Small Airways Disease Functional Assessment in Idiopathic Pulmonary Fibrosis (SWIFT-IPF) (SWIFT-IPF)

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, fibrosing, and progressive lung disease of unknown cause, whose incidence increases proportionally from the age of 60. It is characterized by a poor prognosis. Antifibrotic therapy can slow the progression of the disease and reduce mortality, but the life expectancy is less than 7-10 years in the vast majority of patients with IPF. There are no studies in the literature that have evaluated the presence of small airway disease in patients with IPF prior to the initiation of pharmacological therapy, using the nitrogen washout test. This test is currently considered the only non-invasive method capable of detecting ventilation inhomogeneity and closing volume, which are indicators of small airway dysfunction. The investigators carried out an Italian prospective, observational, multicenter study with the primary aim to assess the prevalence of small airway disease measured by the nitrogen washout test (evaluating the following functional parameters: phase 3 slope, closing volume, closing capacity, closing volume/vital capacity, closing capacity/total lung capacity, and phase 4 slope) in a group of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy. During outpatients visits clinical, functional and radiological data will be collected. Results will be compared to an healthy control group matched with IPF population. Variations in small airways disease parameters will be assessed after one year of antifibrotic treatment.

Study Overview

• Status: Recruiting
• Conditions: Idiopathic Pulmonary Fibrosis; Small Airways Disease

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

Study Locations

• Italy
  • Lombardy
    • Milan, Lombardy, Italy, 20142
      • Recruiting
      • Pulmonology Unit, ASST Santi Paolo e Carlo. Department of Health Sciences, University of Milan, Milan (Italy)
      • Contact: Jacopo Cefalo, MD; Phone Number: +390281843025; Email: jacopo.cefalo@asst-santipaolocarlo.it
      • Contact: Carmine Salerni, MD; Phone Number: +390240222488; Email: carmine.salerni@asst-santipaolocarlo.it
      • Sub-Investigator: Jacopo Cefalo, MD
      • Sub-Investigator: Carmine Salerni, MD
      • Sub-Investigator: Giulia Nalesso, MD
      • Principal Investigator: Michele Mondoni, MD, Prof.
    • Milan, Lombardy, Italy
      • Recruiting
      • Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy. Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milano, Italy
      • Contact: Dejan Radovanovic, MD; Phone Number: +39 0239042277; Email: dejan.radovanovic@unimi.it
      • Contact: Valentina Fraccon, MD; Phone Number: +390239042372; Email: valentina.fraccon@unimi.it
      • Principal Investigator: Pierachille Santus, MD, Prof.
      • Sub-Investigator: Fiammetta Danzo, MD
      • Sub-Investigator: Valentina Fraccon, MD
      • Sub-Investigator: Peter Dilov, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with IPF of any severity diagnosed according to the 2022 ATS/ERS/JRS/ALAT guidelines, attending the specialist outpatient clinics of the Pulmonology Units of ASST Santi Paolo e Carlo and ASST Fatebenefratelli-Sacco (Milan, Italy).

Description

Inclusion Criteria:

• Age over 18 years
• IPF of any degree of severity, diagnosed according to the 2022 ATS/ERS/JRS/ALAT guidelines

Exclusion Criteria:

• Refusal to participate in the study
• Patients unable to provide informed consent for participation in the study
• IPF exacerbation in the 6 months prior to enrollment
• Previous diagnosis of chronic airway disease (e.g., bronchial asthma, chronic obstructive bronchitis, bronchiectasis with a cause other than IPF)
• Presence of bronchial obstruction defined by an FEV1/FVC (or FEV1/VC) ratio below the lower limit of normal
• Chronic therapy with long-acting bronchodilators or combinations of bronchodilators and inhaled corticosteroids
• Inability of the patient to perform reproducible pulmonary function tests
• Chronic treatment with systemic corticosteroids or immunosuppressants
• Concomitant lung or pleural cancer
• Pregnancy or breastfeeding women

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
IPF; IPF of any severity degree, diagnosed according to the 2022 ATS/ERS/JRS/ALAT guidelines

