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The Prognostic Value of the GAP Model In Chronic Interstitial Lung DiseaseStaging in Chronic Interstitial Lung Disease: The Quest for a Staging System

Athol U. Wells, MD; Katerina M. Antoniou, MD
Author and Funding Information

From the Interstitial Lung Disease Unit (Dr Wells), Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust; and Department of Thoracic Medicine & Laboratory of Cellular and Molecular Pneumonology (Dr Antoniou), Medical School, University of Crete

Correspondence to: Athol U. Wells, MD, Emmanuel Kaye Bldg, Manresa Rd, Chelsea, London SW3 6LR, England; e-mail: athol.wells@rbht.nhs.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2014;145(4):672-674. doi:10.1378/chest.13-2908
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Extract

The validation and use of staging in interstitial lung disease (ILD) is long overdue. Treatment decisions made by clinicians are dichotomous: essentially, to introduce a treatment or to enroll a patient in a treatment trial. The data on which such decisions tend to be made are continuous (eg, measured FVC values), which immediately poses the question of which severity thresholds should be used to identify patients at higher risk of disease progression. In idiopathic pulmonary fibrosis (IPF), staging systems have been based on a combination of the composite physiologic index and 6-min walk data1 and on the integration of spirometric volumes, gas transfer levels, age, and sex (the GAP model).2 In non-IPF chronic ILD, the evaluation of high-resolution CT (HRCT) scanning has been combined with pulmonary function tests in staging ILD in systemic sclerosis,3 other forms of connective tissue disease,4 and sarcoidosis.5 However, until now, informative severity thresholds have been disease-specific and, by virtue of this fact, are less likely to be applied with confidence in mixed populations of patients with ILD.

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