Subclinical Interstitial Lung Abnormalities: Toward the Early Detection of Idiopathic Pulmonary Fibrosis?

摘要

The beneficial treatment effects on pulmonary function trends with the use of antifibrotic agents in idiopathic pulmonary fibrosis (IPF) have prompted a focus on key IPF subgroups, including patients with "mild disease" as judged by FVC levels. In recent analyses, treatment effects have been virtually identical above and below FVC thresholds of 70% and 80%. These findings have led to increasing interest in the identification of subclinical IPF, with a view to early intervention. Recent studies of subclinical "interstitial lung abnormalities" (ILAs) on computed tomography (CT) scans in large cohorts provide a conceptual basis for a possible screening strategy. In this issue of the Journal, Araki and colleagues (pp. 1514-1522) have extended their previous observations and data reported by other groups in the first report of the prevalence of ILA and patterns of progression (as judged by serial high-resolution CT [HRCT] and pulmonary function trends) in a general population, consisting of adult participants in the Framingham Heart Study. They report that in a large Framingham Heart Study cohort, progression of ILA was associated with an increased risk of pulmonary function decline and death.