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Original Research: Diffuse Lung Disease |

Predicting Pulmonary Fibrosis Disease Course From Past Trends in Pulmonary FunctionPredicting Pulmonary Function Trends

Shelley L. Schmidt, MD; Nabihah Tayob, MS; Meilan K. Han, MD; Christopher Zappala, MD; Dolly Kervitsky, CRT; Susan Murray, ScD; Athol U. Wells, MD; Kevin K. Brown, MD, FCCP; Fernando J. Martinez, MD; Kevin R. Flaherty, MD, FCCP
Author and Funding Information

From the University of Michigan Health System (Drs Schmidt, Han, Martinez, and Flaherty), Ann Arbor, MI; University of Michigan Department of Biostatistics (Ms Tayob and Dr Murray), Ann Arbor, MI; Royal Brompton and Harefield National Health Service Foundation Trust (Drs Zappala and Wells), London, England; and National Jewish Health (Ms Kervitsky and Dr Brown), Denver, CO.

Correspondence to: Kevin R. Flaherty, MD, FCCP, 3916 Taubman Center, 1500 E Medical Center Dr, SPC 5360, Ann Arbor, MI 48109-5360; e-mail: Flaherty@med.umich.edu


Part of this article was presented at the American Thoracic Society International Conference, May 13-18, 2011, Denver, CO, and in abstract form (Schmidt SL, Han MK, Tayob N, et al. Am J Respir Crit Care Med. 2011;183:A5299).

Funding/Support: This study was supported by National Institutes of Health [Grant HL093351 to Dr Han and Grants K24HL11316, R01HL19743 and HL007749 to Dr Flaherty].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):579-585. doi:10.1378/chest.13-0844
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Background:  The clinical course of idiopathic pulmonary fibrosis (IPF) is characterized by progressive decline in lung function and eventual mortality. We sought to determine if future declines in pulmonary function, mortality, or both can be predicted from prior trends in pulmonary function tests (PFTs).

Methods:  Data from 1981 to 2008 on 4,431 PFTs and mortality were analyzed from 734 subjects with IPF. The Kaplan-Meier method was used for mortality analyses. Mixed models were used to describe longitudinal pulmonary function dynamics, since PFTs were observed at varying time points from baseline.

Results:  During the first year of follow-up, 135 subjects (73%) had stable FVC while 50 subjects (37%) showed a decline in FVC. During months 12 to 24 (1-2 years after diagnosis), a stable FVC occurred with the same frequency among both subjects whose FVC had declined during year 1 and whose FVC had remained stable (84.0% and 80.7%, respectively; P = .59). Among subjects alive at the end of year 1, those with a stable FVC were more likely to be alive at the end of year 2 than those whose FVC declined (hazard ratio [HR], 0.91 [95% CI, 0.87-0.94] and HR, 0.71 [95% CI, 0.62-0.78], respectively).

Conclusions:  PFT decline predicts early mortality, but not future declines in physiology, regardless of time since diagnosis.

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