Cough in Fibrotic Interstitial Lung Disease: Effects and Implications
Notice bibliographique
Résumé
Cough is one of three main symptoms of fibrotic interstitial lung disease (fILD) (1) and is likely promoted by an imbalance between cough-suppressive and cough-stimulating factors (2).Coughenhancing effects of architectural distortion on vagal afferents, expressed predominantly in airways (3), may explain why, in our experience, cough tends to be prominent among patients with the most severe traction bronchiectasis/bronchiolectasis.Cough frequency and/or effects on how patients feel and function can be assessed in several ways.Visual analogue scales (VASs) are patient-reported outcome measures that ask respondents to place a tic on an unmarked, typically horizontal, 100-mm line with anchors at either end, which, in the case of cough severity, could read "No cough" (left) and "Worst cough imaginable" (right).The score is the distance in millimeters from the left end to the tic.The absence of reliably effective, nonopioid antitussives forces many patients with fILD with cough to endure this distressing symptom (4).In addition to better antitussives, our field needs an improved understanding of how cough affects patients' disease journeys and its implications for longitudinal disease behavior.In this issue of the Journal, Khor and colleagues (pp.1035-1044) used data from the Canadian Registry for Pulmonary Fibrosis (CARE-PF) to examine cough severity VAS ratings (VASc) in patients with idiopathic pulmonary fibrosis (IPF) or non-IPF fILD (5).VASc was prominently right-skewed, but about 40% in each group had a rating >30 mm.Correlations between VASc and lung physiology were weak, and although VASc was highly variable within subgroups defined by ILD-GAP (gender age physiology) index, higher ILD-GAP stage was associated with more severe cough.Multivariate analyses revealed associations between higher-enrollment VASc and lower FVC% and DL CO %, worse health status, greater impairment in healthrelated quality of life (HRQL), and gastroesophageal reflux.Higher enrollment VASc (continuous or dichotomized around a >30-mm threshold) was also associated with greater annual decline in DL CO %, disease progression (according to guidelines [6]), and shorter time to death.Longitudinal analyses revealed modeled mean VASc increases over time (IPF: 2.2 mm/yr; non-IPF: 1.1 mm/yr).Compared with nonprogressors, fILD progressors had higher enrollment VASc; however, modeled VASc slopes (change per year) did not differ between progressors and nonprogressors or between patients taking versus not taking ILD-targeted therapies.We applaud Khor and her Canadian coinvestigators for developing CARE-PF-an incredible real-world data resource-and for calling more attention to a troubling symptom for many patients with fILD.Their analyses, some including data from nearly 4,000 patients, reinforce that cough impairs health status and HRQL in some patients with fILD.Their results remind us that although cough
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,003 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».