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Article: Challenges in the Diagnosis and Management of Patients with Fibrosing Interstitial Lung Disease.

Tolle, Leslie B

2022 Volume 2022, Page(s) 9942432

Abstract: Interstitial lung diseases (ILDs) are heterogeneous in their clinical presentation. Making a differential diagnosis of ILD requires a thorough medical history, clinical examination, serologies, high-resolution computed tomography (CT) scan, and, in some ... ...

Abstract	Interstitial lung diseases (ILDs) are heterogeneous in their clinical presentation. Making a differential diagnosis of ILD requires a thorough medical history, clinical examination, serologies, high-resolution computed tomography (CT) scan, and, in some cases, bronchoalveolar lavage or surgical lung biopsy. Multidisciplinary discussion is recommended to improve diagnostic confidence. ILDs have a variable and unpredictable clinical course. Patients should be closely monitored to ensure that progression of ILD is detected promptly. This involves regular assessment of symptoms, lung function, and, where appropriate, high-resolution CT. Patients with some fibrosing ILDs may respond well to immunosuppressants, but even patients who respond well to immunosuppressants initially may later show deterioration despite appropriate management. The tyrosine kinase inhibitor nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis, other chronic fibrosing ILDs with a progressive phenotype, and systemic sclerosis-associated ILD. The three case studies described in this article illustrate the challenges in the diagnosis and management of patients with fibrosing ILDs and the importance of taking a multidisciplinary and individualized approach to care, including regular monitoring and consideration of whether a patient's drug regimen needs to be changed when there is evidence of disease progression.
Language	English
Publishing date	2022-02-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2666707-1
ISSN	2090-6854 ; 2090-6846
ISSN (online)	2090-6854
ISSN	2090-6846
DOI	10.1155/2022/9942432
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Idiopathic pulmonary fibrosis: exploring the clinical and economic implications of the evolving treatment landscape.

de Andrade, Joao A / Owens, Gary M / Tolle, Leslie

The American journal of managed care

2021 Volume 27, Issue 7 Suppl, Page(s) S131–S137

Abstract: Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia, a form of interstitial lung disease characterized by abnormal wound healing in the lung that leads to progressive scarring and loss of lung function. Comorbidities ... ...

Abstract	Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia, a form of interstitial lung disease characterized by abnormal wound healing in the lung that leads to progressive scarring and loss of lung function. Comorbidities are highly prevalent in IPF and often lead to further complications and worse outcomes. In fact, undetected and untreated comorbidities are independently associated with poor outcomes. IPF not only affects patient quality of life (QOL) but also requires significant cost for delivering care. Given the potential for rapid progression of IPF and the associated risk for mortality, early diagnosis is critical for retaining the highest lung function and QOL for as long as possible. Delayed diagnosis of IPF is associated with increased costs in terms of investigations performed, and delayed referral can result in lower survival rates independent of disease severity or associated prognostic factors. Significant progress has been made in understanding IPF pathogenesis, which has, in turn, led to the development of novel therapeutic options that improve outcomes, extend life, and minimize disease burden on patients' daily lives. For patients with IPF in the absence of underlying liver disease, pirfenidone and nintedanib are licensed for the treatment of IPF. Additionally, a number of investigational therapeutic options are currently in development. The extent of clinical effectiveness compared with the cost of therapy has led to a lack of consensus on the cost-vs-benefit analyses for the drugs.
MeSH term(s)	Early Diagnosis ; Humans ; Idiopathic Pulmonary Fibrosis/diagnosis ; Idiopathic Pulmonary Fibrosis/drug therapy ; Lung ; Pyridones/therapeutic use ; Quality of Life ; Treatment Outcome
Chemical Substances	Pyridones
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2021.88655
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Article ; Online: Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease.

Vehar, Susan J / Yadav, Ruchi / Mukhopadhyay, Sanjay / Nathani, Avantika / Tolle, Leslie B

American journal of clinical pathology

2022 Volume 159, Issue 2, Page(s) 146–157

Abstract: Objectives: To describe the clinical, radiologic, and pathologic findings in cases where smoking-related interstitial fibrosis (SRIF) was diagnosed in surgical lung biopsy specimens from patients with clinical and imaging features of diffuse parenchymal ...

