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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Increased expiratory flows identify early interstitial lung disease.

Sami Mohammed Alyami1, Onofre Moran-Mendoza2

  • 1Department of Medicine, Division of Pulmonology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Annals of Thoracic Medicine
|September 4, 2023
PubMed
Summary

High expiratory flows, specifically forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), may be the earliest pulmonary function test abnormality in interstitial lung disease (ILD) and idiopathic pulmonary fibrosis (IPF). This finding suggests simple spirometry can aid early diagnosis.

Keywords:
Expiratory flowsidiopathic pulmonary fibrosisinterstitial lung diseases

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Interstitial lung diseases (ILDs) commonly present with restrictive ventilatory defects.
  • Low diffusing capacity for carbon monoxide (Dlco) is an early indicator but requires specialized equipment.
  • Identifying early pulmonary function test (PFT) abnormalities is crucial for timely ILD diagnosis.

Purpose of the Study:

  • To investigate if high expiratory flows are the earliest PFT abnormality in patients with idiopathic pulmonary fibrosis (IPF) and other ILDs.
  • To determine the utility of simple spirometry in detecting early-stage ILD/IPF.

Main Methods:

  • A real-world cohort of 289 incident ILD cases diagnosed between 2013-2017 was analyzed.
  • Initial PFTs were examined in patients with normal forced vital capacity (FVC), total lung capacity (TLC), and Dlco.
  • High expiratory flows (FEV1/FVC, FEF25, FEF25-75, FEF75, and peak expiratory flow) were assessed, adjusting for emphysema, airway resistance, and obesity.

Main Results:

  • Among 88 patients (30%) with normal FVC, TLC, and Dlco, high FEV1/FVC was the most frequent abnormality (37%).
  • This abnormality was more pronounced in nonobese patients (43%) and those without emphysema and normal airway resistance (58%).
  • Similar findings were observed in 88 patients diagnosed with IPF.

Conclusions:

  • Elevated FEV1/FVC ratios can identify patients with ILD/IPF in early disease stages.
  • Simple spirometry may facilitate earlier diagnosis and treatment initiation for ILD/IPF.
  • This approach offers a cost-effective alternative to complex PFTs for early detection.