolled (male of 56 and female of 39). The median (range) age was 69 (35-85). The median (range) observation period was 16 months (4-34). The rate of identifying the etiology in study periods is 42% (n=40). The numbers of diagnoses of IPF, CHP and collagen vascular disease-related interstitial pneumonia (CVD-IP) are 8, 17 and 15, respectively. The median (range) duration from the first-visit to the definite diagnosis was 1 month (0-27), 3 months (1-27) in IPF, 2 months (1-27) in CHP and 1 month (0-7) in CVD-IP, respectively. The number of patients who were diagnosed within 1 month were 10 of 25 (40%) in IPF and CHP group, and 12 of 15 (80%) in CVD-IP group (p=0.022), respectively. Twenty-one patients (13 in CHP, 2 in IPF and 6 in undiagnosed group) underwent the antigen avoidance tests, and 5 patients in CHP underwent the antigen inhalation provocation tests to decide CHP or not. For 11 patients (65%) in CHP, the result of the aforementioned tests contributed to their diagnosis.
CONCLUSION:
Some phenotypes such as CVD-IP could be diagnosed using blood examinations and clinical manifestations within a few months, while other phenotypes such as IPF and CHP took a relatively long period in this study. Due to the need of long time in diagnostic process of interstitial pneumonia, the antigen avoidance tests and the antigen inhalation provocation tests could be potential candidates to diagnose.
The diagnostic process of identifying the etiology of interstitial pneumonia (IP), in particular distinguishing between idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP), is clinically important but challenging. The aim of this study is to clarify the diagnostic process of interstitial pneumonia in clinical settings.
METHODS:
Single-centered prospective cohort study was performed to describe the identification process of the etiology of IP. This study was approved by the Tokyo Medical and Dental University Institutional Review Board (no. G2000-217). This study included untreated outpatients with IP diagnosed by chest high-resolution computed tomography (HRCT) at Tokyo Medical and Dental University Hospital between December 2015 and June 2018. The etiology of IP was determined by multidisciplinary discussion using clinical manifestations, radiologic findings and blood examinations.
RESULTS:
Of the 95 patients were enrolled (male of 56 and female of 39). The median (range) age was 69 (35-85). The median (range) observation period was 16 months (4-34). The rate of identifying the etiology in study periods is 42% (n=40). The numbers of diagnoses of IPF, CHP and collagen vascular disease-related interstitial pneumonia (CVD-IP) are 8, 17 and 15, respectively. The median (range) duration from the first-visit to the definite diagnosis was 1 month (0-27), 3 months (1-27) in IPF, 2 months (1-27) in CHP and 1 month (0-7) in CVD-IP, respectively. The number of patients who were diagnosed within 1 month were 10 of 25 (40%) in IPF and CHP group, and 12 of 15 (80%) in CVD-IP group (p=0.022), respectively. Twenty-one patients (13 in CHP, 2 in IPF and 6 in undiagnosed group) underwent the antigen avoidance tests, and 5 patients in CHP underwent the antigen inhalation provocation tests to decide CHP or not. For 11 patients (65%) in CHP, the result of the aforementioned tests contributed to their diagnosis.
CONCLUSION:
Some phenotypes such as CVD-IP could be diagnosed using blood examinations and clinical manifestations within a few months, while other phenotypes such as IPF and CHP took a relatively long period in this study. Due to the need of long time in diagnostic process of interstitial pneumonia, the antigen avoidance tests and the antigen inhalation provocation tests could be potential candidates to diagnose.