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Bedeutung von Komorbiditäten bei der idiopathische Lungenfibrose

Importance of comorbidities in idiopathic pulmonary fibrosis

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Komorbiditäten der idiopathischen Lungenfibrose (IPF) sind sehr häufig und zumeist mit einer verschlechterten Lebensqualität und Prognose der Patienten verbunden. Vor allem pulmonale Hypertonie, chronische obstruktive Lungenerkrankung/Lungenemphysem, Lungenkarzinom und die koronare Herzerkrankung sind prognostisch relevant. Während Mikroaspirationen zwar als möglicher Auslöser und Progressionsfaktor einer IPF diskutiert werden, ist die Refluxerkrankung jedoch mit einer besseren Prognose assoziiert. Die Ursachen hierfür sind noch unklar, möglicherweise handelt es sich um einen „lead time bias“ oder einen Therapieeffekt des Refluxes; allerdings spricht die aktuelle Datenlage gegen einen solchen Zusammenhang für antazide Medikamente. Das Risiko ein Lungenkarzinom zu entwickeln, ist bei IPF signifikant höher im Vergleich zur Normalbevölkerung und die zweithäufigste respiratorische Todesursache bei der IPF. Eine Therapie des nicht-kleinzelligen Bronchialkarzinoms (NSCLC) ist jedoch nur im frühen Stadium der IPF mit einem verbesserten Outcome assoziiert, in anderen Fällen allerdings mit einem sehr hohen periinterventionellen Risiko. Bisherige Daten suggerieren, dass ein Screening auf Komorbiditäten und deren konsequente Therapie zu einer verbesserten Lebensqualität und Prognose der chronisch erkrankten IPF-Patienten führen könnten.

Abstract

Comorbidities of idiopathic pulmonary fibrosis (IPF) are very frequent and mostly associated with a reduced quality of life and poorer prognosis for the patient. In particular, pulmonary hypertension, chronic obstructive pulmonary disease/lung emphysema, lung cancer and coronary heart disease are prognostically relevant. While microaspiration might be a possible trigger and a progression factor in IPF, gastroesophageal reflux disease (GERD) is associated with a better prognosis. The reasons for this are still unclear but could possibly be explained by a lead time bias or a therapeutic effect of GERD treatment; however, such an association with antacid medication is not supported by the currently available data. The risk of developing lung cancer is significantly higher in IPF than in the general population and is the second most common respiratory cause of death in IPF; however, treatment of non-small cell lung cancer (NSCLC) is only associated with a better outcome in patients with an early stage of IPF, in other cases patients have a higher peri-interventional risk. Current data suggest that screening for comorbidities followed by consistent treatment could lead to an improvement of the quality of life and prognosis in patients with chronic IPF.

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M. Polke und M. Kreuter geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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U. Costabel, Essen

J. Behr, München

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Polke, M., Kreuter, M. Bedeutung von Komorbiditäten bei der idiopathische Lungenfibrose. Pneumologe 17, 169–176 (2020). https://doi.org/10.1007/s10405-019-00294-5

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