Clinical Predictors of Lung-Function Decline in Systemic-Sclerosis-Associated Interstitial Lung Disease Patients with Normal Spirometry

Abstract

Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). Progressive pulmonary fibrosis (PPF) is defined as progression in 2 domains including clinical, radiological or lung-function parameters. Our aim was to assess predictors of functional decline in SSc-ILD patients and compare disease behavior to that in idiopathic pulmonary fibrosis (IPF) patients. Patients with normal forced vital capacity (FVC > 80% predicted; SSc-ILD: n = 31; IPF: n = 53) were followed for at least 1 year. Predictors of functional decline including clinical symptoms, comorbidities, lung-function values, high-resolution CT pattern, and treatment data were analyzed. SSc-ILD patents were significantly younger (59.8 ± 13.1) and more often women (93 %) than IPF patients. The median yearly FVC decline was similar in both groups (SSc-ILD = −67.5 and IPF = −65.3 mL/year). A total of 11 SSc-ILD patients met the PPF criteria for functional deterioration, presenting an FVC decline of −153.9 mL/year. Cough and pulmonary hypertension were significant prognostic factors for SSc-ILD functional progression. SSc-ILD patients with normal initial spirometry presenting with cough and PH are at higher risk for showing progressive functional decline.

Keywords: cough; interstitial lung disease; predictors of treatment response; pulmonary hypertension; systemic sclerosis.

Figure 1

Patient selection for analysis. FVC, forced vital capacity; ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis; MDT, multidisciplinary team; SSc-ILD, systemic-sclerosis-associated interstitial lung disease.

Figure 2

Annual rate of decline in FVC (mL per year) in IPF and SSc-ILD patients. FVC, forced vital capacity; IPF, idiopathic pulmonary fibrosis; SSc-ILD, systemic-sclerosis-associated interstitial lung disease.

Figure 3

Annual changes in FVC (A) and DL_CO (B) % of the predicted value in all IPF and SSc-ILD patients according to specific treatment groups. DL_CO, diffusing capacity for carbon monoxide; FVC, forced vital capacity; IPF, idiopathic pulmonary fibrosis; NT, no treatment; SSc-ILD, systemic-sclerosis-associated interstitial lung disease; T, treatment.