Pulmonary manifestations of ulcerative colitis rare, but can affect mortality risk
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Researchers characterized several pulmonary manifestations of ulcerative colitis, although they noted these lung diseases only occurred among 5% of their cohort, according to study results published in CHEST.
“The current findings suggest that ulcerative colitis-related lung disease (UC-LD) is one of the important extraintestinal manifestations of UC, which could result in a risk of mortality depending on the presence of fibrosis,” Mitsuhiro Moda, MD, of the department of respiratory medicine at the National Hospital Organization Kinki-Chuo Chest Medical Center in Japan, and colleagues wrote.
In a longitudinal retrospective cohort study, Moda and colleagues analyzed 563 patients (mean age, 42 years; age range, 14-86 years; 44% female; 68.2% never smoked) hospitalized with UC between January 2011 and July 2016 to gain a better understanding of the incidence, characteristics, clinical course and risk factors for various UC-LDs.
Researchers evaluated medical charts/records of those with UC and assessed chest radiography, chest CT scans, pulmonary function tests and bronchoscopy data.
Within a mean follow-up of 77 months, 52.4% of patients received immunosuppressants and/or biologics and 33.7% had a colectomy.
Overall, 28 (5%) patients had a UC-LD, including 13 (2.3%) cases of airway disease, 10 (1.8%) organizing pneumonias, six (0.8%) interstitial pneumonias and one (0.2%) case of pleuritis.
Mean follow-up for patients with airway disease was 52 months from diagnosis, with no deaths during the course of the study in this cohort. Nine of these patients had undergone colectomy, five of whom developed airway disease within 1 year of the procedure.
This cohort of patients generally responded well to inhaled or systemic corticosteroids, with only five patients needing antibiotics due to frequent exacerbations.
Risk factors for airway disease included older age (OR = 1.06; 95% CI, 1.03-1.12) and history of colectomy (OR = 3.58; 95% CI, 1.06-12.1) in multivariate analysis.
Mean follow-up for patients with organizing pneumonia was 68 months from diagnosis. All but one of the cases most likely occurred because of drug-induced pathogenesis within 24 months. Researchers found that discontinuing the suspected drugs (5-aminosalicylic acid, salazosulfapyridine and infliximab) and/or initiation of corticosteroid contributed to favorable clinical courses in these patients, with recurrence in only one patient.
Researchers could not find any risks factors for organizing pneumonia.
Mean follow-up for patients with interstitial pneumonia was 64 months from diagnosis, during which two patients with fibrosis died. The clinical course varied according to whether the patient simultaneously had fibrosis (n = 4). Gradual deterioration was found in those with interstitial pneumonia plus fibrosis.
Additionally, univariate analysis showed that older age was a risk factor for interstitial pneumonia (OR = 1.08; 95% CI, 1.02-1.14).
The one patient with pleuritis responded when the suspected drug (5-aminosalicylic acid) was discontinued and after receiving short-term corticosteroid therapy, following no response to treatment with antibiotics.
“The clinical course and risk factors of UC-LDs differ based on the type, and UC-LDs other than interstitial pneumonia with fibrosis have a good prognosis and respond well to steroid therapy, along with the specific management for each UC-LD,” Moda and colleagues wrote. “These findings guide us to better management of pulmonary manifestations in patients with UC.”
This study by Moda and colleagues brings awareness to different UC-LDs, according to an accompanying editorial by Aman Pande, MD, section chief of pulmonary medicine at Cleveland Clinic.
“Their [Moda and colleagues’] painstaking review of individual medical records allows credible analysis of the risk factors involved,” Pande wrote. “We now have a more nuanced picture of the different categories of pulmonary disease that have been identified and their expected clinical course.”