The initial phase of interstitial pneumonia manifests itself. Treatment of interstitial pneumonia

The date: 21.04.2019

You are a fairly active person who cares and thinks about your respiratory system and health in general, continue to play sports, healthy lifestyle life, and your body will delight you throughout your life, and no bronchitis will bother you. But do not forget to undergo examinations on time, maintain your immunity, this is very important, do not overcool, avoid severe physical and strong emotional overload.

It's time to start thinking about what you're doing wrong...

You are at risk, you should think about your lifestyle and start taking care of yourself. Physical education is obligatory, and even better start playing sports, choose the sport that you like best and turn it into a hobby (dancing, cycling, gym or just try to walk more). Do not forget to treat colds and flu in time, they can lead to complications in the lungs. Be sure to work with your immunity, temper yourself, be in nature and fresh air as often as possible. Do not forget to undergo scheduled annual examinations, treat lung diseases on initial stages much easier than in the running form. Avoid emotional and physical overload, smoking or contact with smokers, if possible, exclude or minimize.

It's time to sound the alarm! In your case, the likelihood of getting pneumonia is huge!

You are completely irresponsible about your health, thereby destroying the work of your lungs and bronchi, pity them! If you want to live long, you need to radically change your whole attitude towards the body. First of all, go through an examination with specialists such as a therapist and a pulmonologist, you need to take drastic measures, otherwise everything may end badly for you. Follow all the recommendations of doctors, radically change your life, it may be worth changing your job or even your place of residence, absolutely eliminate smoking and alcohol from your life, and keep contact with people who have such addictions to a minimum, harden, strengthen your immunity, as much as possible be outdoors more often. Avoid emotional and physical overload. Completely exclude all aggressive products from everyday use, replace them with natural, natural products. Do not forget to do wet cleaning and airing the room at home.

Before giving a definition of interstitial pneumonia, you need to find out what interstitial tissue or interstitium is. Everyone knows that the lungs consist of an extensive system of air ducts (the trachea is divided into 2 main bronchi), at the end of the smallest bronchiole there is an alveolus - a bubble filled with air. The interstitium is a connective tissue partition that separates the alveoli. Their inflammation is characterized by thickening, proliferation of fibroblasts, deposition of collagen protein, and, if left untreated, culminates in pulmonary fibrosis. This is what is meant by a problem called interstitial pneumonia (the term "interstitial pneumonia" is also acceptable).

Pathologies of the pulmonary interstitium basically have many causes and risk factors. The list may include:

Adverse impact of environmental and production conditions.
Connective tissue diseases.
Various infectious diseases.
The impact of drugs.
Systemic vascular diseases.

In a number of situations, establishing the cause is not difficult, but about a third of the reported interstitial lesions do not have a clear cause of their occurrence. Such cases are grouped under the name "idiopathic interstitial pneumonia».

Among the diseases of the connective tissue as the causes of lesions of the interstitial tissue of the lung can be called:

Dermato- and polymyositis.
Sjögren's syndrome.
Systemic lupus erythematosus.
Systemic scleroderma.
Undifferentiated and mixed connective tissue diseases.

Drugs intended for chemotherapy, a group of cytostatics, as well as narcotic substances heroin, cocaine contribute to the development of interstitial pneumonia. To the surprise of lovers of corrections of the lips and other parts of the body, silicone injections have a similar effect to cause lung parenchyma disease.

Among professions, the following are unfavorable on the basis of the occurrence of occupational lung diseases:

Aluminum production.
Extraction and processing of coal.
asbestos production.
Working with heavy metals and silicon.
Radiation exposure (radio and X-ray installations).
Farmers.
poultry industry.
Coffee, tea and mushroom plantations.
Production of beer (malt).
Hot shops and humidification plants.

Vascular lesions such as giant cell and microscopic polyangiitis, periarteritis nodosa, Takayasu's disease, granulomatosis with polyangiitis can cause lung changes.

Other diseases that cause damage to the pulmonary interstitium:

Amyloidosis.
Systematic aspiration.
Sarcoidosis.
Neurofibromatosis.

Some of the reasons do not require mandatory work with a harmful agent, it is enough that a person constantly inhales dust, gases, allergens, chemical and air pollutants (aerosols, smoke from the combustion of wood, vegetation and biomass).

If the etiology is not determined

If the cause could not be established, then idiopathic interstitial pneumonias are implied. These include:

Acute interstitial pneumonia.
Cryptogenic organizing pneumonia.
Desquamative interstitial pneumonia.
idiopathic pulmonary fibrosis.
Lymphoid interstitial pneumonia.
Nonspecific interstitial pneumonia.
Respiratory bronchiolitis associated with any interstitial lung disease.

