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IPF Excel Database

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Characteristics

Identity

Demographics

Environmental and occupational exposure

Comorbidities

Physical examination

Surgical lung biopsy

Bronchoalveolar lavage (BAL)

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Characteristics: Identity

Hospital name (code)

Physician name (code)

Patient's initial (code)

註冊患者資訊在 Characteristics 分頁 其他分頁會參照 Characteristics 分頁的 Identity

其他分頁的 Identity 如果是多筆資料，每一列請重複填寫

Characteristics: Demographics

Variable Predefined Value

Gender M: Male, F: Female

Birthday (yyyy/mm/dd)

Education level University and above, High school, Below high school

Initial diagnosis date (yyyy/mm/dd)

Smoking status Never, Current smoker, Ex-smoker

(Pack Year)

A quantification of lifetime tobacco exposure defined as (number of cigarettes smoked per day x number of years smoked)/20. One pack-year is smoking 20 cigarettes a day for one year.

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Characteristics: Environmental and occupational exposures

Variable Predefined Value

None Y: Yes, N: No

Metal dusts Y: Yes, N: No

Wood dusts Y: Yes, N: No

Vegetable dusts Y: Yes, N: No

Farming Y: Yes, N: No

Livestock exposures Y: Yes, N: No

Birds exposures Y: Yes, N: No

Hair dressing Y: Yes, N: No

Stone cutting /polishing Y: Yes, N: No

Passive smoking Y: Yes, N: No

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Characteristics: Comorbidities

Variable Predefined Value

Gastroesophageal reflux (GER)

No,Acid reflux sensation, Retrosternal heartburn sensation, Nocturnal cough

GER Treatment Y: Yes, N: No

Diabetes mellitus Y: Yes, N: No

Familial pulmonary fibrosis Y: Yes, N: No

Cancer history Y: Yes, N: No

Characteristics: Physical examination / Surgical lung biopsy / BAL Physical examination Predefined Value

Clubbed finger Y: Yes, N: No

Surgical lung biopsy

Date Performed (yyyy/mm/dd)

Location

Right middle, Right upper, Right low, Left middle, Left upper, Left low

Method VATS, Open, Other

Biopsy UIP Pattern

UIP Probable, UIP Possible, UIP Non-classifiable fibrosis, Not UIP

Bronchoalveolar lavage (optional)

BAL Yes, No

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Serological tests

Date of Assessment 不同的 Date of Assessment 分別寫在不同列 一位患者可以有多次的紀錄 ( 以 Date of Assessment 區分 ,

日期一定要填 )

Complete blood count Values

Other serological tests Value or Positive/Negative

空白視為未做 請確實填寫每一列的 Identity

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Serological tests: Complete blood count

Test Name

Hematocrit (%) Unit: %

Hemoglobin (g/dL) Unit: g/dL

Platelets (10^9/L) Unit: 10^9/L

Red Blood Cells (10^12/L) Unit: 10^12/L

White Blood Cells (10^9/L) Unit: 10^9/L

Neutrophils (%) Unit: %

Lymphocytes (%) Unit: %

Monocytes (%) Unit: %

Eosinophils (%) Unit: %

Basophils (%) Unit: %

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Serological tests: Other serological tests

Test Name

Creatine Kinase (U/L) Unit: U/L

Rheumatoid Factor Negative, Positive, Not Done

Antinuclear Antibodies Negative, Positive, Not Done

Antisynthetase (anti-Jo1) Antibodies Negative, Positive, Not Done

Sjogrens SS-A Antibodies Negative, Positive, Not Done

Sjogrens SS-B Antibodies Negative, Positive, Not Done

Scleroderma-70 Antibody Negative, Positive, Not Done

Arterial Blood Gas (Optional)Normal, Abnormal - NCS, Abnormal - CS, Not Done

Epstein-Barr Virus (EBV) Negative, Positive, Not Done

Hepatitis C Virus (HCV) Antibody Negative, Positive, Not Done

Cytomegalovirus IgG Antibody Negative, Positive, Not Done

Cytomegalovirus IgM Antibody Negative, Positive, Not Done

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HRCT criteria

Date of Assessment

不同的 Date of Assessment 分別寫在不同列 一位患者可以有多次的紀錄 ( 以 Date of Assessment 區

分 , 日期一定要填 )

HRCT UIP pattern

Inconsistent with UIP pattern

Emphysema

Yes or No?

請確實填寫每一列的 Identity

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HRCT: HRCT UIP pattern

HRCT UIP pattern

Subpleural, basal predominance Y: Yes, N: No

Reticular abnormality Y: Yes, N: No

Honeycombing with or without traction bronchiectasis Y: Yes, N: No

Absence of features listed as inconsistent with UIP pattern Y: Yes, N: No

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HRCT: Inconsistent with UIP pattern

Inconsistent with UIP

Upper or mid-lung predominance Y: Yes, N: No

Peribronchiovascular predominance Y: Yes, N: No

Extensive ground glass abnormality (extent > reticular abnormality) Y: Yes, N: No

Profuse micronodules (bilateral, predominantly upper lobes) Y: Yes, N: No

Discrete cysts (multiple, bilateral, away from areas of honeycombing) Y: Yes, N: No

Diffuse mosaic attenuation/air-trapping (bilateral, in three or more lobes)

Y: Yes, N: No

Consolidation in bronchopulmonary segment(s)/lobe(s) Y: Yes, N: No

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Physiology

Date of Assessment 不同的 Date of Assessment 分別寫在不同列 一位患者可以有多次的紀錄 ( 以 Date of Assessment 區分 , 日期

一定要填 )

Dyspnea Mild, Moderate, Severe, Life-threatening

Spirometry

Cardiopulmonary exercise testing

Six-Minute-Walk testing (6MWT)

空白視為未執行該檢測 請確實填寫每一列的 Identity

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Physiology: Spirometry

Variable

FVC (mL) Unit: mL

FVC (% predicted) Unit: %

FEV1 (mL) Unit: mL

FEV1 (% predicted) Unit: %

FEV1/FVC ratio (%) Unit: %

DLCO (mmol/min/lPa) Unit: mmol/min/lPa

DLCO (% predicted) Unit: %

Total lung capacity (mL) Unit: mL

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Physiology: CPET Pattern

Question Predefined value

CPET Pattern

• Normal Patient• Heart Failure• Pulmonary Vascular Disease• Deconditioning• COPD• ILD• Obesity• Psychogenic disorders• Neuromuscular Disease• Poor effort and malingering• Not determined

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Physiology: Six-Minute-Walk testing

Variable

Resting saturation (SpO2, %) Unit: %

Exercise saturation (SpO2, %) Unit: %

6 Minutes Distance (meters) Unit: meters

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Treatment

單一患者可以有不同的藥品紀錄 請確實填寫每一列的 Identity

Variable Predefined Values

Name of Treatment

Dose

Dose Units mg, mcg, g, mL, mcL

Dosing Frequency QD, BID, TID, QOD, Q3D, Unknown

Start Date (yyyy/mm/dd)

End Date (yyyy/mm/dd)