Abstract	Objectives: To describe the clinical, radiologic, and pathologic findings in cases where smoking-related interstitial fibrosis (SRIF) was diagnosed in surgical lung biopsy specimens from patients with clinical and imaging features of diffuse parenchymal lung disease (DPLD). Methods: Cases were included in this study if patients had clinical and imaging evidence of DPLD and surgical lung biopsy specimens revealed SRIF. A dedicated multidisciplinary conference was held to correlate clinical, radiologic, and pathologic findings. Results: Six cases met inclusion criteria; all six (five women/one man, aged 42-57 years, mean age 47 years) were either current smokers (five of six) or ex-smokers (one of six) and were evaluated for respiratory symptoms and abnormal pulmonary function tests, most commonly reduced forced vital capacity (n = 3) and diffusing capacity for carbon monoxide (n = 6). The most common imaging abnormalities were bilateral ground-glass opacities, which correlated with histopathologic SRIF. Follow-up of up to 10 years showed stable or improved clinical symptoms, pulmonary function tests, and radiologic findings with smoking cessation (three patients) or a decrease in smoking (three patients). No specific treatments were given, and those treated with empiric corticosteroid tapers did not show discernible responses. Conclusions: SRIF can present as clinically meaningful diffuse parenchymal lung disease in relatively young heavy smokers, characterized by bilateral ground-glass opacities and a stable clinical course.
MeSH term(s)	Male ; Humans ; Female ; Middle Aged ; Lung/diagnostic imaging ; Lung/pathology ; Bronchiolitis/pathology ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/etiology ; Lung Diseases, Interstitial/pathology ; Smoking/adverse effects ; Fibrosis
Language	English
Publishing date	2022-12-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2944-0
ISSN	1943-7722 ; 0002-9173
ISSN (online)	1943-7722
ISSN	0002-9173
DOI	10.1093/ajcp/aqac144
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Article ; Online: COVID19 Acute respiratory distress syndrome and extra-corporeal membrane oxygenation; A mere option or ultimate necessity.

Ahmed, Taha / Ahmed, Talha / Karimi, Hussain / Tolle, Leslie / Iqbal, Muhammad Nouman

Perfusion

2020 Volume 36, Issue 6, Page(s) 559–563

Abstract: Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether ... ...

Abstract	Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.
MeSH term(s)	COVID-19 ; Extracorporeal Membrane Oxygenation ; Humans ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-10-02
Publishing country	England
Document type	Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/0267659120961507
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Article ; Online: Idiopathic pulmonary fibrosis: What primary care physicians need to know.

Tolle, Leslie B / Southern, Brian D / Culver, Daniel A / Horowitz, Jeffrey C

Cleveland Clinic journal of medicine

2018 Volume 85, Issue 5, Page(s) 377–386

Abstract: Idiopathic pulmonary fibrosis (IPF) is a specific type of fibrosing interstitial pneumonia of unknown cause. It is usually chronic and progressive, tends to affect mainly adults over age 60, has a predilection for men, and is often fatal. The condition ... ...

Abstract	Idiopathic pulmonary fibrosis (IPF) is a specific type of fibrosing interstitial pneumonia of unknown cause. It is usually chronic and progressive, tends to affect mainly adults over age 60, has a predilection for men, and is often fatal. The condition is still underappreciated by pulmonologists and primary care physicians. This article attempts to close that information gap by reviewing the natural course of IPF and presenting an algorithmic approach to diagnosis and treatment based on evidence-based international guidelines. New treatment options are briefly discussed, to raise awareness of new medications that target pulmonary fibrosis.
MeSH term(s)	Aged ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Idiopathic Pulmonary Fibrosis/diagnosis ; Idiopathic Pulmonary Fibrosis/therapy ; Male ; Middle Aged ; Physicians, Primary Care ; Pulmonologists
Language	English
Publishing date	2018-05-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.85a.17018
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Article ; Online: Danger-associated molecular patterns (DAMPs) in acute lung injury.

