Idiopathic Pulmonary Fibrosis, Small Airways Disease
Conditions
Keywords
IPF, SAD, SBW-N₂
Brief summary
Idiopathic Pulmonary Fibrosis (IPF) is a chronic, fibrosing, and progressive lung disease of unknown cause, whose incidence increases proportionally from the age of 60. It is characterized by a poor prognosis. Antifibrotic therapy can slow the progression of the disease and reduce mortality, but the life expectancy is less than 7-10 years in the vast majority of patients with IPF. There are no studies in the literature that have evaluated the presence of small airway disease in patients with IPF prior to the initiation of pharmacological therapy, using the nitrogen washout test. This test is currently considered the only non-invasive method capable of detecting ventilation inhomogeneity and closing volume, which are indicators of small airway dysfunction. The investigators carried out an Italian prospective, observational, multicenter study with the primary aim to assess the prevalence of small airway disease measured by the nitrogen washout test (evaluating the following functional parameters: phase 3 slope, closing volume, closing capacity, closing volume/vital capacity, closing capacity/total lung capacity, and phase 4 slope) in a group of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy. During outpatients visits clinical, functional and radiological data will be collected. Results will be compared to an healthy control group matched with IPF population. Variations in small airways disease parameters will be assessed after one year of antifibrotic treatment.
Interventions
None listed
Sponsors
University of Milan
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age over 18 years * IPF of any degree of severity, diagnosed according to the 2022 ATS/ERS/JRS/ALAT guidelines
Exclusion criteria
* Refusal to participate in the study * Patients unable to provide informed consent for participation in the study * IPF exacerbation in the 6 months prior to enrollment * Previous diagnosis of chronic airway disease (e.g., bronchial asthma, chronic obstructive bronchitis, bronchiectasis with a cause other than IPF) * Presence of bronchial obstruction defined by an FEV1/FVC (or FEV1/VC) ratio below the lower limit of normal * Chronic therapy with long-acting bronchodilators or combinations of bronchodilators and inhaled corticosteroids * Inability of the patient to perform reproducible pulmonary function tests * Chronic treatment with systemic corticosteroids or immunosuppressants * Concomitant lung or pleural cancer * Pregnancy or breastfeeding women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of small airway disease in a group of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy. | 1 year | To evaluate the percentage of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy, with small airway disease measured by the nitrogen washout test (assessing the following functional parameters: phase 3 slope, closing volume, closing capacity, closing volume/vital capacity, closing capacity/total lung capacity, and phase 4 slope). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relationship between computed tomography (CT) features and functional parameters indicative of small airway disease. | 1 year | To evaluate the relationship between CT features (radiologic pattern type, presence/absence of mediastinal lymphadenopathy, presence/absence of any type of emphysema involving ≥5% of total lung volume, extent of disease, disease progression, air trapping, black lung) and functional parameters indicative of small airway disease. |
| To compare the indices of small airway dysfunction and the prevalence of small airway disease in patients with IPF and age-matched healthy subjects | 1 year | To compare the indices of small airway dysfunction and the prevalence of small airway disease in patients with IPF and age-matched healthy subjects (without respiratory comorbidities). |
| Relationship between clinical and epidemiological characteristics of the cohort and the presence and severity of small airway disease | 1 year | To study the relationship between clinical and epidemiological characteristics of the cohort and the presence and severity of small airway disease |
| Prevalence of small airway disease in patients with IPF and concomitant emphysema with patients with IPF alone | 1 year | To compare the prevalence of small airway disease in patients with IPF and concomitant emphysema (combined pulmonary fibrosis and emphysema, CPFE), defined as the presence of any type of emphysema involving ≥5% of total lung volume, with patients with IPF alone. |
| Correlation between functional characteristics, parameters of small airway dysfunction and fibrosis extent indices on chest CT-scan | 1 year | To evaluate the correlation between functional characteristics: forced expiratory flow at 25-75% of vital capacity (FEF25-75), forced vital capacity (FVC) and diffusing of the lung for carbon monoxide (DLCO) with parameters of small airway dysfunction from the Single Breath Nitrogen (SBN2) test, as well as disease extent indices on chest CT-scan |
| Relationship between exercise performance and the presence and severity of small airway disease | 1 year | To evaluate the relationship between exercise performance (meters, oxygen saturation nadir), assessed by the six-minute walk test distance, and the presence and severity of small airway disease |
| Relationship between dyspnea degree and the presence and severity of small airway disease. | 1 year | To evaluate the relationship between the degree of dyspnea, measured by the modified Medical Research Council (mMRC) scale, and the presence and severity of small airway disease. |
| Clinical and functional characteristics of IPF patients with different alterations in the DLCO subcomponents | 1 year | To evaluate the clinical and functional characteristics of IPF patients with different alterations in the DLCO subcomponents (alveolar volume - VA \<80% predicted, Transfer Coefficient of CO - KCO \<80% predicted, ventilation inhomogeneity - VA/Total Lung Capacity (TLC) \<0.8) |
| Relationship between different scores as the GAP index, CPI, KBILD and UCSD Shortness of Breath Questionnaire, and the presence and severity of small airway disease | 1 year | To evaluate the relationship between different scores as the Gender Age Physiology (GAP) index, Composite Physiologic Index (CPI) , the King's Brief Interstitial Lung Disease (KBILD) score and the University of California San Diego (UCSD) Shortness of Breath Questionnaire, and the presence and severity of small airway disease; |
| Variation of small airway dysfunction parameters in IPF patients after one year of antifibrotic treatment. | 1 year | Evaluate presence and variation of small airway dysfunction parameters from the Single Breath Nitrogen (SBN2) test in IPF patients after one year of antifibrotic therapy. |
| Prevalence of tidal expiratory flow limitation at the time of diagnosis, before the initiation of antifibrotic therapy and after one year of antifibrotic treatment. | 1 year | To evaluate the percentage of patients with IPF with tidal expiratory flow limitation measured by means of Negative Expiratory Pressure (NEP), at the time of diagnosis, before the initiation of antifibrotic therapy and after one year of therapy with antifibrotic treatment |
Countries
Italy
Outcome results
None listed