Assessment of current practice in the diagnosis and therapy of idiopathic pulmonary fibrosis
Assessment of current practice in the diagnosis and therapy of idiopathic pulmonary fibrosis
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DOI：
10.1016/j.rmed.2008.03.018
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发表时间：
2008-09-01
影响因子：
4.3
通讯作者：
Ryu, J. H.
中科院分区：
文献类型：
--
作者：
Peikert, T.;Daniels, C. E.;Ryu, J. H.
背景：美国胸科学会/欧洲呼吸学会(ATS/ERS)于2000年发表了关于特发性肺纤维化(IPF)诊断和治疗的共识声明。对这些准则的接受和执行情况尚未进行评估。我们调查了美国胸科医师学会(FCCP)的会员，以建立目前关于IPF诊断和治疗的实践模式。方法：我们以电子方式向所有6443名获得美国胸科医师学会肺部医学委员会认证的会员发放了一份包含32个项目的问卷。有效率为13%。结果：72%的受访者熟悉ATS/ERS共识声明，63%的受访者认为它在临床上有用。然而，同样数量的受访者表示需要进行更新。支气管镜检查和外科肺活检很少使用。45%的肺科医生主张只为临床试验外的患者提供支持性护理。如果推荐药物治疗，则优先开泼尼松(单独或与硫唑嘌呤合用)或非标签药物。尽管医生知道临床试验(79%)，但感兴趣的患者并不总是被转介(54%)。大多数受访者(61%)认为肺移植是治疗IPF的唯一有效方法，86%的受访者建议他们的患者去肺移植中心。结论：不同的肺科医生对IPF的诊断和处理存在很大的差异。这可能在一定程度上反映了目前缺乏有效的药物治疗。IPF的诊断和治疗需要更新的实践指南。(C)2008爱思唯尔有限公司。保留所有权利。
Background: The consensus statement on the Diagnosis and Therapy of Idiopathic Pulmonary Fibrosis (IPF) formulated by the American Thoracic Society/European Respiratory Society (ATS/ERS) was published in 2000. Acceptance and implementation of these guidelines have not been assessed. We surveyed the fellows of the American College of Chest Physicians (FCCP) to establish current practice patterns regarding the diagnosis and therapy of IPF.Methods: We electronically distributed a 32-item questionnaire to all 6443 pulmonary medicine board-certified Fellows of the American College of Chest Physicians. The response rate was 13%. Demographic characteristics were similar between respondents and non-respondents.Results: Seventy-two percent of respondents were familiar with the ATS/ERS consensus statement and 63% found it clinically useful. However, a similar number of respondents indicated that an update is needed. Bronchoscopy and surgical lung biopsy are used infrequently. Forty-five percent of pulmonary physicians advocate providing only supportive care for patients outside of clinical trials. If pharmacological therapy is recommended, prednisone (either alone or in combination with azathioprine) or off-label agents are preferentially prescribed. Despite physician awareness (79%) of clinical trials, interested patients are not consistently referred (54%). A majority of respondents (61%) felt that lung transplantation represents the only effective therapy for IPF, and 86% refer their patients to lung transplant centers.Conclusions: There is substantial variability among pulmonary physicians in the diagnosis and management of IPF. This may, in part, reflect the current lack of effective pharmacologic therapy. Updated practice guidelines are needed for the diagnosis and therapy of IPF. (C) 2008 Elsevier Ltd. All rights reserved.