The increasing trend and seasonal variation in attendance in patients with interstitial lung disease
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Authors
Joshi, V
Issue Date
2023
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Lung diseases
Alternative Title
Abstract
Sir,
I read with interest, an article on an increasing trend and seasonal variation in DPLD attendance by Bhattacharyya et al.[1] published in Lung India recently. I am pleased to see that an important topic has been touched upon through research.
The study concludes with findings of an increased trend in attendance to outpatient clinics and seasonal variation in attendance of DPLD patients. The rising trend remains unexplained. The probable reason for seasonal variation (Winter and Summer peaks) in hypersensitivity pneumonitis (HP) and sarcoidosis are attributed to overuse of coolers/AC during the summer months and hypercalcemia.[2,3] Winter peaks have been related to the increased frequency of viral infections and overcrowding.
I was intrigued by the fact that DPLD was diagnosed through clinical and radiological correlation. What radiological features/patterns were considered diagnostic in this cohort population e.g., for diagnosing sarcoidosis and HP. I suspect serology, bronchoscopy/surgical lung biopsy would have been helpful in specific cases to support the diagnosis.
It is surprising that the study does not comment on the incidence/prevalence of connective tissue diseases related to interstitial lung disease (CTD -ILD), Idiopathic interstitial pneumonia (IIP), or idiopathic pulmonary fibrosis (IPF). I am not clear if this was due to the predefined cohort in this study or limited diagnostic ability. Radiological features of chronic HP, fibrotic NSIP, and UIP/IPF can overlap and unless histology is available to correct diagnosis may not be achieved.
The rising trend in ILD cases could be multifactorial - secondary to increased awareness amongst clinicians, superior diagnostic modalities, rising ambient pollution, aging population, or associated comorbidities. This study does not report any associated comorbidities which may have led to clinic attendance. The seasonal variation in hospitalization and mortality has been attributed to a rise in ambient air pollution, viral infections driving acute exacerbations of ILD, and autoimmune disease activity during the winter period.[4]
The most common interstitial lung diseases reported in India are HP and sarcoidosis.[5] Up-to-date epidemiological research may shed a light on the seasonality and various aetiologies of ILDs.
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Conflicts of interest
There are no conflicts of interest.
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REFERENCES
1. Bhattacharyya P, Jana MK, Saha D, Paul M, Mukherjee A, Saha R. The increasing trend and the seasonal variation in attendance of diffuse parenchymal lung disease patients presenting to a pulmonary clinic in Eastern India. Lung India. 2021;38:529–32. [PMC free article] [PubMed] [Google Scholar]
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Articles from Lung India : Official Organ of Indian Chest Society are provided here courtesy of Wolters Kluwer -- Medknow Publications
Description
Citation
Joshi V. The increasing trend and seasonal variation in attendance in patients with interstitial lung disease. Lung India. 2023 Mar-Apr;40(2):188-189. doi: 10.4103/lungindia.lungindia_713_21. PMID: 37006111; PMCID: PMC10174661