Families with autosomal recessive inheritance of desquamative interstitial alveolitis are extremely rare. The prognosis is always unfavorable - children die in infancy.

Interstitial pneumonia in children is often combined with congenital pathology, such as reirofibromatosis, Marfan's syndrome. With prematurity and a child weighing less than 1500 g, the chance of survival is no more than 30%.

Acute interstitial pneumonia

In fact, this is a respiratory distress syndrome that suddenly occurs in apparently healthy people over 40 years old. In the partitions, inflammatory changes, fibroblast proliferation, thickening of the walls of the alveoli, atypical pneumocytes. The collapse of the airways occurs, hypoxia develops with respiratory failure. The onset is sudden, with a rise in temperature, cough and shortness of breath.

differentiate from others inflammatory diseases lungs is difficult, since the changes are morphological in nature, and a histological examination of a lung biopsy can finally confirm the diagnosis. The radiograph is characterized by diffuse bilateral darkening of the lung fields.

Computed tomography, which is performed on high-resolution machines, helps in making a diagnosis. At the same time, symmetrical darkening is determined by the type of "frosted glass", sometimes "honeycombs" that affect less than a tenth of the lungs. This concludes the diagnosis of interstitial pneumonia, since no characteristic laboratory parameters have been identified.

Treatment is reduced to maintaining impaired respiratory function with the use of artificial lung ventilation, oxygen therapy. Attempts to use glucocorticoid hormones did not give reliable positive results.

The prognosis is serious, but not hopeless: 60% of patients die in the first six months from increasing respiratory failure. Survivors of the first attack have a chance for a full recovery.

Cryptogenic organizing pneumonia

Subject people to the same age group. Moreover, cryptogenic organizing pneumonia does not depend on the fact of smoking. The essence of the disease is that actively developing granulations block the lumen of the alveoli, causing inflammation in neighboring alveoli.

The onset of the disease is gradual, reminiscent of a protracted respiratory infection or flu. Temperature, weakness, malaise, shortness of breath, cough, weight loss are delayed, cough and shortness of breath increase during exercise and this causes a visit to a doctor who, when examining a patient, hears a characteristic “cellophane crack” on inspiration.

Radiographically, bilateral diffuse peripheral opacities, infiltrates, and a "honeycomb lung" pattern are more often detected. High resolution CT is helpful in making the diagnosis. Focal nodular opacities, wall thickening, and bronchial dilatation are added to ground glass changes. More often localized in the peripheral parts of the lower lobes.

Every fifth patient has bronchial obstruction. In the blood test, nonspecific leukocytosis, accelerated ESR.

Biopsy confirms granulation proliferation and areas of organizing pneumonia. These changes can be secondary and be determined against the background of any other interstitial pathology.

Organizing pneumonia is treated with corticosteroid hormones. The prognosis is favorable - usually after 2 weeks the patient recovers. The situation is somewhat more serious with linear darkening and increased lung pattern.

Desquamative interstitial pneumonia

The disease has a direct relationship with the inhalation of cigarette smoke in the past or present. Developing chronic inflammation lungs with infiltration by mononuclear cells of the air-bearing parts of the lungs. Desquamation of the lungs means desquamation. Where does it take place? It turned out that macrophage cells, which are located in the terminal sections of the bronchi, were mistakenly taken for desquamated pneumocytes. The walls of the alveoli are swollen pneumocytes, the interstitium is infiltrated with lymphocytes, plasma cells, rarely eosinophils.

Desquamative interstitial pneumonia affects younger segments of the population (age 30–40 years). Radiologists see cloudy shadows in the lower lobes. HRCT reveals "ground glasses", in their area of cysts. Linear dimming also occurs. A biopsy is needed in some cases.

Desquamative pneumonia is the most favorable in terms of treatment. It is enough to give up smoking and the chance of recovery increases to 75%. Sometimes a course of corticosteroids and cytostatics is needed.

Idiopathic pulmonary fibrosis

This is a common form that is characterized by progressive fibrosis. People of both sexes over the age of 50 get sick. There is a clear association with smoking. In the development of the disease there is a role of genetic predisposition. Combination various factors reprograms the cells lining the alveoli, resulting in the proliferation of fibroblasts.

