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Cardiopulmonary Exercise Testing Allows Discrimination Between Idiopathic Non-specific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis in Mild to Moderate Stages of the Disease

  • Lars HagmeyerEmail author
  • Simon Herkenrath
  • Norbert Anduleit
  • Marcel Treml
  • Winfried Randerath


It is unclear whether there are cardiopulmonary exercise testing (CPET) parameters which may indicate poor prognosis in the early course of fibrosing interstitial lung disease. 27 untreated consecutive subjects (13 idiopathic non-specific interstitial pneumonia (iNSIP), 14 idiopathic pulmonary fibrosis (IPF); 19 male; age 69 ± 10 years) were enrolled in this observational pilot study. Subjects underwent routine pulmonary function testing and CPET. Statistically, the t test and the Mann–Whitney-U test were applied in the presence of normal and non-normal distribution (according to Shapiro–Wilk), respectively. Analyzing the whole cohort, only mild functional impairments were determined. Comparison of iNSIP and IPF groups detected significant differences for the CPET parameters V’O2Peak[%pred] (p = 0.011), V’O2/kgPeak (p = 0.033), Watt[%pred] (p = 0.048), V’E/V’CO2 (Rest: p = 0.016; AT: p = 0.011; Peak: p = 0.019; Slope: p = 0.040), V’E/V’O2 (Rest: p = 0.033 AT: p = 0.014; Peak: p = 0.035). CPET parameters may indicate IPF-specific impairments even in mild disease. It may be hypothesized that these parameters are early biomarkers of poor prognosis.


Interstitial lung disease Lung fibrosis Pulmonary function test Prognosis 



Alveolar-arterial oxygen partial pressure difference


Anaerobic threshold


Body mass index


Breathing reserve


Cardiopulmonary exercise test


Diffusion capacity of the lung for carbon monoxide


Forced exspiratory volume in one second


Exspiratory forced vital capacity


Interstitial lung disease


Idiopathic pulmonary fibrosis


Idiopathic non-specific interstitial pneumonia


Transfer coefficient for carbon monoxide


Oxygen uptake efficiency slope

O2 pulse

Oxygen pulse


Pulmonary function test


Single breath


Total lung capacity


Alveolar volume


In inspiratory vital capacity


Minute ventilation


Carbon dioxide output


Oxygen uptake


Percent of predicted value


Author Contributions

LH was involved in study conception and design, data acquisition, data analysis and interpretation, manuscript drafting, critical revision, and final approvement. SH was involved in data acquisition, data analysis and interpretation, critical revision of the manuscript, and final approvement. NA was involved in data acquisition, data analysis and interpretation, critical revision of the manuscript, and final approvement. MT was involved in data analysis and interpretation, manuscript drafting, critical revision of the manuscript, and final approvement. WR was involved study conception and design, data analysis and interpretation, critical revision of the manuscript, and final approvement.


This work was supported by Intermune/Roche. Intermune/Roche was not involved in preparation of data or the manuscript.

Compliance with Ethical Standards

Conflict of interest

Lars Hagmeyer reports travel grants and speaking fees by Roche and Boehringer Ingelheim. Simon Herkenrath, Norbert Anduleit, Marcel Treml states that there is no conflict of interest. Winfried Randerath reports travel grants and speaking fees by Roche.

Ethical Approval

This study was approved by the Ethics Committee of the University Witten/Herdecke. NCT02636452.

Informed Consent

All subjects have given their written informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hospital Bethanien Solingen, Institute of PneumologyUniversity of CologneSolingenGermany
  2. 2.Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory CareSolingenGermany

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