Cardiopulmonary Exercise Testing Allows Discrimination Between Idiopathic Non-specific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis in Mild to Moderate Stages of the Disease
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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.
KeywordsInterstitial lung disease Lung fibrosis Pulmonary function test Prognosis
Alveolar-arterial oxygen partial pressure difference
Body mass index
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
Pulmonary function test
Total lung capacity
In inspiratory vital capacity
Carbon dioxide output
Percent of predicted value
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.
This study was approved by the Ethics Committee of the University Witten/Herdecke. ClinicalTrials.gov NCT02636452.
All subjects have given their written informed consent.
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