The disease develops gradually, shortness of breath increases, unproductive cough, wheezing on inspiration, resembling the crackling of cellophane. The progression of the disease lasts from 3 months to 3 years, after which death occurs from respiratory failure. More often than usual, these patients have lung cancer.

One of the signs of idiopathic pulmonary fibrosis is a change in the terminal phalanges of the fingers - they take on the appearance of drumsticks.

Diagnosis is based on results computed tomography, where asymmetrical thickened septa are visible, located under the pleura in the lower lobes (picture of the "honeycomb lung"). X-ray - increased lung pattern, bronchiectasis, separate cysts.

Treatment does not give much prospects for recovery. Therapy is aimed at maintaining respiratory function. Oxygen therapy is recommended. Some countries use the drug Pirfenidone - it inhibits the development of fibrous tissue.

Lung transplantation is performed in the absence of other changes in the body. There are age restrictions - no older than 65 years.

Lymphoid interstitial pneumonia

This form is more common in women and girls. It is assumed that the cause of its occurrence is an autoimmune process or the body's reaction to the introduction of a virus. Epstein-Barr virus is often found in such patients, and there is also a connection with HIV infection. In lymphoid interstitial pneumonia, primary damage to the interalveolar septa and alveoli occurs due to infiltration by lymphocytes and plasma cells.

The average age of the patients is 54 years. The main complaints are cough and shortness of breath, gradually increasing over several months or years. Moist rales are heard on auscultation. These patients often have concomitant diseases from the systemic group: systemic lupus erythematosus, rheumatoid arthritis, Hoshimoto's thyroiditis.

X-ray changes are nonspecific, as are the CT findings. A lung biopsy confirms the diagnosis more accurately. In the analysis of the blood in almost all patients, low temperature rises, gammopathy and a decrease in gamma globulins are detected.

Lymphoid interstitial pneumonia is treated with glucocorticoids alone or in combination with cytotoxic drugs. The prognosis is very variable - spontaneous recovery may occur, fibrosis may develop with an increase in respiratory failure.

Lymphoid interstitial pneumonia gives a chance of five-year survival to a little more than half of the patients.

Nonspecific interstitial pneumonia

A feature of this nonspecific pneumonia is the high incidence in young women without smoking. The average age is 40–45 years. Nonspecific interstitial pneumonia according to clinical course similar to idiopathic pulmonary fibrosis. The main complaints are cough and chronic, increasing shortness of breath. There may be low rises in temperature, malaise.

Reticulated opacities in the lower lobes on x-ray are of little help in making a diagnosis. Therefore, confirmation requires HRCT and mandatory surgical biopsy of lung tissue. Histologists usually observe a picture of inflammation and fibrosis in this form - it can wear focal character, combined with areas of unchanged lung tissue.

When making a diagnosis, it is necessary to differentiate with lung damage in systemic scleroderma, polymyositis, or if the interstitium is damaged by some medicines, as well as hypersensitivity pneumonitis (obsolete name pulmonitis).

Treatment of interstitial pneumonia of this form is reduced to the appointment of corticosteroids and immunosuppressants. The prognosis depends on the severity of fibrosis, but in general there is a 10-year survival rate.

Respiratory bronchiolitis

Smokers are again in the zone of attention, and men are more likely to get sick. This form of the disease is characterized by a combination of an inflammatory process in the small bronchi (bronchioles), which occurs against the background of any other lesion of the interstitial tissue. Including it can be idiopathic interstitial pneumonia. There is a great similarity with desquamative interstitial pneumonia, however, with this pathology, the process is not so extensive.

The main complaints of patients are coughing and shortness of breath, although the severity of symptoms is much less. Moist rales are heard above the lung fields.

Radiologically, mesh or nodular opacities of various shapes are found, including ring-shaped, thickened walls of the bronchi, hyperplasia of surrounding tissues. In a functional study, signs of two processes are observed - obstruction and restriction of the bronchi.

Treatment of this pathology requires a complete cessation of smoking, which significantly improves the prognosis for life. Showing corticosteroids.

Pneumonitis and pneumonia

To clarify, it is worth deciding on the differences in terminology. Pneumonia is an acute infectious disease with a focal lesion of the respiratory department and the presence of intraalveolar exudate. Pneumonitis is an inflammation of non-infectious, often immune origin, which affects the interstitial tissue of the lung and is not accompanied by intraalveolar effusion.

In fact, everything that is stated above refers to the description of symptoms in interstitial pneumonitis, diagnosis, treatment and prognosis.