Tolle, Leslie B / Standiford, Theodore J

The Journal of pathology

2012 Volume 229, Issue 2, Page(s) 145–156

Abstract: Danger-associated molecular patterns (DAMPs) are host-derived molecules that can function to regulate the activation of pathogen recognition receptors (PRRs). These molecules play a critical role in modulating the lung injury response. DAMPs originate ... ...

Abstract	Danger-associated molecular patterns (DAMPs) are host-derived molecules that can function to regulate the activation of pathogen recognition receptors (PRRs). These molecules play a critical role in modulating the lung injury response. DAMPs originate from multiple sources, including injured and dying cells, the extracellular matrix, or exist as immunomodulatory proteins within the airspace and interstitium. DAMPs can function as either toll-like receptor (TLR) agonists or antagonists, and can modulate both TLR and nod-like receptor (NLR) signalling cascades. Collectively, this diverse group of molecules may represent important therapeutic targets in the prevention and/or treatment of acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS).
MeSH term(s)	Acute Lung Injury/immunology ; Acute Lung Injury/metabolism ; Acute Lung Injury/pathology ; Animals ; Extracellular Matrix/metabolism ; Extracellular Matrix/pathology ; Humans ; Ligands ; Lung/immunology ; Lung/metabolism ; Lung/pathology ; Pulmonary Surfactant-Associated Proteins/metabolism ; Receptors, Immunologic/metabolism ; Signal Transduction ; Stress, Physiological ; Toll-Like Receptors/metabolism
Chemical Substances	Ligands ; Pulmonary Surfactant-Associated Proteins ; Receptors, Immunologic ; Toll-Like Receptors
Language	English
Publishing date	2012-10-25
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	3119-7
ISSN	1096-9896 ; 0022-3417
ISSN (online)	1096-9896
ISSN	0022-3417
DOI	10.1002/path.4124
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Article ; Online: A case of vaping-induced acute respiratory distress syndrome requiring extracorporeal life support.

Krishnan, Sudhir / Thind, Guramrinder Singh / Soliman, Mona / Tolle, Leslie / Mireles-Cabodevila, Eduardo / Adi, Ahmad / Anandamurthy, Balaram / Bribriesco, Alejandro / Yun, James

Perfusion

2020 Volume 36, Issue 3, Page(s) 308–310

Abstract: Introduction: An upsurge of e-cigarette, or vaping, product use-associated lung injury has been reported in the United States. The potential role of extracorporeal life support in e-cigarette, or vaping, product use-associated lung injury merits ... ...

Abstract	Introduction: An upsurge of e-cigarette, or vaping, product use-associated lung injury has been reported in the United States. The potential role of extracorporeal life support in e-cigarette, or vaping, product use-associated lung injury merits consideration. Case report: We present a case of vaping-induced severe acute respiratory distress syndrome that was salvaged with extracorporeal life support and had excellent recovery. Discussion: The mechanistic reasons for the sudden outbreak of e-cigarette, or vaping, product use-associated lung injury are under active investigation. A predominantly diffuse, bilateral pattern of lung injury has been reported, with some cases meeting the criteria for severe acute respiratory distress syndrome. To date, 68 deaths from e-cigarette, or vaping, product use-associated lung injury have been confirmed by the centers of disease control. However, resolution of lung injury has been reported in most cases, thereby justifying candidacy for extracorporeal life support, if required. Conclusion: Extracorporeal life support can be successfully utilized as a bridge to recovery in vaping-induced severe acute respiratory distress syndrome.
MeSH term(s)	Electronic Nicotine Delivery Systems ; Extracorporeal Membrane Oxygenation/adverse effects ; Humans ; Lung Injury ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; United States ; Vaping/adverse effects
Language	English
Publishing date	2020-07-10
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/0267659120925634
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Article ; Online: COVID19 Acute respiratory distress syndrome and extra-corporeal membrane oxygenation; A mere option or ultimate necessity

Ahmed, Taha / Ahmed, Talha / Karimi, Hussain / Tolle, Leslie / Iqbal, Muhammad Nouman

Perfusion

2020 , Page(s) 26765912096150

Abstract	Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.
Keywords	Radiology Nuclear Medicine and imaging ; Advanced and Specialised Nursing ; Safety Research ; Cardiology and Cardiovascular Medicine ; General Medicine ; covid19
Language	English
Publisher	SAGE Publications
Publishing country	us
Document type	Article ; Online
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/0267659120961507
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Article ; Online: Prospective cohort of cryobiopsy in interstitial lung diseases: a single center experience.

