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al., 1979; Keogh & Crystal, 1980). Patients have an enhanced risk of death if the Vࡆo2max
less than 8.3 ml/kg/min at baseline (Fell et al., 2010). The 6MWT has become the most
extensively employed exercise test in most of the lung diseases, including IPF, given its easy
execution and reproducibility (Eaton et al., 2005; Kadikar et al., 1997). Distance walked
(Lederer et al., 2006b; Caminati et al., 2009) and desaturation (Hallstrand et al., 2005;
Flaherty et al., 2006) during the 6MWT both have been observed to anticipate mortality, and
in one study a composite of the product of distance and desaturation anticipated mortality
better than either of the measures alone (Lettieri et al., 2006b). Abnormal heart rate recovery
after 1 minute of rest after the 6MWT also may be a unique and strong indicator of mortality
(Lettieri et al., 2006b). Current data exhibits that a significant modification in 6MWD is
extremely predictive of mortality (i.e., a decrease in 6MWD > 50 m over 24 wk is related
with a fourfold enhancement in the risk of death at 1 year [P < 0.001]) (Bois et al., 2011). It
has been recommended additionally that the least significant distinction for 6MWD is nearly
30 m (i.e, patients can distinguish the smallest modification in distance as distinct from the
earlier test and that would authorize, an alteration in the management in the lacking of
annoying side effects and lavish costs) (Swigris et al., 2010; Bois et al., 2011). The
confirmation to the effectiveness of desaturation during exercise testing for anticipating
mortality can be done by two other exercise tests, the 15-step and 4-minute step tests (Shitrit
et al., 2009; Stephan et al., 2007).
Pathologic Predictors:
The histopathologic pattern is UIP that recognizes IPF, and it conveys the worst
prognosis amongst the idiopathic interstitial pneumonias (American Thoracic Society &
European Respiratory Society, 2002; Bjoraker et al., 1998; Nicholson et al., 2000). Biopsies
from distinct lobar specimens in the same patient fascinatingly may exhibit histologic
discordance, that is, nonspecific interstitial pneumonia in one area and patterns of UIP in
another area (i.e., discordant UIP). Discordant UIP category patients exhibit survival, clinical
and physiologic characteristics comparable to those observed in the concordant UIP category,
and significantly, the prognosis in both concordant and discordant UIP categories was
notably worse than that of the concordant nonspecific interstitial pneumonia category
(Flaherty et al., 2001; Monaghan et al., 2004).
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