Titles

Idiopathic interstitial pneumonia refers to a special type of pneumonia affecting the morphological changes in the lungs without apparent etiology. Pneumonia, popularly called pneumonia, can occur in various forms and present with mixed symptoms. To identify exactly interstitial pneumonia, it will be necessary to make a high-quality multilateral diagnosis of the body.

Characteristics of the disease

A specific type of lung disease, interstitial pneumonia is a group diffuse diseases pulmonary system, which is characterized by the absence of visible causes.

The sphere of manifestation is the connective anatomical tissue of the interstitium, which, under the influence of pathogens, begins to thicken, the breathing process becomes rapid and difficult for a person, shortness of breath, dry cough, sometimes heat. Symptoms of the disease may vary. The concept of interstitial pneumonia, which is also called interstitial, includes such types of lung disease as:

IPF - idiopathic pulmonary fibrosis. It is characterized by the formation of so-called "honeycombs" in the lungs, the process of scarring of the interstitium begins. Often observed in people over 50 years of age. The disease can develop over several years, making it difficult to detect and treat.
NSIP - nonspecific interstitial pneumonia. May be seen in older people. Accompanied by weight loss, lethargy, shortness of breath, a slight growing cough.
Acute interstitial pneumonia develops very quickly and can lead to a sharp deterioration in the patient's condition. Requires immediate connection of devices that ensure the viability of the lungs. The body temperature rises, the quality of life worsens, very severe shortness of breath and chills appear.
Cryptogenic organizing pneumonia, or bronchiolitis. It is characterized by an inflammatory process in the lungs in the absence of infection. Bronchioles are involved along with the interstitium, and during diagnosis, the formation of polyp-like granules is observed in the lungs.
Desquamative interstitial pneumonia is common in males, especially male smokers. The first thing to do in this case is to stop smoking and take appropriate medications. This disease is completely curable.
Lymphoid interstitial pneumonia is more often observed in forty-year-old women. It can grow over a period of one to several years. Symptoms: shortness of breath, persistent cough, pain in the joints, chest and back.

And this is not the whole list. possible diseases group of interstitial pneumonia.

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Children's pneumonia

Interstitial pneumonia is common in children, especially in newborns. The reason may be early diseases SARS, bronchitis in the mother or the penetration of viruses, mycoplasma infections. Children are very difficult to tolerate such a disease due to severe shortness of breath, high fever and weakness.

Parents may not know that a common cough can be not just bronchitis, but also interstitial pneumonia, so conventional drugs for treating a child with bronchitis do not work. If there is the slightest suspicion of pneumonia of any type, you should immediately call an ambulance and hospitalize. In stationary conditions, mandatory oxygen therapy is prescribed to maintain lung function. Antibiotics and symptomatic treatment should be used.

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Symptoms and Causes

Symptoms of interstitial lung disease:

shortness of breath (deep and severe);
dry cough, sometimes with small selection sputum, often with pus;
weight reduction;
increase in body temperature is possible.

For different types disease, the manifestation of symptoms is characterized by periodicity: symptoms can appear in one day, develop quickly and sharply worsen the condition, or they can stretch for years. Causes of lung disease:

There are cases when the cause of the disease is simply impossible to identify. Also important causes of the disease can be the constant inhalation of chemicals: dust, talc, asbestos. Also, the disease can occur under the influence of taking antibiotics, like allergic pneumonia, or in the process of taking drugs.

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Diagnosis of the disease

A pulmonologist can diagnose lung disease. Usually people come only when they are unbearably tired of coughing and shortness of breath. To identify the type of pneumonia, the doctor prescribes the following diagnostics:

Computed tomography to detail the structure of the lungs. The degree of damage to the lungs, the number of changes in the lower sections, the presence of a shadow or “frosted glass”, the transformation of the structure into honeycombs will be immediately visible. The doctor on the referral should indicate that the CT scan should be done in high resolution so that the position of the interstitium can be seen.
x-ray thoracic. The general condition of the respiratory system is assessed.
Lung tests (body plethysmography, spirometry) to check the quality of breathing.
Lung biopsy. A sample of material from the lungs is taken in several ways: bronchoscopy, using video-assisted thoracoscopic surgery, or open biopsy (thoracotomy).

A progressive inflammatory process affecting the walls of the alveoli and the connective tissue of the parenchyma, with possible secondary intraalveolar exudation and outcome in fibrous restructuring of the lung structures. The disease is accompanied by increasing shortness of breath, dry or with slight sputum cough, chest pain, subfebrile condition, "warm" cyanosis, cardiopulmonary insufficiency. Diagnosis of interstitial pneumonia includes analysis of X-ray data and CT scan of the lungs, breath tests, lung biopsy. With interstitial pneumonia, corticosteroids, cytostatics, oxygen therapy, mechanical ventilation are used.