Ribeiro Neto, Manuel L / Arrossi, Andrea Valeria / Yadav, Ruchi / Culver, Daniel A / Mukhopadhyay, Sanjay / Parambil, Joseph G / Southern, Brian D / Tolle, Leslie / Pande, Aman / Almeida, Francisco A / Sahoo, Debasis / Glennie, Jessica / Ahmad, Usman / Mehta, Atul C / Gildea, Thomas R

BMC pulmonary medicine

2022 Volume 22, Issue 1, Page(s) 215

Abstract: Rationale: Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to ... ...

Abstract	Rationale: Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy. Objectives: To evaluate the diagnostic yield and complications of cryobiopsy in patients selected by multidisciplinary discussion. Methods: This was a prospective cohort from 2017 to 2019. We included consecutive patients with suspected interstitial lung diseases being considered for lung biopsy presented at our multidisciplinary meeting. Measurements and main results: Of 112 patients, we recommended no biopsy in 31, transbronchial forceps biopsy in 16, cryobiopsy in 54 and surgical biopsy in 11. By the end of the study, 34 patients had had cryobiopsy and 24 patients, surgical biopsy. Overall pathologic and multidisciplinary diagnostic yield of cryobiopsy was 47.1% and 61.8%, respectively. The yield increased over time for both pathologic (year 1: 28.6%, year 2: 54.5%, year 3: 66.7%, p = 0.161) and multidisciplinary (year 1: 50%, year 2: 63.6%, year 3: 77.8%, p = 0.412) diagnosis. Overall rate of grade 4 bleeding after cryobiopsy was 11.8%. Cryobiopsy required less chest tube placement (11.8% vs 100%, p < 0.001) and less hospitalizations compared to surgical biopsy (26.5% vs 95.7%, p < 0.001), but hospitalized patients had a longer median hospital stay (2 days vs 1 day, p = 0.004). Conclusions: Diagnostic yield of cryobiopsy increased over time but the overall grade 4 bleeding rate was 11.8%.
MeSH term(s)	Biopsy/adverse effects ; Hemorrhage/etiology ; Humans ; Lung Diseases, Interstitial/complications ; Prospective Studies ; Surgical Instruments/adverse effects
Language	English
Publishing date	2022-06-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-022-01990-4
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Article ; Online: Bariatric surgery in patients with interstitial lung disease.

Ardila-Gatas, Jessica / Sharma, Gautam / Nor Hanipah, Zubaidah / Tu, Chao / Brethauer, Stacy A / Aminian, Ali / Tolle, Leslie / Schauer, Philip R

Surgical endoscopy

2018 Volume 33, Issue 6, Page(s) 1952–1958

Abstract: Background: Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, ... ...

Abstract	Background: Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility, and outcomes of patients with ILD who underwent bariatric surgery at our institution. Methods: After IRB approval, all patients with preoperative diagnosis of ILD who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed. Results: A total of 25 patients with ILD underwent bariatric surgery: Roux-en-Y gastric bypass (n = 17, 68%), sleeve gastrectomy (n = 7, 28%), and adjustable gastric banding (n = 1, 4%). Twenty-one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (IQR 42-58) years and 39 (IQR 37-44) kg/m Conclusion: In our experience, bariatric patients with ILD achieved significant weight loss and improvement in PFT. Bariatric surgery in these higher risk ILD patients appears relatively safe with acceptable perioperative morbidity and improved candidacy for lung transplantation.
MeSH term(s)	Bariatric Surgery ; Body Mass Index ; Female ; Humans ; Length of Stay/statistics & numerical data ; Lung Diseases, Interstitial/epidemiology ; Lung Diseases, Interstitial/surgery ; Lung Transplantation ; Male ; Middle Aged ; Ohio/epidemiology ; Operative Time ; Postoperative Complications/epidemiology ; Respiratory Function Tests ; Retrospective Studies ; Weight Loss
Language	English
Publishing date	2018-10-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-018-6475-7
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