Pulmonary valve stenosis - Symptoms & causes
Interstitial Lung Abnormalities In Patients With COPD Linked To Cancer ...
Interstitial lung abnormalities (ILAs) in patients with chronic obstructive pulmonary disease (COPD) are linked to lower lung adenocarcinoma rates but higher rates of other cancers and heart failure.
Interstitial lung abnormalities (ILAs) are associated with various comorbidities in patients with chronic obstructive pulmonary disease (COPD), particularly lung cancer, according to a study published in BMC Pulmonary Medicine.1
Although COPD diagnoses typically rely on patient-reported symptoms and pulmonary function tests, chest computed tomography (CT) imaging is often used to further characterize the disease and associated comorbidities.2 COPD frequently coexists with various comorbidities, like cardiovascular disease, lung cancer, and diabetes.3
Chest CT scans can also detect and characterize ILAs, incidental non-dependent abnormalities that affect at least 5% of lung parenchyma in patients without suspected interstitial lung disease (ILD).4 Previous studies linked ILA with a heightened risk for various pulmonary morbidities, like COPD and lung cancer.1
Despite the well-established relationship between ILA and respiratory morbidities, its correlation with non-respiratory comorbidities remains unexplored. Consequently, the researchers aimed to assess the association between the presence of ILA in patients with COPD and their comorbidities, along with their clinical and laboratory characteristics.
Interstitial lung abnormalities (ILAs) in patients with chronic obstructive pulmonary disease (COPD) are linked to lower lung adenocarcinoma rates but higher rates of other cancers and heart failure.Image Credit: Peakstock - stock.Adobe.Com
They examined a retrospective cohort of patients hospitalized with COPD at the First Affiliated Hospital of Xiamen University. Eligible patients were those diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and were hospitalized between January 2015 and August 2021.
The researchers extracted all data on eligible patients from their medical records. Next, they classified patients based on the presence or absence of ILA. Then, the researchers performed analyses to identify differences in demographic characteristics, clinical profiles, laboratory results, and comorbid conditions between the 2 groups.
The study population consisted of 1131 hospitalized patients with COPD, with males comprising 93.7%. Of these patients, 82.3% were hospitalized due to acute exacerbations, and 60% had respiratory infections; the median hospitalization duration was 8 days. Additionally, 85.6% (n = 962) had emphysema, and 14.6% (n = 165) exhibited ILAs. The 3 most prevalent comorbidities were lung cancer (19.3%), history of tuberculosis (12.7%), and coronary artery disease (9.9%).
After stratifying the study population into groups based on ILA presence, the researchers noted no statistically significant differences in clinical, demographic, or laboratory parameters. However, the one exception was circulating fibrinogen (FIB) and procalcitonin (PCT) levels. Compared with those without ILA, patients with ILA displayed significantly lower levels of FIB (3.82 g/L vs 4.34 g/L; P = .018) and PCT (0.046 ng/mL vs 0.064 ng/mL; P = .005).
Similarly, the researchers found significant differences in the prevalence of several comorbid conditions among patients with and without ILA. In particular, the incidence of lung cancer among those with ILA was about half that of those without ILA (11.5% vs 20.6%; OR, 0.50; 95% CI, 0.30-0.83; P = .006).
Of those with comorbid lung cancer, 198 were diagnosed during hospitalization, and 20 had a prior diagnosis. The researchers found that 8.6% (n = 17) of the patients diagnosed during hospitalization also had an ILA, a rate comparable to that observed in the group diagnosed before hospitalization (10%). Additionally, they further examined the association of ILA with 3 major lung cancer subtypes: adenocarcinoma (ADC), squamous cell carcinoma (SCC), and other lung cancers.
Compared with those without comorbid lung cancer, those with lung ADC exhibited a significantly lower ILA prevalence (OR, 0.32; 95% CI, 0.15-0.71; P = .005). The researchers found a similar trend among patients with COPD and comorbid lung SCC (OR, 0.48; 95% CI, 0.22-1.11; P = .09); however, this was not statistically significant. Conversely, the prevalence of ILA in patients with other lung cancer subtypes was comparable to that in patients without lung cancer.
Lastly, the researchers found that the prevalence of cancers other than lung cancers in the ILA group was significantly higher than in the non-ILA group (7.9% vs 3.6%; OR, 2.27; 95% CI, 1.16-4.39; P = .012). Similarly, they discovered heart failure was more prevalent in the ILA group (11.5% vs 6.9%; OR, 1.75; 95% CI, 1.04-3.00; P = .04).