ICD-10

J84.1 Other interstitial lung diseases with mention of fibrosis

General information

Interstitial (idiopathic interstitial) pneumonia is a primary acute or chronic inflammation of the interstitial lung tissue of unclear etiology, characterized by its fibroproliferative changes and decreased respiratory function. The clinical and pathological classification distinguishes idiopathic interstitial pneumonias as a separate group of interstitial lung diseases (ILD), the exact prevalence of which is difficult to assess due to the rare establishment of the correct diagnosis. Among the many problems of pulmonology, interstitial pneumonia occupies a special place, because it is characterized by a long severe course, often with an unfavorable outcome due to the steadily progressing fibrous and sclerotic transformation of the lungs. With interstitial pneumonia, there is almost always a decrease in the quality of life and disability of patients.

Classification of interstitial pneumonia

The group of interstitial pneumonia includes various pathomorphological forms of the disease. These include:

common interstitial pneumonia (idiopathic pulmonary fibrosis/fibrosing alveolitis)
non-specific
acute (Hamman-Rich syndrome)
desquamative (macrophage)
lymphoid (lymphocytic)
cryptogenic organizing
respiratory bronchiolitis associated with ILD.

The lesion in interstitial pneumonia can be focal or diffuse, and in terms of volume it can cover an entire lobe or the entire lung.

All variants of interstitial pneumonia have some pathogenetic, morphological and clinical differences, features of the course and prognosis. For idiopathic pulmonary fibrosis(IPF) are characterized by a violation of the architectonics of the lungs of a heterogeneous nature, scarring of the interstitial tissue, a “honeycomb” transformation of the lungs with many thin-walled cavities without content and infiltration, and fibroblast foci. Nonspecific interstitial pneumonia(NSIP) has a pattern of homogeneous inflammatory changes interstitium and fibrosis with a rare occurrence of fibroblastic foci. At acute interstitial pneumonia(OIP) there is a sharp swelling of the alveolar walls, the formation of exudate and hyaline membranes inside the alveoli, the frequent development of interstitial fibrosis.

Cryptogenic organizing pneumonia(COP), or obliterating bronchiolitis with organizing pneumonia, proceeds with the preservation of pulmonary architectonics, organized intraalveolar exudate and diffuse polyp-like granulations in the bronchioles. At desquamative form(DIP) there is a slight uniform inflammation of the interstitium of the lung parenchyma with an accumulation of alveolar macrophages in the lining of the alveoli. Lymphoid intestinal pneumonia(LIP) is manifested by a combination of a homogeneous pronounced lymphocytic infiltration of the interstitium and peribronchial lymphoid follicles. For respiratory bronchiolitis typical bronchocentric migration of alveolar macrophages with minimal signs of inflammation and fibrosis of the alveoli and interstitium.

The most common are idiopathic pulmonary fibrosis and a nonspecific form of interstitial pneumonia. IPF is more common in older men ( average age 65 years), other forms of IIP are more often detected in female patients (35-55 years), and nonspecific and desquamative sometimes occur in children.

Causes of Interstitial Pneumonia

The etiology of idiopathic interstitial pneumonia is not fully understood. Violation of immunological homeostasis may be involved in the disease, and a certain antigen to which the body begins to produce antibodies acts as a triggering factor.

The development of this pathology can be provoked by infectious agents (mycoplasmas, chlamydia, pneumocystis, legionella, rickettsia, respiratory viruses, CMV, herpes virus) and certain types of dust. Smokers or former smokers, HIV-infected and AIDS patients (mainly children) are prone to interstitial pneumonia. The lymphoid form may be associated with autoimmune diseases(Sjögren's syndrome), immunopathies (hypo- and hypergammaglobulinemia). Smoking is one of the main causes of desquamative pneumonia and respiratory bronchiolitis. Cryptogenic organizing pneumonia is usually idiopathic, but may be associated with collagenoses or drug therapy amiodarone, gold preparations.

Inflammation in interstitial pneumonia proceeds according to the type of pneumonitis (alveolitis), is most often of an immune non-infectious nature, affecting mainly the alveolar walls and extra-alveolar connective tissue of the lungs, sometimes with a secondary organization of exudate inside the alveoli. Interstitial pneumonia is characterized by primary inflammation of the interstitial tissue with the accumulation of immunocompetent cells in it, releasing various damaging mediators (oxidants, interleukin-1, etc.) early stage and fibrogenic factors that cause the development of fibroproliferative reactions at a late stage.

