Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20497
Title: Eligibility for anti-fibrotic treatment in idiopathic pulmonary fibrosis depends on the predictive equation used for pulmonary function testing.
Authors: Burgess, Andrew;Goon, Ken;Brannan, John D;Attia, John;Palazzi, Kerrin;Oldmeadow, Christopher;Corte, Tamera J;Glaspole, Ian;Goh, Nicole S L;Keir, Gregory;Allan, Heather;Chapman, Sally;Cooper, Wendy;Ellis, Samantha;Hopkins, Peter;Moodley, Yuben;Reynolds, Paul;Zappala, Chris;Macansh, Sacha;Grainge, Christopher
Affiliation: Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
Respiratory Department, John Hunter Hospital (JHH), Newcastle, NSW, Australia
School of Medicine, Newcastle University, Newcastle, NSW, Australia
Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
Australian Idiopathic Pulmonary Fibrosis Registry (AIPFR), Brisbane, QLD, Australia
Lung Foundation Australia, Brisbane, QLD, Australia
Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
School of Medicine, University of Queensland, Brisbane, QLD, Australia
Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia
Tissue pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
School of Medicine, Western Sydney University, Sydney, NSW, Australia
Department of Respiratory Medicine, Princess Alexandria Hospital, Brisbane, QLD, Australia
Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, Monash University, Melbourne, VIC, Australia
Issue Date: 28-Mar-2019
EDate: 2019
Citation: Respirology (Carlton, Vic.) 2019; online first: 28 March
Abstract: Publicly funded therapy for idiopathic pulmonary fibrosis (IPF) relies on percentage predicted values from pulmonary function testing, for example Australian patients must have a forced vital capacity ≥50% (%FVC), transfer factor of the lung for carbon monoxide ≥ 30% (%TLco) and forced expiratory volume in 1 s (FEV1 )/FVC ratio > 0.7. Despite defined cut-off values, no jurisdiction prescribes a reference equation for use; multiple equations exist. We hypothesized that access to subsidized treatment varies depending on the chosen equation. The %FVC and %TLco from different commonly used reference equations across general respiratory patients, and IPF-specific patients, were compared. FVC and TLco measurements from a large general respiratory laboratory and the Australian Idiopathic Pulmonary Fibrosis Registry (AIPFR) database were analysed using multiple equations. Differences between %FVC and %TLco for each equation were calculated, with particular interest in classification of patients (%) at the threshold for subsidized treatment. A total of 20 378 general respiratory database results were analysed. The %FVC ≥ 50% increased from 86% with the Roca equation to 96% with Quanjer (European Coal and Steal Community, ECSC) and %TLco≥30% increased from 91% with Paoletti to 98% with Thompson. However, overall increase in eligibility for subsidized treatment was modest, varying from 48.2% to 49.2%. A total of 545 AIPFR database results were analysed. The %FVC ≥ 50% increased from 73% with Roca to 94% with Quanjer (ECSC) and %TLco≥30% increased from 87% with Paoletti to 96% with Miller. Overall eligibility for subsidized treatment in the AIPFR group varied from 73.6% to 82.8% between surveyed interstitial lung disease (ILD) centres based entirely on the equation used. Substantial variability exists between reference equations, impacting access to subsidized treatment. Treating clinicians should be aware of this when assessing patients around public funding thresholds.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20497
DOI: 10.1111/resp.13540
ORCID: 0000-0001-7218-2091
0000-0002-7096-9365
0000-0002-5118-2890
0000-0003-2065-4346
0000-0001-9979-8726
0000-0002-9310-7258
0000-0002-0777-1196
0000-0002-2273-1774
0000-0002-6565-9928
PubMed URL: 30924257
Type: Journal Article
Subjects: fibrosis
lung function
predicted equations
treatment
Appears in Collections:Journal articles

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