May Small Airways Dysfunction (SAD) Play a Role in the Idiopathic Pulmonary Fibrosis (IPF) and May SAD Be a Therapeutic Target?

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The author present a very interesting and thorough manuscript reviewing emerging data on SAD and their potential pathophysiologic and therapeutic roles in patients with IPF.

The manuscript is well written, updated, and includes the major relevant studies in the field. It provides a very good summary of current literature in this "hot topic".

I would, however, suggest some minor points:

1. Maybe include discussion of the very recent publication: "Kurche JS, Cool CD, Blumhagen RZ, Dobrinskikh E, Heinz D, Herrera JA, Yang IV, Schwartz DA. MUC5B IPF Risk Variant Promotes a Muco-Secretory Phenotype and Loss of Small Airway Secretory Cells. Am J Respir Crit Care Med. 2024 Jun 26. doi: 10.1164/rccm.202311-2111LE. Epub ahead of print. PMID: 38924494."

2. Please discuss shortly other fibrotic diseases, such as fibrotic HP, which commonly involve airways, and the DD between IPF and those conditions (to my knowledge there is very few data regarding SAD in FHP)

Author Response

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I would like to thank you very much for your valuable comments and suggestions

I have accepted all comments and tips . The article  has been corrected accordingly, additional references has been included, the ambiguities have been clarified or removed.

Added new sentences and references are marked in red

Thank you again

With best regard

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Editor, 

Dr Ziora provides a short review / commentary on the potential value of small airway disease in IPF. The manuscript discusses an emerging issue in IPF, alongside future questions, alhtough it does not provide an exhaustive review of the literature. 

Comments:

- line 26, please also add "loss of alveolar attachments" that is shown to have a profound role on small airway dyfunction in COPD. 

- line 124, it is not clear exactly in what method c was found to be useful. 

- lines 148-149. In my opinion Ax and low frequency reactance area (ALX)  is the same thing. 

- line 143. I suggest using the general term oscillometry, insteand of statitng FOT and IOS.

- Since MMEF is an insensitive and not specific marker of small airway dysfunction, I would suggest the authors to expand and focus on the section of oscillometry, Adding references that combine imaging markers of small airway disease with oscillometry would be also useful [e.g. Mikamo, M., et al et al. Clinical Significance of Forced Oscillation Technique for Evaluation of Small Airway Disease in Interstitial Lung Diseases. Lung 194, 975–983 (2016)]. Also, I would suggest citing the study by van Noord JA, Clément J, Cauberghs M, Mertens I, Van de Woestijne KP, Demedts M. Total respiratory resistance and reactance in patients with diffuse interstitial lung disease. Eur Respir J. 1989 Oct;2(9):846-52. It is one of the first studies to employ oscillometry in ILDs.  

 

Author Response

I would like to thank you very much for your valuable comments and suggestions

I have accepted all comments and tips . The article  has been corrected accordingly, additional references has been included, the ambiguities have been clarified or removed.

Added new sentences and references are marked in red

Thank you again

With best regard