Causes of hospitalization and their impact on the course of fibrosing interstitial lung diseases

Interstitial lung disease (ILD) is a diverse and heterogenous group of chronic lung diseases affecting lung parenchyma and characterized by inflammation followed by pulmonary fibrosis that can progress and lead to hospitalization. The impact of hospitalizations on the clinical course of ILD is not fully understood. The aim was to analyze the causes of hospitalization related to the underlying disease and their relationship with the clinical and functional features of the disease course in patients with fibrosing ILD (f-ILD). Methods. This study was an open comparative non interventional study. We analyzed findings from two groups of patients with f-ILD, who had or did not have hospitalizations due to respiratory reasons during the previous 12 months. Additionally, we analyzed demographic and clinical data, severity of ILD according to Gender, Age, Physiology (GAP) scale, lung function and echocardiographic parameters, physical tolerance in 6-minute walk test (6MWT), and pharmacological therapy. Results. Ninety-five patients with f-ILD were involved in the study. Of them, 37 patients had one to four previous hospitalizations due to respiratory reasons during the previous 12 months, and 58 patients did not have any hospitalizations during this period. Most frequent reasons for hospitalization were progressing or exacerbation of f-ILD, less frequent reasons were community-acquired pneumonia and other respiratory infections, and pulmonary embolism. One third of the patients (n = 29) were hospitalized for elective procedures to verify the diagnosis. Patients with previous hospitalizations had more severe course of f-ILD according to GAP scale, lower parameters of lung function, oxygenation, and physical tolerance and more often were treated with pharmacological agents and supplemental oxygen. Conclusion. Most common reasons for hospitalization of f-ILD patients were progressing or exacerbation of f-ILD and the need in elective procedures to verify the diagnosis. Patients hospitalized for respiratory reasons during the previous 12 months had more severe clinical course of the disease with lower lung function and physical tolerance and more often required pharmacological therapy and supplemental oxygen as compared to the patients who had no hospitalizations in this time interval. Further studies are needed to investigate the prognostic value of hospitalizations in f-ILD.

1. Geiser T., Guler S. Diagnostische abklärung bei verdacht auf interstitielle pneumopathie. Ther. Umsch. 2016; 73 (1): 7–10. DOI: 10.1024/0040-5930/a000748.

2. Trushenko N.V., Suvorova O.A., Pershina E.S. et al. Predictors of progression and mortality in patients with chronic hypersensitivity pneumonitis: retrospective analysis of registry of fibrosing interstitial lung diseases. Life (Basel). 2023; 13 (2): 467. DOI: 10.3390/life13020467.

3. Avdeev S.N., Chikina S.Yu., Tyurin I.E. et al. [Chronic fibrosing progressing interstitial lung disease: a decision of Multidisciplinary Expert Board]. Pul'monologiya. 2021; 31 (4): 505–510. DOI: 10.18093/0869-0189-2021-31-4-505-510 (in Russian).

4. Nashatyreva M.S., Trofimenko I.N., Chernyak B.A., Avdeev S.N. Pulmonary fibrosis and progressive pulmonary fibrosis in a prospective registry of interstitial lung diseases in Eastern Siberia. Life (Basel). 2023; 13 (1): 212. DOI: 10.3390/life13010212.

5. Brown A.W., Fischer C.P., Shlobin O.A. et al. Outcomes after hospitalization in idiopathic pulmonary fibrosis: a cohort study. Chest. 2015; 147 (1): 173–179. DOI: 10.1378/chest.13-2424.

6. Behr J., Kreuter M., Hoeper M.M. et al. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry. Eur. Respir. J. 2015; 46 (1): 186–196. DOI: 10.1183/09031936.00217614.

7. Wälscher J., Witt S., Schwarzkopf L., Kreuter M. Hospitalisation patterns of patients with interstitial lung disease in the light of comorbidities and medical treatment – a German claims data analysis. Respir. Res. 2020; 21 (1): 73. DOI: 10.1186/s12931-020-01335-x.

8. Suissa S., Dell'Aniello S., Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012; 67 (11): 957–963. DOI: 10.1136/thoraxjnl-2011-201518.

9. Montagnani A., Mathieu G., Pomero F. et al. Hospitalization and mortality for acute exacerbation of chronic obstructive pulmonary disease (COPD): an Italian population-based study. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (12): 6899–6907. DOI: 10.26355/eurrev_202006_21681.