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of small airway disease in a group of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy.	To evaluate the percentage of patients with IPF at the time of diagnosis, before the initiation of antifibrotic therapy, with small airway disease measured by the nitrogen washout test (assessing the following functional parameters: phase 3 slope, closing volume, closing capacity, closing volume/vital capacity, closing capacity/total lung capacity, and phase 4 slope).	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To compare the indices of small airway dysfunction and the prevalence of small airway disease in patients with IPF and age-matched healthy subjects	To compare the indices of small airway dysfunction and the prevalence of small airway disease in patients with IPF and age-matched healthy subjects (without respiratory comorbidities).	1 year
Relationship between clinical and epidemiological characteristics of the cohort and the presence and severity of small airway disease	To study the relationship between clinical and epidemiological characteristics of the cohort and the presence and severity of small airway disease	1 year
Prevalence of small airway disease in patients with IPF and concomitant emphysema with patients with IPF alone	To compare the prevalence of small airway disease in patients with IPF and concomitant emphysema (combined pulmonary fibrosis and emphysema, CPFE), defined as the presence of any type of emphysema involving ≥5% of total lung volume, with patients with IPF alone.	1 year
Relationship between exercise performance and the presence and severity of small airway disease	To evaluate the relationship between exercise performance (meters, oxygen saturation nadir), assessed by the six-minute walk test distance, and the presence and severity of small airway disease	1 year
Relationship between computed tomography (CT) features and functional parameters indicative of small airway disease.	To evaluate the relationship between CT features (radiologic pattern type, presence/absence of mediastinal lymphadenopathy, presence/absence of any type of emphysema involving ≥5% of total lung volume, extent of disease, disease progression, air trapping, black lung) and functional parameters indicative of small airway disease.	1 year
Correlation between functional characteristics, parameters of small airway dysfunction and fibrosis extent indices on chest CT-scan	To evaluate the correlation between functional characteristics: forced expiratory flow at 25-75% of vital capacity (FEF25-75), forced vital capacity (FVC) and diffusing of the lung for carbon monoxide (DLCO) with parameters of small airway dysfunction from the Single Breath Nitrogen (SBN2) test, as well as disease extent indices on chest CT-scan	1 year
Relationship between dyspnea degree and the presence and severity of small airway disease.	To evaluate the relationship between the degree of dyspnea, measured by the modified Medical Research Council (mMRC) scale, and the presence and severity of small airway disease.	1 year
Clinical and functional characteristics of IPF patients with different alterations in the DLCO subcomponents	To evaluate the clinical and functional characteristics of IPF patients with different alterations in the DLCO subcomponents (alveolar volume - VA <80% predicted, Transfer Coefficient of CO - KCO <80% predicted, ventilation inhomogeneity - VA/Total Lung Capacity (TLC) <0.8)	1 year
Relationship between different scores as the GAP index, CPI, KBILD and UCSD Shortness of Breath Questionnaire, and the presence and severity of small airway disease	To evaluate the relationship between different scores as the Gender Age Physiology (GAP) index, Composite Physiologic Index (CPI) , the King's Brief Interstitial Lung Disease (KBILD) score and the University of California San Diego (UCSD) Shortness of Breath Questionnaire, and the presence and severity of small airway disease;	1 year
Variation of small airway dysfunction parameters in IPF patients after one year of antifibrotic treatment.	Evaluate presence and variation of small airway dysfunction parameters from the Single Breath Nitrogen (SBN2) test in IPF patients after one year of antifibrotic therapy.	1 year
Prevalence of tidal expiratory flow limitation at the time of diagnosis, before the initiation of antifibrotic therapy and after one year of antifibrotic treatment.	To evaluate the percentage of patients with IPF with tidal expiratory flow limitation measured by means of Negative Expiratory Pressure (NEP), at the time of diagnosis, before the initiation of antifibrotic therapy and after one year of therapy with antifibrotic treatment	1 year

Collaborators and Investigators

• Sponsor: University of Milan

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2025
• Primary Completion (Estimated): May 15, 2026
• Study Completion (Estimated): May 15, 2027

Study Registration Dates

• First Submitted: December 16, 2025
• First Submitted That Met QC Criteria: December 16, 2025
• First Posted (Actual): December 31, 2025

Study Record Updates

• Last Update Posted (Actual): January 28, 2026
• Last Update Submitted That Met QC Criteria: January 26, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: SAD; IPF; SBW-N₂
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Lung Diseases, Interstitial; Pulmonary Fibrosis; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive; Idiopathic Pulmonary Fibrosis
• Other Study ID Numbers: SWIFT-IPF

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No