The researchers acknowledged their limitations, including the study population consisting solely of hospitalized patients with COPD, potentially limiting the generalization of their findings. Because of the male predominance among smokers in China, most patients were male, meaning these findings may not be generalizable to female patients. However, they expressed confidence in their findings and suggested areas for further research.
"...Our study demonstrates that the presence of ILA in patients with COPD is associated with multiple comorbidities of the disease, particularly lung ADC," the authors concluded. "Further investigations are warranted to better understand these relationships and their clinical implications."
References
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Detection Of Emphysema: A Critical Opportunity To Enhance Lung Cancer ...
Recent research published in The Annals of the American Thoracic Society confirms that emphysema was detected in 24% to 31% of patients undergoing lung cancer screening. This means that for millions of Americans, lung cancer screenings can serve as a detection tool for emphysema.
"Medicine is rarely gifted with such a high-yield opportunity to move beyond the individual disease silo to better manage these shared comorbid conditions," write the study's authors.
According to U.S. Preventive Services Task Force (USPSTF) guidelines, approximately 15 million people are now eligible for screening. If fully implemented, up to 3 million individuals could be newly diagnosed with emphysema, enabling earlier and more targeted interventions.
Options for severe emphysema patients
Emphysema is a progressive disease. Until recently, emphysema findings were often not acted upon because they did not always trigger additional care. The standard of care for advanced emphysema patients has traditionally included bronchodilators (inhalers), pulmonary rehabilitation, and in the most severe cases, lung-volume reduction surgery or lung transplantation. Yet, a significant gap remained in treatment options – medical management still often leaves severe patients symptomatic, and surgical options are invasive and risky, making them seldom used.
Now, however, a minimally invasive standard-of-care option is changing how severe emphysema is managed. This procedure, known as bronchoscopic lung volume reduction (BLVR), is indicated for advanced emphysema patients who remain symptomatic despite maximizing pulmonary rehabilitation and medication.
The Zephyr® Valve procedure, a type of BLVR treatment, is approved for these patients. About the size of a pencil eraser, the valves are bronchoscopically placed – with no cutting – in the most diseased part of the lung. The one-way valves release trapped air, helping inhaled oxygen reach healthier tissue, allowing patients to breathe easier and increase activity levels.1 The procedure is clinically proven, backed by extensive research, and reversible, as the valves can be removed if necessary. (See risks associated with this procedure here.)
Quality of life may improve
While BLVR treatment is not a cure, it is an effective intervention that helps patients regain independence in daily activities by improving their breathing. Many patients report being able to walk longer distances without stopping for breath, climb the stairs without extreme breathlessness, and complete everyday tasks – such as shopping or household chores – with greater ease.1
Diagnosis impacts population health
Diagnosing emphysema allows for appropriate management of patients at all stages of the disease. Importantly, this provides access for unrecognized severe cases to advanced, minimally invasive treatments such as BLVR with Zephyr valves.
What can hospitals do?
Hospitals and healthcare systems can take proactive steps to ensure lung cancer screening serves as a more comprehensive tool for detecting and managing lung diseases. A key priority is standardizing radiological reporting of emphysema identified by lung cancer screening and ensuring that findings are clearly communicated to both patients and referring providers. According to the study's authors, three options for achieving this include:
As research continues to refine best practices, integrating emphysema detection into lung cancer screening workflows can drive better patient outcomes and expand preventative care for high-risk populations.
More information on lung cancer and emphysema screenings is available through the American Lung Association. To learn more about Zephyr Valves and BLVR treatment, visit Pulmonx.Com.
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Links:
https://www.Atsjournals.Org/doi/10.1513/AnnalsATS.202207-631PS?Url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.Org&rfr_dat=cr_pub%20%200pubmed#:~:text=Track%20Citations-,Emphysema%20Detection%20in%20the%20Course%20of%20Lung%20Cancer%20Screening%3A%20Optimizing%20a%20Rare%20Opportunity%20to%20Impact%20Population%20Health,-James%20L.%20Mulshine
The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD – Clinical ImagingIncidental Findings on Low-Dose CT Scan Lung Cancer Screenings and Deaths From Respiratory Diseases – CHEST
U.S. Preventive Services Task Force (USPSTF) guidelines
How It Works: Zephyr Valve Treatment for COPD & Emphysema
PulmonxReferences and Bibliography
PulmonxZephyr Valve Prescriptive Information
Lung Cancer Screening ResourcesAmerican Lung Association
www.Pulmonx.Com
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