Symptoms of interstitial pneumonia

Chronic course (more than 12 months) is characteristic of IPF and LIP; subacute/chronic - NSIP; subacute (months and years) - DIP and RB; acute / subacute - COP; sudden - UIP. Clinical forms Interstitial pneumonia is accompanied by an unproductive (dry or with little sputum) cough, shortness of breath (a feeling of "incomplete breath") and increasing shortness of breath, first expressed during exertion, then at rest. There are chest pains, episodes of sudden shortness of breath at night. Shortness of breath limits the patient's activity, is accompanied by rapid fatigue, bad dream, sometimes weight loss.

Symptoms of bronchial obstruction in IPF are observed only in 4% of patients, much more often they are observed in the desquamative form. Patients may present with "warm" cyanosis. skin, which gradually covers the entire body. With COP, NSIP, LIP, fever is possible. The manifestations of the cryptogenic form often resemble those of bacterial pneumonia. For IPF, nonspecific, desquamative and lymphocytic interstitial pneumonias, “Hippocratic fingers” are typical.

IPF has an insidious onset with a slow increase in shortness of breath and cough, general weakness, pain in muscles and joints, absence of fever and hemoptysis. The progression of this form is accompanied by weight loss (up to cachexia), the development of respiratory disorders, and primary pulmonary hypertension. Severe respiratory failure with manifestations of cor pulmonale in IPF can form over a period of 2 months to 2 years.

Symptoms of acute interstitial pneumonia (Hammen-Rich syndrome) are similar to the clinic of influenza and acute respiratory distress syndrome. There is a fulminant course with rapidly progressive respiratory failure and a high percentage of deaths.

Complications of interstitial pneumonia can be lung carnification with the formation of pneumosclerosis, the development of a "cellular" lung, respiratory and heart failure, the addition of a secondary bacterial infection. The stage of the "honeycomb" lung in interstitial pneumonia is defined as prognostically unfavorable in terms of the occurrence of lung cancer.

Diagnosis of interstitial pneumonia

Diagnosis of interstitial pneumonia is difficult, based on the results of an anamnesis, physical examination, radiography and HRCT of the lungs, a study of respiratory function (spirometry, body plethysmography); thoracoscopic or open lung biopsy.

With interstitial pneumonia, mild crepitus is detected: at an early stage, mainly in the basal segments of the lungs, at a late stage - in all lung fields and in the tops of the lungs. For IPF, inspiratory crepitus is typical of the "cellophane cod" type. Harsh breathing, wet or dry small bubbling rales in the lungs are noted. On percussion, there is a slight shortening of the sound corresponding to the affected area.

Functional respiratory tests reveal a violation of ventilation and disorders of the diffusion capacity of the lungs (with IPF - a restrictive type with a sharp and extremely sharp decrease in lung volumes). X-ray signs interstitial pneumonia may be symmetrical translucent darkening of the "frosted glass" type, mainly in the lower parts of the lungs; thickening of the interlobular and intralobular interstitium; fibrocystic changes, perivascular and peribronchial infiltration and traction bronchiectasis.

HRCT helps to clarify the prevalence of lung tissue damage, to assess the stage, activity and rate of progression of the fibrous process. An important step in the diagnosis of interstitial pneumonia is a lung biopsy with a histological analysis of lung tissue biopsies. Echocardiography - symptoms of hemodynamic disturbances in the pulmonary circulation are noted only with sufficiently high indicators of the area of fibrous changes in the lungs.

Differential diagnosis of interstitial pneumonia is carried out with bacterial pneumonia, tuberculosis, other ILDs. Therapeutic and diagnostic measures for interstitial pneumonia involve the interaction of a pulmonologist, thoracic surgeon, radiologist, pathologist.

Treatment of interstitial pneumonia

Early diagnosis of interstitial pneumonia has a positive effect on the effectiveness of treatment and prognosis. When acute form interstitial pneumonia maintenance of respiratory function is carried out with the help of oxygen therapy and artificial ventilation of the lungs. Treatment of other forms is based on the use of glucocorticosteroids (GCS) and cytostatics that can have a pronounced anti-inflammatory and immunosuppressive effect.

