Fernanda Hernández-González

Utilidad de la criobiopsia en el diagnóstico de la enfermedad pulmonar intersticial difusa : análisis de rentabilidad y coste

BACKGROUND Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. METHODS This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications and economic costs of this technique were analyzed. RESULTS Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and gradei (9%) or gradeii (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to €59,846. CONCLUSION Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD. Furthermore, the systematic use of cryobiopsy has an important economic impact.

Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia

Abstract Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables. We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: “presence” or “nonpresence” of bilateral Velcro crackles. Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern. In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care.

Pirfenidone in Lung Interstitial Diseases: Indications and How to Evaluate its Effects

Idiopathic pulmonary fibrosis (IPF) is one of the most severe forms of interstitial pneumonia with a progressive and irreversible course and a mean survival of approximately 3 to 5 years from the time of diagnosis. Previous treatments with combinations of corticosteroids and immunosuppressive drugs did not demonstrate their effectiveness in reducing mortality in IPF. Pirfenidone is one of the newly implemented antifibrotic treatments whose effectiveness has been assessed by recent clinical trials, demonstrating its ability to slow down the progression of the disease, improve exercise tolerance, and reduce mortality. Because of these encouraging results, the Food and Drug Administration and the European Medicine Agency have recently approved its use in the treatment of IPF. Its distribution has been initiated not only in United States of America but also in several other countries. This article aims to review some of the most relevant articles concerning pirfenidone, with a summary of its indications, previous studies that support its use, possible adverse effects, and the clinical monitoring of patients. We also have hypothesized the potential use of pirfenidone in other interstitial lung diseases.