Serial 6-month change in forced vital capacity predicts subsequent decline and mortality in Japanese patients with newly diagnosed idiopathic pulmonary fibrosis |
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Authors: | Yukihiro Toi Reoto Takei Tomoki Kimura Kensuke Kataoka Toshiaki Matsuda Toshiki Yokoyama Junya Fukuoka Takeshi Johkoh Yasuhiro Kondoh |
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Affiliation: | 1. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan;2. Department of Laboratory of Pathology, Nagasaki University Hospital, Nagasaki, Japan;3. Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan;1. St. Marianna University School of Medicine, Division of Respiratory Medicine, Kanagawa, Japan;2. Respiratory Center, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-0073, Japan;1. Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;2. Department of Infectious Diseases, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;3. Department of Pulmonary Medicine, Awaji Medical Center, Japan;4. Department of Pulmonary Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan;5. Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;1. Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan;2. Department of Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan;3. Department of Pulmonary Medicine, Sendai Kousei Hospital, 4-15 Aoba-ku, Sendai, Miyagi, 980-0873, Japan;4. Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan;5. Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, 1-9-6 Naka-ku, Hiroshima, 730-8619, Japan;6. Department of Respiratory Internal Medicine, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan;7. Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan;8. Department of Pharmacology, School of Pharmaceutical Sciences at Fukuoka International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501, Japan;1. Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan;2. Kinki Hokuriku Airway Disease Conference, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan;3. NPO Sapporo Cough Asthma and Allergy Center, Minami 4-jo Nishi 15-chome, Chuo-ku, Sapporo, 064-0804, Japan;4. Hiroshima Allergy and Respiratory Clinic, 14-7 Hatchobori, Naka-ku, Hiroshima, 730-0013, Japan |
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Abstract: | BackgroundThe clinical course of idiopathic pulmonary fibrosis (IPF) is characterized by a progressive decline in lung function; however, predicting changes in lung function is difficult. We sought to determine whether the prior 6-month trend in forced vital capacity (FVC) could predict mortality and the subsequent 6-month trend in FVC.MethodsWe retrospectively analyzed consecutive patients with newly diagnosed IPF who underwent serial pulmonary function tests. The immediate two years after the initial evaluation were divided into four terms of six months each and stratified on the basis of presence or absence of a ≥10% relative decline in FVC at six months (declined and stable groups, respectively).ResultsWe included 107 patients with %predicted FVC of 80.8% and %predicted diffusing capacity of the lung for carbon monoxide of 58.9%. In multivariate analysis, a decline in %predicted FVC in the initial six months was found to be an independent prognostic factor (hazard ratio 4.45, 95% confidence interval 2.62–7.56, p < 0.01). Among the 46 terms in which the FVC declined during the initial 1.5-year study period, a decline in FVC was exhibited in 23 (50.0%) of the subsequent terms. Among 231 terms in which FVC remained stable, a decline was observed in 32 (13.9%) of the subsequent terms (relative risk 3.61, p < 0.01). The frequency of FVC decline in each term was 16–27%. FVC was stable or declined in all four terms in 50.5% and 15.9% of cases, respectively.ConclusionsSix-month decline in FVC predicts subsequent FVC change and mortality in IPF patients in the era of antifibrotic agents. |
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Keywords: | Clinical outcome Forced vital capacity Idiopathic pulmonary fibrosis Prognosis Relative decline in FVC ATS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" American Thoracic Society diffusing capacity of the lung for carbon monoxide ERS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" European Respiratory Society FVC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" forced vital capacity GAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" gender, age physiology IPF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" idiopathic pulmonary fibrosis PFT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" pulmonary function test RR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" relative risk |
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