It has been proposed that idiopathic interstitial pneumonia (IIP) be divided into histopathologic categories. The overall prognosis differs between histopathologic categories; however, individual patients within categories can have an unpredictable response to therapy and survival. The potential for disease progression despite therapy often leads to the early listing of patients for lung transplantation as the mean time on the waiting list is 2-3 years. There is a shortage of donor lungs and this approach can lead to overpopulation of the waiting list and has the potential of preventing allocation of organs to the patients with the greatest need. This project will examine prognostic factors in patients with IIP and use these factors to develop a model that predicts survival. This model will help patients and physicians decide on optimal timing for lung transplantation. The histologic type of IIP is the most important, although not exclusive, factor influencing survival. Determination of histologic type requires a surgical biopsy which is not possible in all patients. Semi-quantitative high resolution CT (HRCT) scoring for the amount of fibrosis also gives prognostic information. A drawback of this technique is observer variability, which could limit widespread utilization. We will collaborate with the University of Iowa to utilize a computerized quantitative scoring system which quantifies HRCT patterns (ground glass, fibrosis) present in the lungs of patients with IIP. We hypothesize that a computerized technique to determine the baseline and serial change in the amount of fibrosis will provide key prognostic information for patients with IIP. It has been suggested that radiologists can accurately diagnose categories of IIP. We will utilize survival analyses to compare the impact of a histologic diagnosis compared to a HRCT diagnosis for patients with IIP. We hypothesize that radiologists will have moderate accuracy in the diagnosis of IIP and that a HRCT diagnosis will provide more prognostic information when compared to a surgically obtained histopathologic diagnosis. The change in a clinical, radiographic, and physiologic (CRP) scoring system after three months of treatment also influences prognosis. A drawback is the requirement of a cardiopulmonary exercise test. We hypothesize that a scoring system utilizing the change in oxygen saturation during a six-minute hall walk will provide equal information without the need for a cardiopulmonary exercise test. During the past 10 years patients undergoing CRP testing have also performed a six-minute walk test. This information will be utilized to develop a new exercise component for a modified CRP scoring system. We will utilize survival analysis to define the patient population most likely to have improved survival through lung transplantation.
| Schmidt, S L; Nambiar, A M; Tayob, N et al. (2011) Pulmonary function measures predict mortality differently in IPF versus combined pulmonary fibrosis and emphysema. Eur Respir J 38:176-83 |
| Fell, Charlene D; Martinez, Fernando J; Liu, Lyrica X et al. (2010) Clinical predictors of a diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 181:832-7 |
| Han, M K; Wise, R; Mumford, J et al. (2010) Prevalence and clinical correlates of bronchoreversibility in severe emphysema. Eur Respir J 35:1048-56 |
| Fell, Charlene D; Liu, Lyrica Xiaohong; Motika, Caroline et al. (2009) The prognostic value of cardiopulmonary exercise testing in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 179:402-7 |
| Han, M K; Murray, S; Fell, C D et al. (2008) Sex differences in physiological progression of idiopathic pulmonary fibrosis. Eur Respir J 31:1183-8 |
| Martinez, Fernando J (2007) Pathogen-directed therapy in acute exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc 4:647-58 |
| Flaherty, Kevin R; Andrei, Adin-Cristian; King Jr, Talmadge E et al. (2007) Idiopathic interstitial pneumonia: do community and academic physicians agree on diagnosis? Am J Respir Crit Care Med 175:1054-60 |
| Martinez, Fernando J; Flaherty, Kevin (2006) Pulmonary function testing in idiopathic interstitial pneumonias. Proc Am Thorac Soc 3:315-21 |
| Flaherty, Kevin R; Andrei, Adin-Cristian; Murray, Susan et al. (2006) Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med 174:803-9 |
| Flaherty, Kevin R; Martinez, Fernando J (2006) Nonspecific interstitial pneumonia. Semin Respir Crit Care Med 27:652-8 |
Showing the most recent 10 out of 17 publications
