Letter to the Director
Relative Versus Absolute Decline in Forced Vital Capacity in Progressive Pulmonary Fibrosis
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"apellidos" => "Turner" ] 9 => array:2 [ "nombre" => "Marc" "apellidos" => "Miravitlles" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622004884?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000012/v2_202305072241/S0300289622004884/v2_202305072241/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Relative Versus Absolute Decline in Forced Vital Capacity in Progressive Pulmonary Fibrosis" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "843" "paginaFinal" => "844" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Horacio Matías Castro, Joaquin Maritano Furcada, Juan Ignacio Enghelmayer" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Horacio Matías" "apellidos" => "Castro" "email" => array:1 [ 0 => "matias.castro@hospitalitaliano.org.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Joaquin" "apellidos" => "Maritano Furcada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Juan Ignacio" "apellidos" => "Enghelmayer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Neumonología, Equipo de Enfermedades Pulmonares Intersticiales Difusas, Hospital Italiano de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "División Neumonología, Hospital de Clínicas José de San Martín, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 572 "Ancho" => 2091 "Tamanyo" => 103719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of a 5% decline in FVC in absolute and relative terms according to the baseline FVC of a theoretical patient: (A) patient with preserved baseline FVC and (B) patient with decreased baseline FVC. As baseline FVC declines, the difference between the relative and absolute percentage value increases. The relative method is more sensitive for detecting decline and this parameter is more marked in patients with reduced baseline FVC values. <span class="elsevierStyleItalic">Absolute FVC</span><span class="elsevierStyleItalic">decline</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>baseline FVC<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>final FVC; <span class="elsevierStyleItalic">relative decline:</span> (baseline FVC<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>final FVC)/baseline FVC; <span class="elsevierStyleItalic">FVC:</span> forced vital capacity; L: liters; <span class="elsevierStyleItalic">Δ</span>: Delta of change between a relative and absolute FVC decline of 5%.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interstitial lung diseases (ILD) have different causes, treatments, and courses. One ILD subgroup that progresses over time despite appropriate treatment is called progressive pulmonary fibrosis (PPF).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> A highly variable proportion of ILD patients develop PPF: between 3% and 63%, depending on the entity.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> No international agreement on the definition of PPF was available until an international group of respiratory societies recently published a consensus document.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> This document defined PPF as the presence of at least 2 of the following criteria occurring within the last year with no alternative explanation: (1) worsening respiratory symptoms (cough and/or dyspnea); (2) decline in forced vital capacity (FVC, % absolute)<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>5% and/or decline in diffusing capacity of the lungs for carbon monoxide<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10% (% absolute); (3) New or increased extent of fibrosis on high-resolution computed tomography. Previously, the most commonly used definition of progression was that of the INBUILD study, which included relative FVC decline among its criteria. These criteria have been widely discussed, and we would like to focus on the definition, differences, and implications of absolute or relative FVC decline as variables for defining progression.</p><p id="par0010" class="elsevierStylePara elsevierViewall">FVC decline is a criterion for progression and a predictor of mortality in fibrotic ILD.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Absolute decline (as a percentage) is calculated as follows: baseline FVC – final FVC; while relative decline is (baseline FVC – final FVC)/baseline FVC.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Both measurements are similar when the patient's FVC is preserved but differ increasingly as FVC declines (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The more severe baseline FVC, the greater the risk of identifying random or non-clinically significant fluctuations using the relative method.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The method used will affect the design and outcomes of clinical trials. When the relative method is used to calculate a ≥5% decline in FVC, smaller sample sizes are needed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> A retrospective study showed that the percentage of patients with PPF differs depending on the definition of progression used.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The choice of method is also associated with earlier detection of progression (the relative method is more sensitive, despite some loss of specificity), which in turn affects the indication for antifibrotic treatment and patient prognosis. Finally, in patients with idiopathic pulmonary fibrosis, the minimum clinically significant difference in the percentage of absolute decrease in FVC has been estimated at 2%-6%.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This value in patients with PPF is unknown. Studies evaluating the clinically significant minimum difference in relative and absolute decline of FVC in patients with PPF would therefore be of value.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, changes in the criteria used to define PPF may have prognostic and therapeutic implications. The relative method is useful for the early detection of decline but is more susceptible to random fluctuations that lack clinical relevance.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">We have no sources of funding for the development of the manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">We have no conflict of interests related directly or indirectly to the contents of this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 572 "Ancho" => 2091 "Tamanyo" => 103719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of a 5% decline in FVC in absolute and relative terms according to the baseline FVC of a theoretical patient: (A) patient with preserved baseline FVC and (B) patient with decreased baseline FVC. As baseline FVC declines, the difference between the relative and absolute percentage value increases. The relative method is more sensitive for detecting decline and this parameter is more marked in patients with reduced baseline FVC values. <span class="elsevierStyleItalic">Absolute FVC</span><span class="elsevierStyleItalic">decline</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>baseline FVC<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>final FVC; <span class="elsevierStyleItalic">relative decline:</span> (baseline FVC<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>final FVC)/baseline FVC; <span class="elsevierStyleItalic">FVC:</span> forced vital capacity; L: liters; <span class="elsevierStyleItalic">Δ</span>: Delta of change between a relative and absolute FVC decline of 5%.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 204807 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Raghu" 1 => "M. Remy-Jardin" 2 => "L. Richeldi" 3 => "C.C. Thomson" 4 => "Y. Inoue" 5 => "T. Johkoh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.202202-0399ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2022" "volumen" => "205" "paginaInicial" => "e18" "paginaFinal" => "e47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35486072" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novedades diagnósticas y terapéuticas en fibrosis pulmonar progresiva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Molina-Molina" 1 => "I. Buendia-Roldan" 2 => "D. Castillo" 3 => "F. Caro" 4 => "C. Valenzuela" 5 => "M. Selman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2022" "volumen" => "58" "paginaInicial" => "418" "paginaFinal" => "424" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relative versus absolute change in forced vital capacity in idiopathic pulmonary fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Richeldi" 1 => "C.J. Ryerson" 2 => "J.S. Lee" 3 => "P.J. Wolters" 4 => "L.L. Koth" 5 => "B. Ley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2011-201184" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "407" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22426899" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes and incidence of PF-ILD according to different definitions in a real-world setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.E. Torrisi" 1 => "N. Kahn" 2 => "J. Wälscher" 3 => "M. Polke" 4 => "J.S. Lee" 5 => "P.L. Molyneaux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fphar.2021.790204" "Revista" => array:5 [ "tituloSerie" => "Front Pharmacol" "fecha" => "2021" "volumen" => "12" "paginaInicial" => "790204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34975486" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forced vital capacity in patients with idiopathic pulmonary fibrosis: test properties and minimal clinically important difference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Du Bois" 1 => "D. Weycker" 2 => "C. Albera" 3 => "W.Z. Bradford" 4 => "U. Costabel" 5 => "A. Kartashov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201105-0840OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "1382" "paginaFinal" => "1389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21940789" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000012/v2_202305072241/S0300289622004896/v2_202305072241/en/main.assets" "Apartado" => array:4 [ "identificador" => "93867" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000012/v2_202305072241/S0300289622004896/v2_202305072241/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622004896?idApp=UINPBA00003Z" ]
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