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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
INTERSTITIAL LUNG DISEASE
  • 42 Downloads

Abstract

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.

Keywords

Interstitial lung disease Lung fibrosis Pulmonary function test Prognosis 

Abbreviations

AaDO2

Alveolar-arterial oxygen partial pressure difference

AT

Anaerobic threshold

BMI

Body mass index

BR

Breathing reserve

CPET

Cardiopulmonary exercise test

DLCO

Diffusion capacity of the lung for carbon monoxide

FEV1

Forced exspiratory volume in one second

FVC

Exspiratory forced vital capacity

ILD

Interstitial lung disease

IPF

Idiopathic pulmonary fibrosis

iNSIP

Idiopathic non-specific interstitial pneumonia

KCO

Transfer coefficient for carbon monoxide

OUES

Oxygen uptake efficiency slope

O2 pulse

Oxygen pulse

PFT

Pulmonary function test

SB

Single breath

TLC

Total lung capacity

VA

Alveolar volume

VC

In inspiratory vital capacity

VE’

Minute ventilation

V'CO2

Carbon dioxide output

V'O2

Oxygen uptake

%pred

Percent of predicted value

Notes

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.

Funding

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. ClinicalTrials.gov 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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