Objective: To identify predictors of immune-related adverse events (IRAEs) in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). Assess associations between outcomes and the development of IRAEs. Methods: Retrospective analysis of patients with NSCLC treated with ICIs between 2016 and 2020 in the Pulmonology Department of our hospital. Patients with and without IRAEs were compared. A logistic regression analysis was performed to determine predictors of IRAEs. Progression-free survival (PFS) and overall survival (OS) curves were calculated using the Kaplan-Meier method, and the long-rank test was used to assess survival differences between groups. Univariate and multivariate Cox proportional-hazards regression models were used to identify factors associated with PFS and OS. The value considered statistically significant was p≤0.05. Results: A total of 184 patients (77.7% men, mean age 66.9±9.5 years) treated with ICIs were analyzed. During follow-up, 49 (26.6%) patients developed IRAEs and 149 (81.0%) died. According to the multivariate logistic regression analysis, treatment with statins (OR:3.15; p = 0.007), previous systemic corticosteroid therapy (OR:3.99; p = 0.001), disease controlled as response to ICI (OR:5.93; p < 0.001) and higher hemoglobin values (OR:1.28; p = 0.040) were independent predictors for the development of IRAEs. Patients who developed IRAEs had significantly longer medians of PFS (41.0 vs 9.0 weeks, p < 0.001) and OS (89.0 vs 28.0 weeks; p < 0.001). Conclusions: Patients treated with statins, pre-ICI systemic corticosteroids, higher baseline hemoglobin value and controlled disease as initial response to ICI had a higher risk of developing IRAEs. The development of IRAEs was associated with better outcomes.

Objective: The frequency of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is high. The clinical course of non-IPF interstitial lung disease (ILD) can be similar to that of IPF. We sought to assess the frequency and predictors of OSA in patients with non-IPF fibrotic ILD, as well as the impact of positive airway pressure (PAP) therapy on the quality of life of such patients. Methods: This was a prospective study in which non-IPF fibrotic ILD patients underwent a home sleep apnea test. The patients with and without OSA were compared, and a multivariate logistic regression model was used to identify independent predictors of OSA. At 3 months after initiation of PAP therapy, we evaluated the participating patients for respiratory events, nocturnal hypoxemia, and changes in quality of life. Results: Of a total of 50 patients, 50% were male, and 76% were diagnosed with OSA. The mean age was 67.8 ± 8.3 years. The patients with OSA had significantly lower TLC (p = 0.033) and awake SpO2 (p = 0.023) than did those without OSA. In the multivariate logistic regression model, SpO2 (OR = 0.46; p = 0.016) and TLC (OR = 0.95; p = 0.026) remained significantly associated with OSA risk. A total of 12 patients received PAP therapy. At 3 months after initiation of PAP therapy, 91.7% were well controlled, Epworth Sleepiness Scale scores decreased significantly (p = 0.006), and emotional well-being tended to improve (p = 0.068). PAP therapy corrected nocturnal hypoxemia in all patients. Conclusions: We found a high frequency of OSA in patients with non-IPF fibrotic ILD. A low TLC was an independent predictor of a higher risk of OSA. PAP therapy can correct nocturnal hypoxemia. There should be a low threshold for suspicion of OSA and initiation of PAP therapy in patients with non-IPF fibrotic ILD.

Introduction: Transbronchial lung cryobiopsy (TBLC) has been used in the diagnostic workup of interstitial lung diseases (ILD), due to its high diagnostic yield and relatively low morbimortality. Still, TBLC is not innocuous, and the high rate of pneumothorax (PTX) has been a major concern. The aim of this study was to identify predictors of post-TBLC PTX. Methods: We retrospectively analyzed patients who underwent TBLC for ILD diagnosis. Clinical data and TBLC performance were reviewed. A multivariate logistic regression model was built to determine independent predictors of post-TBLC PTX. Results: Among 249 patients (60.6% male, mean age 61.5±12.2 years), 52 (20.9%) had post-TBLC PTX and 39 (15.7%) required drainage. Patients presenting PTX had significantly higher FEV1/FVC ratio, lower TLC and lower DLCO. There was an association between PTX and radiological UIP pattern, histological UIP pattern, number of lobes biopsied, >4 biopsies performed and pleura representation in samples. Concerning PTX needing drainage, we found a statistically significant association with radiological UIP pattern, pleura representation in samples, >4 biopsies performed and diagnosis of smoking related lung disease. Independent predictors of post-TBLC PTX were the radiological UIP pattern (p=0.011), high FEV1/FVC ratio (p=0.02) and pleural representation on histology (p=0.004). Conclusion: In our series, PTX was a common complication after TBLC, although only 15.7% required drainage. We identified several risk factors that increase the PTX rate, of which radiological UIP pattern, high FEV1/FVC ratio and presence of pleura in samples presented the highest impact to predict PTX.