Mixed Ventilatory Defects in Pulmonary Sarcoidosis Prevalence and Clinical Features
Por:
Kouranos, V, Ward, S, Kokosi, MA, Castillo, D, Chua, F, Judge, EP, Thomas, S, Van Tonder, F, Devaraj, A, Nicholson, AG, Maher, TM, Renzoni, EA, Wells, AU
Publicada:
1 nov 2020
Resumen:
BACKGROUND: In cohort studies of pulmonary sarcoidosis, abnormal ventilatory patterns have generally been subdivided into restrictive and obstructive defects. Mixed ventilatory defects have largely been overlooked in pulmonary sarcoidosis, as total lung capacity has seldom been taken into account in historical series.
RESEARCH QUESTION: This study evaluated the prevalence of mixed disease in pulmonary sarcoidosis and its clinical associations.
STUDY DESIGN AND METHODS: In patients with pulmonary sarcoidosis (N = 1,110), mixed defects were defined according to American Thoracic Society/European Respiratory Society criteria. Clinical data, pulmonary function variables, and vital status were abstracted from clinical records. Chest radiographs were evaluated independently by two experienced radiologists.
RESULTS: The prevalence of a mixed ventilatory defect was 10.4% in the whole cohort, rising to 25.9% in patients with airflow obstruction. Compared with isolated airflow obstruction, mixed defects were associated with lower diffusing lung capacity for carbon monoxide levels (50.7 16.3 vs 70.8 +/- 18.1; P < .0001), a higher prevalence of chest radiographic stage IV disease (63.5% vs 38.3%; P < .0001), and higher mortality (hazard ratio, 2.36; 95% CI, 1.34-4.15; P = .003). These findings were reproduced in all patient subgroup analyses, including patients with a histologic diagnosis, a clinical diagnosis, incident disease, and prevalent disease.
INTERPRETATION: Mixed disease is present in approximately 25% of patients with pulmonary sarcoidosis and airflow obstruction and is associated with lower diffusing lung capacity for carbon monoxide levels, a higher prevalence of stage IV disease, and higher mortality than seen in a pure obstructive defect. These observations identify a distinct phenotype associated with a mixed ventilatory defect, justifying future studies of its clinical and pathogenetic significance.
Filiaciones:
Kouranos, V:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Ward, S:
Royal Brompton Hosp, Lung Funct Dept, London, England
Kokosi, MA:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Castillo, D:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Hosp Santa Creu & Sant Pau, Interstitial Lung Dis Unit, Barcelona, Spain
Chua, F:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Judge, EP:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Thomas, S:
Royal Brompton Hosp, Lung Funct Dept, London, England
Van Tonder, F:
Royal Brompton Hosp, Dept Radiol, London, England
St Vincents Hosp Melbourne, Dept Radiol, Melbourne, Vic, Australia
Devaraj, A:
Royal Brompton Hosp, Dept Radiol, London, England
Nicholson, AG:
Royal Brompton & Harefield NHS Fdn Trust, Dept Histopathol, London, England
Imperial Coll, Natl Heart & Lung Inst, London, England
Maher, TM:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Imperial Coll, Natl Heart & Lung Inst, London, England
Imperial Coll, Natl Heart & Lung Inst, Fibrosis Res Grp, Royal Brompton Hosp London,NIHR Resp Clin Res Fac, London, England
Renzoni, EA:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Wells, AU:
Royal Brompton Hosp, Interstitial Lung Dis Unit, London, England
Green Submitted
|