Idiopathic interstitial pneumonia medical therapy: Difference between revisions
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==Outline of Medical Therapy in Acute IIPs== | ==Outline of Medical Therapy in Acute IIPs== | ||
*The main treatment for acute interstitial pneumonia (AIP) is supportive care and corticosteroids. | |||
Supportive care with Noninvasive or invasive mechanical ventilation is usually required, since most patients develop respiratory failure also the prevention of complications as venous thromboembolism, gastrointestinal bleeding and nosocomial pneumonia. The optimum dosing of glucocorticoids and its clinical benefit remains unclear, However these are widely used. | |||
'''Glucocorticoids''' | |||
*Once the diagnosis of AIP is made, high dose systemic glucocorticoids ( methylprednisolone 2 gm per day intravenously in divided doses) are given<ref>{{Cite journal | last1 = Vourlekis | first1 = JS. | title = Acute interstitial pneumonia. | journal = Clin Chest Med | volume = 25 | issue = 4 | pages = 739-47, vii | month = Dec | year = 2004 | doi = 10.1016/j.ccm.2004.07.001 | PMID = 15564019 }}</ref> High dose glucocorticoid therapy are just supported by small case series with widely varying results <ref name="Olson-1990">{{Cite journal | last1 = Olson | first1 = J. | last2 = Colby | first2 = TV. | last3 = Elliott| first3 = CG. | title = Hamman-Rich syndrome revisited. | journal = Mayo Clin Proc | volume = 65 | issue = 12 | pages = 1538-48 | month = Dec | year = 1990| doi = | PMID = 2255216 }}</ref><ref name="Vourlekis-2000">{{Cite journal | last1 = Vourlekis | first1 = JS. | last2 = Brown | first2 = KK. | last3 = Cool| first3 = CD. | last4 = Young | first4 = DA. | last5 = Cherniack | first5 = RM. | last6 = King | first6 = TE. | last7 = Schwarz | first7 = MI. | title = Acute interstitial pneumonitis. Case series and review of the literature. | journal = Medicine (Baltimore) | volume = 79 | issue = 6 | pages = 369-78 | month = Nov | year = 2000 | doi = | PMID = 11144035 }}</ref><ref name="Suh-2006">{{Cite journal | last1 = Suh | first1 = GY. | last2 = Kang | first2 = EH. |last3 = Chung | first3 = MP. | last4 = Lee | first4 = KS. | last5 = Han | first5 = J. | last6 = Kitaichi | first6 = M. | last7 = Kwon | first7 = OJ. | title = Early intervention can improve clinical outcome of acute interstitial pneumonia. | journal = Chest | volume = 129 | issue = 3 | pages = 753-61 | month = Mar | year = 2006 | doi = 10.1378/chest.129.3.753 | PMID = 16537878 }}</ref><ref name="Avnon-2009">{{Cite journal | last1 = Avnon | first1 = LS. | last2 = Pikovsky | first2 = O. | last3 = Sion-Vardy | first3 = N. | last4 = Almog | first4 = Y. | title = Acute interstitial pneumonia-Hamman-Rich syndrome: clinical characteristics and diagnostic and therapeutic considerations. | journal = Anesth Analg | volume = 108 | issue = 1 | pages = 232-7 | month = Jan | year = 2009 | doi = 10.1213/ane.0b013e318188af7a | PMID = 19095855 }}</ref><ref name="Quefatieh-2003">{{Cite journal | last1 = Quefatieh | first1 = A. | last2 = Stone | first2 = CH. | last3 = DiGiovine | first3 = B. | last4 = Toews | first4 = GB. | last5 = Hyzy | first5 = RC. | title = Low hospital mortality in patients with acute interstitial pneumonia. | journal = Chest | volume = 124 | issue = 2 | pages = 554-9 | month = Aug | year = 2003 | doi = | PMID = 12907542 }}</ref'''> | |||
'''Antibiotics''' | |||
*Empiric broad-spectrum antibiotics are given to cover any infections. | |||
==Outline of Medical Therapy in Chronic Fibrosing IIPs== | ==Outline of Medical Therapy in Chronic Fibrosing IIPs== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2];
Overview
As IIPs are heterogenous group of unknown interstitial lung disease with different natural history and clinical course, their management should be based on the clinical subtype. Optimal therapy for IPF is controversial as all currently available medications for IPF are severely limited by the lack of clear understanding of the natural history of IPF, the presence of various forms of study designs; heterogeneous patient groups, disputable diagnostic certainty; variable study duration; differences in medication formulation, dosage, route of administration, and duration of treatment; lack of placebo controls; variable intervals between evaluations and differing types of non quantitative assessment criteria. To date, most of treatment strategies have been based on eliminating or suppressing the inflammatory component. As no pharmacological therapy has been proven a clinical efficacy in altering or reversing the inflammatory process of IPF. The clinical trials over the past decades are hopefully held to clear the controversial dilemmas regarding which patients should be treated? When should therapy be started? What is the best treatment and how it should delivered and maintained? and how can be the treatment monitored especially that majority of patients are suffering comorbidities related functional limitations.
