Sheetu Singh1, Bridget F Collins2, Bharat B Sharma3, Jyotsna M Joshi4, Deepak Talwar5, Sandeep Katiyar6, Nishtha Singh7, Lawrence Ho2, Jai Kumar Samaria8, Parthasarathi Bhattacharya9, Rakesh Gupta10, Sudhir Chaudhari11, Tejraj Singh12, Vijay Moond13, Sudhakar Pipavath14, Jitesh Ahuja14, Ravindran Chetambath15, Aloke G Ghoshal16, Nirmal K Jain17, H J Gayathri Devi18, Surya Kant19, Parvaiz Koul20, Raja Dhar21, Rajesh Swarnakar22, Surendra K Sharma23, Dhrubajyoti J Roy24, Kripesh R Sarmah25, Bhavin Jankharia26, Rodney Schmidt27, Santosh K Katiyar6, Arpita Jindal28, Daya K Mangal29, Virendra Singh7, Ganesh Raghu2. 1. 1 Department of Chest and Tuberculosis. 2. 2 Department of Medicine. 3. 3 Department of Medicine. 4. 4 Department of Pulmonary Medicine, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India. 5. 5 Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, India. 6. 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India. 7. 7 Department of Pulmonary Medicine and. 8. 8 Department of Chest Disease, Banaras Hindu University, Varanasi, India. 9. 9 Department of Respiratory Medicine, Institute of Pulmocare and Research, Kolkata, India. 10. 10 Department of Respiratory Medicine, JLN Medical College & Hospital, Ajmer, India. 11. 11 Department of Chest and Tuberculosis, GSVM Medical College, Kanpur, India. 12. 12 Research Division, Asthma Bhawan, Jaipur, India. 13. 13 Department of Radiology, and. 14. 14 Department of Radiology, and. 15. 15 Department of Pulmonary Medicine, Government Medical College, Kozhikode, India. 16. 16 National Allergy Asthma Bronchitis Institute, Kolkata, India. 17. 17 Department of Respiratory Medicine, SoniManipal Hospital, Jaipur, India. 18. 18 Department of Chest Medicine, MS Ramaiah Medical College, Bangalore, India. 19. 19 Department of Pulmonary Medicine, King George's Medical University, Lucknow, India. 20. 20 Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. 21. 21 Department of Pulmonology & Critical Care, Fortis Hospital, Kolkata, India. 22. 22 Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, India. 23. 23 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India. 24. 24 Department of Respiratory Medicine, Pulmonary and Sleep Clinic, Kolkata, India. 25. 25 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati, India. 26. 26 Department of Radiology, Jankharia Imaging, Mumbai, India; and. 27. 27 Department of Pathology, Center for Interstitial Lung Diseases, University of Washington, Seattle, Washington. 28. 28 Department of Pathology, SMS Medical College, Jaipur, India. 29. 29 Department of Research, IIHMR University, Jaipur, India.
Abstract
RATIONALE: Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. OBJECTIVES: To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. METHODS: Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. MEASUREMENTS AND MAIN RESULTS: A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. CONCLUSIONS: Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.
RATIONALE: Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. OBJECTIVES: To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. METHODS: Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. MEASUREMENTS AND MAIN RESULTS: A total of 1,084 patients were recruited. Final diagnosis: hypersensitivitypneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. CONCLUSIONS:Hypersensitivitypneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.
Authors: Christopher J Ryerson; Tamera J Corte; Joyce S Lee; Luca Richeldi; Simon L F Walsh; Jeffrey L Myers; Jürgen Behr; Vincent Cottin; Sonye K Danoff; Kevin R Flaherty; David J Lederer; David A Lynch; Fernando J Martinez; Ganesh Raghu; William D Travis; Zarir Udwadia; Athol U Wells; Harold R Collard Journal: Am J Respir Crit Care Med Date: 2017-11-15 Impact factor: 21.405
Authors: Ayodeji Adegunsoye; Justin M Oldham; Jonathan H Chung; Steven M Montner; Cathryn Lee; Leah J Witt; Danielle Stahlbaum; Rene S Bermea; Lena W Chen; Scully Hsu; Aliya N Husain; Imre Noth; Rekha Vij; Mary E Strek; Matthew Churpek Journal: Chest Date: 2017-09-28 Impact factor: 9.410