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- 저자 : ( Arata Azuma ) (검색결과 4 건)
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( Arata Azuma ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
IPF is an exclusively progressive fibrosing pulmonary disease of unknown cause. Other disease concepts have been excluded for enrichment of accurate diagnosis of IPF. Non-IPF fibrosing ILD is a disease phenotype of poor prognosis despite of widely distributed disease concepts. In recent years, since the introduction of therapeutic drugs, the discussion of the pathological conditions to be treated has been activated like IPF. Pirfenidone’s unclassifiable ILD clinical trial, Nintedanib’s SSc-ILD trial (SENSCIS trial) and PF-ILD (INBUILD) trial were challenging trials, but it has attracted a great deal of attention because it is a ‘positive trial results’. However, although the FVC, which is regarded as a surrogate marker for survival by IPF, has been adopted to determine the therapeutic effect at the primary endpoint, the validity of the discussion by FVC has not been verified for other disease units. In particular, CTD-ILD as a systemic disease needs to be evaluated for prognosis by multiple organ pathologies in addition to immunosuppressive treatment. Under anti-fibrotic management, CTD pathology is very complex. In the future, it will be necessary to discuss the pros and cons of therapeutic intervention while carefully observing the pathological condition.
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( Arata Azuma ),( Luca Richeldi ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.3
The disease concept of interstitial lung disease with idiopathic pulmonary fibrosis at its core has been relied on for many years depending on morphological classification. The separation of non-specific interstitial pneumonia with a relatively good prognosis from usual interstitial pneumonia is also based on the perception that morphology enables predict the prognosis. Beginning with dust-exposed lungs, initially, interstitial pneumonia is classified by anatomical pathology. Diagnostic imaging has dramatically improved the diagnostic technology for surviving patients through the introduction of high-resolution computed tomography scan. And now, with the introduction of therapeutics, the direction of diagnosis is turning. It can be broadly classified into to make known the importance of early diagnosis, and to understand the importance of predicting the speed of progression/deterioration of pathological conditions. For this reason, the insight of “early lesions” has been discussed. There are reports that the presence or absence of interstitial lung abnormalities affects the prognosis. Searching for a biomarker is another prognostic indicator search. However, as is the case with many chronic diseases, pathological conditions that progress linearly are extremely rare. Rather, it progresses while changing in response to environmental factors. In interstitial lung disease, deterioration of respiratory functions most closely reflect prognosis. Treatment is determined by combining dynamic indicators as faithful indicators of restrictive impairments. Reconsidering the history being classified under the disease concept, the need to reorganize treatment targets based on common pathological phenotype is under discussed. What is the disease concept? That aspect changes with the discussion of improving prognosis.
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Clinical benefit of pirfenidone in IPF in Japanese experiences 90min
( Arata Azuma ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
IPF is an irreversible devastating pulmonary disease of unknown cause. Pirfenidone is a disease modulator with inhibition of decline in pulmonary functions, that was firstly available in Japan. Pirfenidone showed proof in attenuation in decline of FVC(VC) of patients with IPF in a clinical trial, that has led subsequently approval over the world. Real life practice makes multivariate analysis leading to other parameters including DLco, 6mw distance, symptoms, quality of life, radiological findings, acute exacerbation, and comorbidities such as lung cancer, risk of surgical procedure, and lastly overall survival. How much dosage is beneficial to IPF patients? Discussion will be continued in balance on risk and benefit. As drug development is globalized, the effectiveness of pirfenidone may depend on ethnic differences. We, all Asian need to share information about clinical practice across countries and times.
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