With NSIP, COP, RB-IBL, DIP and LIP, high or medium doses of prednisolone are indicated for a long course, if necessary, the addition of cytotoxic drugs. Smoking cessation is a prerequisite for the resolution of desquamative interstitial pneumonia and respiratory bronchiolitis associated with ILD. In IPF, corticosteroid monotherapy and more preferred combinations with azathioprine or cyclophosphamide are used for at least 6 months. with careful monitoring of the patient's condition.

Antifibrotic drugs (D-penicillamine, colchicine, interferon γ-1b) are used as additional ones. With the development of hypoxemia, oxygen therapy is recommended, with pulmonary hypertension- vasodilators. Effective use of drugs that affect the functional activity of the endothelium - prostaglandins, antiplatelet agents, endothelin-1 inhibitors, antioxidants. With the formation of a "honeycomb lung", the only treatment for interstitial pneumonia is lung transplantation.

Prognosis of interstitial pneumonia

The outcome of interstitial pneumonia depends on the form of the disease and the severity of pulmonary fibrosis. Survival of patients averages 5-6 years, with IPF with the development of pneumosclerosis and cardiopulmonary insufficiency, life expectancy does not exceed 3 years. Acute interstitial pneumonia, even with timely treatment, has very high mortality rates - up to 50-70%.

Clinical improvement and stabilization of the patient's condition as a result of treatment of nonspecific interstitial pneumonia occurs in approximately 75% of cases; about 35% of patients have a 10-year survival rate. In the desquamative form, improvement/stabilization is observed in 2/3 of cases, and 5- and 10-year survival rates reach 93 and 69%, complete remission is possible. Most cases of lymphocytic interstitial and cryptogenic organizing pneumonia have a favorable prognosis. RB-IBL often resolves with smoking cessation, in some cases persistent progression with relapses occurs. Patients with IPF are regularly vaccinated

When a patient is diagnosed with such a diagnosis as interstitial pneumonia, many people wonder what it is, what differences does the disease imply from the standard manifestation of pneumonia? The difference is that if there is this disease the interstitium becomes inflamed, then the alveoli of the lungs. With absence timely treatment there is a proliferation of connective tissue, which leads to disappointing prognosis. In our article, we look at the symptoms and treatment of interstitial pneumonia in adults and children.

Since this form of pneumonia is not so common, the causes of its development are not fully understood. According to medical practice, the main causes of the development of the disease are pathogenic bacteria and infections that can be found in the dust. The risk of developing interstitial pneumonia is significantly increased in long-term smokers, as well as in people suffering from the human immunodeficiency virus.

Symptoms of pathology

Interstitial pneumonia is divided into several types, depending on which the patient may experience various symptoms. From common features the course of the disease can be distinguished by constant drowsiness, coughing, mostly moist, and general malaise. Consider what symptoms may indicate this disease, depending on its type:

Acute interstitial pneumonia. Like any other disease, interstitial pneumonia can occur in acute stage. This suggests that the disease develops very quickly. At first, the patient is tormented by chills due to a significant change in the level of body temperature. Sometimes the mark rises to 40 degrees. There is severe shortness of breath and paroxysmal cough. With the development of the acute stage of this disease, it may be necessary artificial ventilation lungs until a stable improvement in the patient's condition. On radiography, a standard picture is observed: darkening in the lungs on one or both sides (bilateral interstitial pneumonia).
Nonspecific interstitial pneumonia. This disease proceeds at a very slow rate. In some cases, symptoms of the disease can be observed for several years. There is a constant cough, mainly developing in the morning, when climbing stairs there is shortness of breath, there is a general malaise. It is worth noting that this species disease is typical for older people, especially for those who have been smoking for more than 10 years. At diagnostic study using an X-ray machine, “frosted glass” is observed.
Lymphoid interstitial pneumonia. It is worth noting that this type of disease is very rare compared to the rest. The chances of a full recovery are high, provided that the necessary treatment is given in a timely manner. According to statistics, most of the patients are women. Of the symptoms, general weakness, drowsiness and a dry periodic cough are noted.
Cryptogenic interstitial pneumonia. The onset of the disease is abrupt. The first symptom is an increase in body temperature. Often the cryptogenic form occurs as a complication after the flu. The disease has favorable forecasts. With the help of antibacterial drugs, it is cured in 4-8 weeks.
Desquamative interstitial pneumonia. The type of disease is typical for smokers with experience. Signs of the disease are scarce: a rare cough, shortness of breath with severe physical activity. Symptoms are very easy to confuse with the banal consequences of smoking. In most cases, patients manage to get rid of the disease.
Idiopathic interstitial pneumonia. To date, there is not so much information about this disease, since the disease occurs quite rarely. The disease begins with a common cold, symptoms in the form of shortness of breath, cough and chest pain increase gradually. The x-ray shows a "ground glass" pattern.

