ILD Unit, Pulmonology Department, Hospital universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, Lyon, France.
Curr Opin Pulm Med. 2022 Sep 1;28(5):407-413. doi: 10.1097/MCP.0000000000000908.
Idiopathic pulmonary fibrosis (IPF), characterized by relentless disease progression from the time of diagnosis, is part of a larger group of chronic fibrosing interstitial lung diseases (ILDs). A proportion of patients with non-IPF ILDs may develop, despite conventional treatment, a progressive pulmonary fibrosis (PPF), also referred to as ILD with a progressive fibrosing phenotype (PF-ILD). These patients experience worsening of respiratory symptoms, decline in lung function, and early mortality. The goal of this review is to describe the epidemiology and recent real-life cohorts of PF-ILD, with implications for management.
The relatively new concept of PF-ILD has aroused active clinical research over the past years. To understand risk factors for progression and the real burden of the disease is crucial to improve management. In the last 2 years, different cohort studies have addressed these questions. They showed that almost one-third of the non-IPF fibrotic ILD patients develop PF-ILD or PPF.
Emerging data show similarities in prognosis between patients with IPF or with non-IPF PF-ILD patients. Early detection and appropriate treatment of this group of patients is a priority. Further research is needed to identify risk factors of progression, to clarify the assessment of progression in clinical practice, for a better management of patients with PF-ILD in a real-world setting.
特发性肺纤维化(IPF)从诊断开始就呈现出持续进展的疾病特征,属于慢性纤维性间质性肺疾病(ILD)的一大类。尽管接受了常规治疗,一部分非特发性间质性肺病(non-IPF)患者仍可能出现进行性肺纤维化(PPF),也称为具有进行性纤维化表型的ILD(PF-ILD)。这些患者会出现呼吸症状恶化、肺功能下降和早期死亡。本文旨在描述 PF-ILD 的流行病学和最近的真实队列研究,为其治疗管理提供参考。
PF-ILD 这一相对较新的概念在过去几年中引起了积极的临床研究。了解进展的危险因素和疾病的真实负担对于改善管理至关重要。在过去 2 年中,不同的队列研究已经解决了这些问题。研究表明,近三分之一的非特发性肺纤维化ILD 患者会发展为 PF-ILD 或 PPF。
新出现的数据表明,IPF 患者和非特发性 PF-ILD 患者的预后存在相似之处。早期发现并适当治疗这组患者是当务之急。需要进一步研究以确定进展的危险因素,阐明临床实践中进展的评估,从而更好地管理真实环境中的 PF-ILD 患者。