10. Martinez-Garcia M.Á., Athanazio R., Gramblicka G. et al. Prognostic value of frequent exacerbations in bronchiectasis: the relationship with disease severity. Arch. Bronconeumol. (Engl. Ed.). 2019; 55 (2): 81–87. DOI: 10.1016/j.arbres.2018.07.002.

11. Alcaraz-Serrano V., Gimeno-Santos E., Scioscia G. et al. Association between physical activity and risk of hospitalisation in bronchiectasis. Eur. Respir. J. 2020; 55 (6): 1902138. DOI: 10.1183/13993003.02138-2019.

12. Renom F., Yáñez A., Garau M. et al. Prognosis of COPD patients requiring frequent hospitalization: role of airway infection. Respir. Med. 2010; 104 (6): 840–848. DOI: 10.1016/j.rmed.2009.12.010.

13. Torres-Sánchez I., Cabrera-Martos I., Díaz-Pelegrina A. et al. Physical and functional impairment during and after hospitalization in subjects with severe COPD exacerbation. Respir. Care. 2017; 62 (2): 209–214. DOI: 10.4187/respcare.04597.

14. Wang M., Lin E.P., Huang L.C. et al. Mortality of cardiovascular events in patients with COPD and preceding hospitalization for acute exacerbation. Chest. 2020; 158 (3): 973–985. DOI: 10.1016/j.chest.2020.02.046.

15. Suzuki A., Kondoh Y., Brown K.K. et al. Acute exacerbations of fibrotic interstitial lung diseases. Respirology. 2020; 25 (5): 525–534. DOI: 10.1111/resp.13682.

16. Buschulte K., Kabitz H.J., Hagmeyer L. et al. Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry. Respir. Res. 2024; 25 (1): 5. DOI: 10.1186/s12931-023-02588-y.

17. Kreuter M., Del Galdo F., Miede C. et al. Impact of lung function decline on time to hospitalisation events in systemic sclerosis-associated interstitial lung disease (SSc-ILD): a joint model analysis. Arthritis Res. Ther. 2022; 24 (1): 19. DOI: 10.1186/s13075-021-02710-9.

18. Singer D., Chastek B., Sargent A. et al. Impact of chronic fibrosing interstitial lung disease on healthcare use: association between FVC decline and inpatient hospitalization. BMC Pulm. Med. 2023; 23 (1): 337. DOI: 10.1186/s12890-023-02637-8.

19. Quanjer P.H., Stanojevic S., Cole T.J. et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur. Respir. J. 2012; 40 (6): 1324–1343. DOI: 10.1183/09031936.00080312.

20. Bhakta N.R., McGowan A., Ramsey K.A. et al. European Respiratory Society/American Thoracic Society technical statement: standardisation of the measurement of lung volumes, 2023 update. Eur. Respir. J. 2023; 62 (4): 2201519. DOI: 10.1183/13993003.01519-2022.

21. Graham B.L., Brusasco V., Burgos F. et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49 (1): 1600016. DOI: 10.1183/13993003.00016-2016.

22. Holland A.E., Spruit M.A., Troosters T. et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur. Respir. J. 2014; 44 (6): 1428–1446. DOI: 10.1183/09031936.00150314.

23. Ley B., Ryerson C.J., Vittinghoff E. et al. A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann. Intern. Med. 2012; 156 (10): 684–691. DOI: 10.7326/0003-4819-156-10-201205150-00004.

24. von der Beck D., Grimminger F., Seeger W. et al. Interstitial lung disease: seasonality of hospitalizations and in-hospital mortality 2005–2015. Respiration. 2022; 101 (3): 253–261. DOI: 10.1159/000519214.

25. Chikina S.Yu., Ataman K.S., Trushenko N.V., Avdeev S.N. [A comparison of informative between 6-minute walking test and sit-to-stand test in patients with fibrosing interstitial lung diseases]. Pul'monologiya. 2022; 32 (2): 208–215. DOI: 10.18093/0869-0189-2022-32-2-208-215 (in Russian).

26. Singh S.J., Puhan M.A., Andrianopoulos V. et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur. Respir. J. 2014; 44 (6): 1447–1478. DOI: 10.1183/09031936.00150414.