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In patients with hypersensitivity pneumonitis, presence of radiologic honeycombing suggests a poor prognosis in line with what might be expected with idiopathic pulmonary fibrosis, results of a recent study suggest.
When radiologic honeycombing was present, event-free survival was uniformly poor, regardless of whether the patient had hypersensitivity pneumonitis (HP) or idiopathic pulmonary fibrosis (IPF). By contrast, HP patients with nonhoneycomb fibrosis had longer event-free survival than IPF patients with honeycomb features on CT, wrote researchers led by Margaret L. Salisbury, MD, of the division of pulmonary and critical care medicine at the University of Michigan, Ann Arbor.
“Given the uniformly poor outcome among subjects with radiologic honeycombing, pursuit of invasive diagnostic tests directed at differentiating IPF from HP may be of limited value,” Dr. Salisbury and her coinvestigators wrote in Chest.
In the study, 117 patients with HP and 161 with IPF underwent high-resolution CT, results of which were evaluated by three thoracic radiologists. Patients with HP who had no fibrosis on CT had the best event-free median survival, or time to transplant or death, at greater than 14.73 years. For HP patients with nonhoneycomb fibrosis, that median survival was greater than 7.95 years, compared with just 5.20 years in IPF patients without honeycomb features.
Looking specifically at patients with honeycomb features, median event-free survival was poor for both HP and IPF patients, at 2.76 and 2.81 years, respectively.
The HP patients with no fibrosis had a significant improvement in percent predicted forced vital capacity over time, while fibrotic patients experienced significant declines, the investigators wrote. Thus, HP patients with nonhoneycomb fibrosis had forced vital capacity declines despite longer transplant-free survival.
“These results highlight the importance of making a correct diagnosis of HP versus IPF in patients with nonhoneycomb fibrosis, as well as the limited utility in differentiating HP from IPF among patients with radiologic honeycombing,” Dr. Salisbury and her coinvestigators concluded.
Dr. Salisbury reported grants from the National Institutes of Health during the study. Her coauthors reported disclosures related to the NIH, Bayer, Centocor, Gilead, Promedior, Ikaria, Genentech, Nycomed/Takeda, Pfizer, and others.
SOURCE: Salisbury ML et al. Chest. 2019 Apr;155(4):699-711.
This study provides “clearly defined” phenotypes that are practical and potentially important for stratification and prognosis in patients with hypersensitivity pneumonitis (HP), according to David A. Lynch, MB.
“They should be widely adopted,” Dr. Lynch wrote of the three HP CT phenotypes in an editorial.
The study adds further evidence on the significance of honeycombing in the clinical course of fibrotic HP versus that of idiopathic pulmonary fibrosis, he added. Symptom duration in the HP patients was similar regardless of nonfibrotic, fibrotic, or honeycomb patterns, and was not linked to survival time. With that in mind, classifying HP based on fibrosis and its pattern may be more useful in determining prognosis than traditional acute, subacute, or chronic classification
That said, the present study does not provide much information on what demographic or exposure factors were associated with three phenotypes.
“Further study of this question will be important,” Dr. Lynch wrote. “Additionally, it will be important to understand the histologic correlates of the CT phenotypes.”
Dr. Lynch is with the department of radiology at National Jewish Health in Denver. His remarks are taken from his editorial that appeared in Chest (2019;155[4]:655-6). Dr. Lynch reported disclosures related to Genentech, Boehringer Ingelheim, Veracyte, Boehringer Ingelheim, and the France Foundation.
This study provides “clearly defined” phenotypes that are practical and potentially important for stratification and prognosis in patients with hypersensitivity pneumonitis (HP), according to David A. Lynch, MB.
“They should be widely adopted,” Dr. Lynch wrote of the three HP CT phenotypes in an editorial.
The study adds further evidence on the significance of honeycombing in the clinical course of fibrotic HP versus that of idiopathic pulmonary fibrosis, he added. Symptom duration in the HP patients was similar regardless of nonfibrotic, fibrotic, or honeycomb patterns, and was not linked to survival time. With that in mind, classifying HP based on fibrosis and its pattern may be more useful in determining prognosis than traditional acute, subacute, or chronic classification
That said, the present study does not provide much information on what demographic or exposure factors were associated with three phenotypes.
“Further study of this question will be important,” Dr. Lynch wrote. “Additionally, it will be important to understand the histologic correlates of the CT phenotypes.”
Dr. Lynch is with the department of radiology at National Jewish Health in Denver. His remarks are taken from his editorial that appeared in Chest (2019;155[4]:655-6). Dr. Lynch reported disclosures related to Genentech, Boehringer Ingelheim, Veracyte, Boehringer Ingelheim, and the France Foundation.
This study provides “clearly defined” phenotypes that are practical and potentially important for stratification and prognosis in patients with hypersensitivity pneumonitis (HP), according to David A. Lynch, MB.
“They should be widely adopted,” Dr. Lynch wrote of the three HP CT phenotypes in an editorial.
The study adds further evidence on the significance of honeycombing in the clinical course of fibrotic HP versus that of idiopathic pulmonary fibrosis, he added. Symptom duration in the HP patients was similar regardless of nonfibrotic, fibrotic, or honeycomb patterns, and was not linked to survival time. With that in mind, classifying HP based on fibrosis and its pattern may be more useful in determining prognosis than traditional acute, subacute, or chronic classification
That said, the present study does not provide much information on what demographic or exposure factors were associated with three phenotypes.
