Acute exacerbations of progressive-fibrosing interstitial lung diseases

Martin Kolb, Benjamin Bondue, Alberto Pesci, Yasunari Miyazaki, Jin Woo Song, Nitin Y. Bhatt, John T. Huggins, Justin Oldham, Maria L. Padilla, Jesse Roman, Shane Shapera

Research output: Contribution to journalReview article

21 Scopus citations

Abstract

Acute exacerbation of interstitial lung disease (ILD) is associated with a poor prognosis and high mortality. Numerous studies have documented acute exacerbation in idiopathic pulmonary fibrosis (IPF), but less is known about these events in other ILDs that may present a progressive-fibrosing phenotype. We propose defining acute exacerbation as an acute, clinically significant respiratory deterioration, typically less than 1 month in duration, together with computerised tomography imaging showing new bilateral glass opacity and/or consolidation superimposed on a background pattern consistent with fibrosing ILDs. Drawing on observations in IPF, it is suspected that epithelial injury or proliferation and autoimmunity are risk factors for acute exacerbation in ILDs that may present a progressive-fibrosing phenotype, but further studies are required. Current acute exacerbation management strategies are based on recommendations in IPF, but no randomised controlled trials of acute exacerbation management have been performed. Although there are no formal strategies to prevent the development of acute exacerbation, possible approaches include antifibrotic drugs (such as nintedanib and pirfenidone), and minimising exposure to infection, airborne irritants and pollutants. This review discusses the current knowledge of acute exacerbation of ILDs that may present a progressive-fibrosing phenotype and acknowledges limitations of the data available.

Original languageEnglish (US)
Article number180071
JournalEuropean Respiratory Review
Volume27
Issue number150
DOIs
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Kolb, M., Bondue, B., Pesci, A., Miyazaki, Y., Song, J. W., Bhatt, N. Y., Huggins, J. T., Oldham, J., Padilla, M. L., Roman, J., & Shapera, S. (2018). Acute exacerbations of progressive-fibrosing interstitial lung diseases. European Respiratory Review, 27(150), [180071]. https://doi.org/10.1183/16000617.0071-2018