Medical Response of Clinical Subtype
The following points are a general summary for the responsiveness of each subtype of IIPs
Chronic Fibrosing IIPs
- Idiopathic Pulmonary Fibrosis
- poor response to corticosteroids and cytotoxic drugs
- Idiopathic Nonspecific Interstitial Pneumonia
- good response to corticosteroids
Acute/Subacute IIPs
- Cryptogenic Organizing Pneumonia
- good response to corticosteroids
- Acute Interstitial Pneumonia (Hamman-Rich Syndrome)]
- unknown response to corticosteroids
- Respiratory Bronchiolitis-Interstitial Lung Disease
- good response to smoking cessation but unknown response to corticosteroids
- Desquamative Interstitial Pneumonia
- good response to smoking cessation but unknown response to corticosteroids
Outline of Medical Therapy in Acute IIPs
- The main treatment for acute interstitial pneumonia (AIP) is supportive care and corticosteroids.
Supportive care with Noninvasive or invasive mechanical ventilation is usually required, since most patients develop respiratory failure also the prevention of complications as venous thromboembolism, gastrointestinal bleeding and nosocomial pneumonia. The optimum dosing of glucocorticoids and its clinical benefit remains unclear, However these are widely used. Glucocorticoids
- Once the diagnosis of AIP is made, high dose systemic glucocorticoids ( methylprednisolone 2 gm per day intravenously in divided doses) are given[1] High dose glucocorticoid therapy are just supported by small case series with widely varying results [2][3][4][5][6]
References
- ↑ Vourlekis, JS. (2004). "Acute interstitial pneumonia". Clin Chest Med. 25 (4): 739–47, vii. doi:10.1016/j.ccm.2004.07.001. PMID 15564019. Unknown parameter
|month=ignored (help) - ↑ Olson, J.; Colby, TV.; Elliott, CG. (1990). "Hamman-Rich syndrome revisited". Mayo Clin Proc. 65 (12): 1538–48. PMID 2255216. Unknown parameter
|month=ignored (help) - ↑ Vourlekis, JS.; Brown, KK.; Cool, CD.; Young, DA.; Cherniack, RM.; King, TE.; Schwarz, MI. (2000). "Acute interstitial pneumonitis. Case series and review of the literature". Medicine (Baltimore). 79 (6): 369–78. PMID 11144035. Unknown parameter
|month=ignored (help) - ↑ Suh, GY.; Kang, EH.; Chung, MP.; Lee, KS.; Han, J.; Kitaichi, M.; Kwon, OJ. (2006). "Early intervention can improve clinical outcome of acute interstitial pneumonia". Chest. 129 (3): 753–61. doi:10.1378/chest.129.3.753. PMID 16537878. Unknown parameter
|month=ignored (help) - ↑ Avnon, LS.; Pikovsky, O.; Sion-Vardy, N.; Almog, Y. (2009). "Acute interstitial pneumonia-Hamman-Rich syndrome: clinical characteristics and diagnostic and therapeutic considerations". Anesth Analg. 108 (1): 232–7. doi:10.1213/ane.0b013e318188af7a. PMID 19095855. Unknown parameter
|month=ignored (help) - ↑ Walter, N.; Collard, HR.; King, TE. (2006). "Current perspectives on the treatment of idiopathic pulmonary fibrosis". Proc Am Thorac Soc. 3 (4): 330–8. doi:10.1513/pats.200602-016TK. PMID 16738197. Unknown parameter
|month=ignored (help)