“Further study of this question will be important,” Dr. Lynch wrote. “Additionally, it will be important to understand the histologic correlates of the CT phenotypes.”
Dr. Lynch is with the department of radiology at National Jewish Health in Denver. His remarks are taken from his editorial that appeared in Chest (2019;155[4]:655-6). Dr. Lynch reported disclosures related to Genentech, Boehringer Ingelheim, Veracyte, Boehringer Ingelheim, and the France Foundation.
In patients with hypersensitivity pneumonitis, presence of radiologic honeycombing suggests a poor prognosis in line with what might be expected with idiopathic pulmonary fibrosis, results of a recent study suggest.
When radiologic honeycombing was present, event-free survival was uniformly poor, regardless of whether the patient had hypersensitivity pneumonitis (HP) or idiopathic pulmonary fibrosis (IPF). By contrast, HP patients with nonhoneycomb fibrosis had longer event-free survival than IPF patients with honeycomb features on CT, wrote researchers led by Margaret L. Salisbury, MD, of the division of pulmonary and critical care medicine at the University of Michigan, Ann Arbor.
“Given the uniformly poor outcome among subjects with radiologic honeycombing, pursuit of invasive diagnostic tests directed at differentiating IPF from HP may be of limited value,” Dr. Salisbury and her coinvestigators wrote in Chest.
In the study, 117 patients with HP and 161 with IPF underwent high-resolution CT, results of which were evaluated by three thoracic radiologists. Patients with HP who had no fibrosis on CT had the best event-free median survival, or time to transplant or death, at greater than 14.73 years. For HP patients with nonhoneycomb fibrosis, that median survival was greater than 7.95 years, compared with just 5.20 years in IPF patients without honeycomb features.
Looking specifically at patients with honeycomb features, median event-free survival was poor for both HP and IPF patients, at 2.76 and 2.81 years, respectively.
The HP patients with no fibrosis had a significant improvement in percent predicted forced vital capacity over time, while fibrotic patients experienced significant declines, the investigators wrote. Thus, HP patients with nonhoneycomb fibrosis had forced vital capacity declines despite longer transplant-free survival.
“These results highlight the importance of making a correct diagnosis of HP versus IPF in patients with nonhoneycomb fibrosis, as well as the limited utility in differentiating HP from IPF among patients with radiologic honeycombing,” Dr. Salisbury and her coinvestigators concluded.
Dr. Salisbury reported grants from the National Institutes of Health during the study. Her coauthors reported disclosures related to the NIH, Bayer, Centocor, Gilead, Promedior, Ikaria, Genentech, Nycomed/Takeda, Pfizer, and others.
SOURCE: Salisbury ML et al. Chest. 2019 Apr;155(4):699-711.
In patients with hypersensitivity pneumonitis, presence of radiologic honeycombing suggests a poor prognosis in line with what might be expected with idiopathic pulmonary fibrosis, results of a recent study suggest.
When radiologic honeycombing was present, event-free survival was uniformly poor, regardless of whether the patient had hypersensitivity pneumonitis (HP) or idiopathic pulmonary fibrosis (IPF). By contrast, HP patients with nonhoneycomb fibrosis had longer event-free survival than IPF patients with honeycomb features on CT, wrote researchers led by Margaret L. Salisbury, MD, of the division of pulmonary and critical care medicine at the University of Michigan, Ann Arbor.
“Given the uniformly poor outcome among subjects with radiologic honeycombing, pursuit of invasive diagnostic tests directed at differentiating IPF from HP may be of limited value,” Dr. Salisbury and her coinvestigators wrote in Chest.
In the study, 117 patients with HP and 161 with IPF underwent high-resolution CT, results of which were evaluated by three thoracic radiologists. Patients with HP who had no fibrosis on CT had the best event-free median survival, or time to transplant or death, at greater than 14.73 years. For HP patients with nonhoneycomb fibrosis, that median survival was greater than 7.95 years, compared with just 5.20 years in IPF patients without honeycomb features.
Looking specifically at patients with honeycomb features, median event-free survival was poor for both HP and IPF patients, at 2.76 and 2.81 years, respectively.
The HP patients with no fibrosis had a significant improvement in percent predicted forced vital capacity over time, while fibrotic patients experienced significant declines, the investigators wrote. Thus, HP patients with nonhoneycomb fibrosis had forced vital capacity declines despite longer transplant-free survival.
“These results highlight the importance of making a correct diagnosis of HP versus IPF in patients with nonhoneycomb fibrosis, as well as the limited utility in differentiating HP from IPF among patients with radiologic honeycombing,” Dr. Salisbury and her coinvestigators concluded.
Dr. Salisbury reported grants from the National Institutes of Health during the study. Her coauthors reported disclosures related to the NIH, Bayer, Centocor, Gilead, Promedior, Ikaria, Genentech, Nycomed/Takeda, Pfizer, and others.
SOURCE: Salisbury ML et al. Chest. 2019 Apr;155(4):699-711.
FROM CHEST®