How the disease is diagnosed

It is very difficult to diagnose the first signs of the disease for the reason that characteristic symptoms similar to other diseases and ailments. To confirm the presence of ordinary interstitial pneumonia, you need to undergo the following types of examination:

X-ray examination of the lungs. Despite the fact that this type of diagnosis is uninformative, you can visually notice changes that signal a pathological change in the organ.
Computed tomography (CT). More informative method diagnostics, which helps to identify the structure of the organ, to consider changes in the organ in more detail.
Electrocardiogram. At untimely treatment Interstitial pneumonia often causes complications that can affect the heart. An ECG is needed if complications are suspected.
Sputum examination. If the cough is wet, a laboratory test of sputum may be required to detect sensitivity to antibacterial agents.
Biopsy. AT individual cases of particular severity, a histological examination of the organ may be prescribed.

Help: When you find the first symptoms of the disease, be sure to consult a doctor for diagnosis and treatment.

What complications are possible

As mentioned above, interstitial pneumonia can lead to undesirable consequences. Against the background of a general ailment, the following may occur:

Fibrosis of the lung. The most common complication that occurs with the growth of connective tissue.
secondary infection. Occurs when the disease is not detected in time. The mucus in the lungs begins to build up and rot, which can lead to sepsis or an abscess.
Heart problems. Diseases of organs respiratory system often give complications to the heart. Most often, heart failure or arrhythmias of various etiologies occur.
Oncological disease. The most dangerous moment is the development of organ cancer. It is more common in older smokers.

Separately, it is worth mentioning that interstitial pneumonia in children and newborns proceeds a little differently. AT without fail the development of the disease is signaled by a high body temperature. Complications in children are quite common. In addition to the above, pulmonary edema or emphysema may occur.

Treatment of the disease

Interstitial pneumonia should be treated immediately after diagnosis. In this case, the chances of a full recovery and avoiding serious complications are significantly increased. It should be noted that the disease is treated exclusively in stationary conditions.

The main therapy is medications group of glucocorticosteroids. The drug Prednisolone proved to be excellent.
As a complementary therapy, adults and children are prescribed antibacterial drugs in accordance with age. For high efficiency the drug is administered intramuscularly. The drug is usually used a wide range actions - Ceftriaxone.
Mandatory to take drugs that contribute to the liquefaction and release of sputum.
Oxygen therapy is prescribed, which stimulates the restoration of lung tissue and respiratory function.
Vitamin courses intramuscularly are shown. This is necessary to stimulate the increase in immunity. Usually vitamins of the main groups (A, B, C, D) are used.

In addition to the main treatment, a certain diet is shown. Against the background of the disease, patients with interstitial pneumonia rapidly lose weight, which is highly undesirable during treatment. For this reason, the maximum calorie is assigned. Depending on the individual features Patients' diets may vary.

Reference: The course of treatment of interstitial pneumonia is strictly individual. The timing of therapy depends on the form of the disease, its severity and the individual characteristics of the organism.

Folk remedies

Of course the recipes traditional medicine not able to save the patient from the disease. But still, doctors recommend using them as an additional therapy. Some recipes contribute to the discharge of sputum and the restoration of respiratory function. Let's take a closer look:

Licorice root must be placed in water and brought to a boil. The resulting liquid is cooled to room temperature. The decoction is recommended to drink 1/3 cup three times a day.
Peppermint and thyme are finely chopped with a knife and poured with vegetable oil. Insist in a dark place for about a week. Oil is rubbed on the back and chest daily at night.
St. John's wort leaves are steamed with boiling water. Leave for at least 3 hours. The decoction is taken in a glass during the day.
If the patient is concerned about a dry cough with a sore throat, warm milk with liquid honey helps well (at the rate of 1 tablespoon per glass of liquid).

Preventive measures

Get a flu shot once a year.
When symptoms occur colds start treatment on time.
Beware of hypothermia.
Daily breathing exercises.
Daily wet cleaning of the room.
In crowded places, use a medical mask.
Give up smoking.
Healthy food.

It is important! Interstitial pneumonia is an insidious disease that can occur in a latent form. Only modern methods of diagnostics and laboratory research some analyses. If symptoms characteristic of this type of pneumonia appear, in no case do not self-medicate and consult a doctor as soon as possible.