https://doi.org/10.55788/6398bd40
Dr Elizabeth Renzoni (Royal Brompton Hospital, UK), who presented the new guidelines at ATS 2022, explained that IPF can be identified through radiological and histologic characteristics of usual interstitial pneumonia (UIP) [1]. A diagnosis of UIP via biopsy is based on a set of histopathological features. Although transbronchial lung cryobiopsy (TBLC) is more likely to detect a probable UIP pattern than a definite UIP pattern compared with surgical lung biopsy (SLB), a novel systematic review has been published since the development of the IPF guidelines of 2018, demonstrating that TBLC may be a valid alternative to SLB in experienced centres [3,4]. Therefore, the committee made the conditional recommendation that TBLC may be an alternative to SLB when making a histopathological diagnosis in patients with ILD.
The committee did not make a recommendation for the use of an additional genomic classifier test in patients with ILD who are being diagnosed for UIP through transbronchial forceps biopsy, due to a lack of consensus between the members. Although the systematic review that was analysed to make an informed decision on this topic did not lead to a recommendation, the experts agreed that the use of genomic classifier testing should be revised if new studies are being published [5].
Furthermore, 2 treatment-related recommendations were made. Firstly, a conditional recommendation was made to not use antacid medication in patients with IPF if the goal is to improve respiratory outcomes. A recently published systematic review did not reveal definitive benefits of antacid medication to treat respiratory issues in patients with IPF [6]. However, antacid medication may still be appropriate in patients with IPF and gastro-oesophageal reflux disease (GERD) for treating GERD-related outcomes.
Additionally, the committee made the conditional recommendation that patients with IPF should not be referred to anti-reflux surgery with the goal of improving respiratory outcomes. The systematic review analysing this matter did not demonstrate a significant respiratory benefit for this type of surgery in patients with IPF but did show that surgical complications occurred in approximately 15% of the patients [6]. Nonetheless, anti-reflux surgery may still be appropriate in patients with IPF to treat GERD-related outcomes.
A definition of PPF in patients with non-IPF ILD
In patients with ILD, other than IPF, and with radiological evidence of pulmonary fibrosis, PPF was defined by the committee as the occurrence of at least 2 of the following 3 features, within the last 12 months, if no alternative explanation was present: worsening of respiratory symptoms, physiological evidence of disease progression, and radiological evidence of disease progression.
In addition, the committee made a conditional recommendation to use nintedanib for the treatment of PPF in patients with fibrotic ILD (other than IPF) who failed on standard management but emphasised that research is needed to establish the performance of nintedanib in specific ILDs that display PPF. This recommendation was based on a systematic review that demonstrated significant efficacy of nintedanib in patients with PPF, measured as the annual decline of forced vital capacity (FVC), without persistent adverse events if the therapy was discontinued [7].
Finally, the experts recommended that research needs to be conducted to assess the efficacy, effectiveness, and safety of pirfenidone in patients with non-IPF ILD who display PPF. Although the committee agreed that pirfenidone is a promising therapy for PPF, the systematic review that was studied by the group did not provide sufficient evidence to make a recommendation.
- Renzoni E, et al. Recent ILD Guidelines. Session PG10, ATS International Conference 2022, San Francisco, CA, USA, 13ā18 May.
- Raghu G, et al. Am J Respir Crit Care Med. 2022;205(9):e18āe47.
- Kheir F, et al. Ann Am Thorac Soc. 2022. Doi:10.1513/AnnalsATS.202102-198OC.
- Raghu G, et al. Am J Respir Crit Care Med 2018;198:e44āe68.
- Kheir F, et al. Ann Am Thorac Soc. 2022;19(5):827ā832.
- Khor YH, et al. Ann Am Thorac Soc. 2022;19(5):833ā844.
- Ghazipura MHM, et al. Ann Am Thorac Soc. 2022; May 2. Doi:10.1513/AnnalsATS.202103-343OC.
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Table of Contents: ATS 2022
Featured articles
Letter from the Editor
COVID-19
Nebulised aviptadil āfutileā in I-SPY COVID-19 trial
Lung transplantation after COVID-19-associated ARDS
Mesenchymal stem cells offer no benefit in COVID-19
Alpha-1 antitrypsin for ARDS secondary to severe COVID-19
Frailty prevalent 5 months following hospitalisation for COVID-19
Paediatric long COVID lacks definitions
Asthma Clinical Trial Updates
MANDALA and DENALI pattern success for albuterol-budesonide in asthma
ACOUSTICS data sounds good for adolescent asthma exacerbations
Type 2 asthma in children managed by dupilumab, despite atopic comorbidities
NAVIGATOR steers asthma patients to tezepelumab
High-intensity interval training slashes daily corticosteroids in asthma
Chronic Obstructive Pulmonary Disease
Threeās a crowd for triple therapy in COPD
Higher 1-year COPD mortality after hospitalisation for White patients
Reducing dyspnoea in chronic lung disease through weight loss
CT-evident mucus plugs in COPD associated with death
Home-based rehabilitation improves COPD: a randomised study
Highlighted Advances
Novel P2X3 antagonist can SOOTHE chronic cough
Colistimethate sodium PROMISing for non-cystic fibrosis bronchiectasis
Is avacopan better than prednisone for respiratory ANCA-associated vasculitis outcomes?
PAGANINI phase 2b data promising for eliapixant
POISE-3: Tranexamic acid for non-cardiac surgery
Obstructive sleep apnoea in most children with pulmonary hypertension
No screening evidence for COPD
Novel PDE4B inhibitor offers breakthrough for IPF
Hydrocortisone does not help preterm infants
CPAP temporarily supports pulmonary oxygenation in morbidly obese patients
ISAACC trial: CPAP controls blood pressure in ACS patients with severe OSA
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