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Examination and treatment of interstitial pneumonia

 Wheezing is painful, like drowning


  Normally speaking, the normal lung tissue is like a big sponge, and the alveoli are like many small bubbles in the sponge. Each bubble is roughly uniform in size. The bubbles cannot be free due to the fixation of the surrounding connective tissue. Swing ensures the synchronization and efficiency of breathing. Normally, there are some fibrous filaments in the connective tissue around the bubble, such as the reinforcing steel in reinforced concrete, that is, collagen fibers. These "fiber filaments" are slender and thin, and will not prevent the oxygen in the inhaled air from dispersing into the blood vessels around the bubbles; at the same time, the lungs are maintained elasticity. The lungs can not only contract and exhale air freely, but also fully expand and accommodate more. More air ensures the oxygen supply to the whole body. These supporting tissues around the alveoli, including blood vessels and lymphatic vessels, are called "interstitial". Diseases that mainly invade the interstitium are called "interstitial lung diseases". In fact, interstitial lung diseases can also invade the "lung parenchyma" such as alveoli. Only the center or main part of the disease is in the "interstitium".

  Lungs with interstitial lung disease When the lungs form interstitial lung disease, the "fibrils" around the alveoli will increase and thicken, and at the same time these "fibrils" will shrink and pull the surrounding tissues. Alveoli are easily ruptured after being pulled, and the ruptured bubbles will fuse with each other to form a honeycomb-like change; pulling the bronchus will cause bronchiectasis. The entire lung will also shrink and become hardened due to being stretched. In addition, these fibrous filaments will also wrap the alveoli layer by layer. The alveoli seem to be entangled with iron chains, which makes the lungs lose their elasticity and reduce their diastolic and contraction functions. One breath and one breath become shallower, and the amount of air inhaled into the lung becomes smaller. The oxygen of the worm is blocked by the "fibers" and cannot enter the blood vessels around the alveoli freely, resulting in insufficient oxygen to support the needs of the whole body, resulting in hypoxia and even respiratory failure. To use an analogy, the lungs of interstitial lung disease are like loofah flesh, hardened and thickened with fibrils, and inside are large and small bubbles with extremely poor breathing efficiency. Of course, "fiber silk" is a simplified image metaphor, and the mechanism of interstitial lung disease is much more complicated.


Normal lungs have a moderate volume, good elasticity, and no excessive fiber deposition.


The volume of the fibrotic lung is significantly reduced. The white fibrillar fibers increase. There are many honeycombs formed.

What checks should be done for interstitial lung disease


  High-resolution CT (HRCT) HRCT is an important examination method for diagnosing and judging the severity of interstitial lung disease. On HRCT, interstitial lung disease is mainly manifested as strip shadow, grid shadow, and honeycomb shadow, and some are manifested as film Ground glass shadow, diffuse nodular shadow, etc. Ordinary CT cannot show the details of the fibrotic lesions, and sometimes the fibrous cord shadows appear as patchy shadows, so the diagnosis of interstitial lung disease is mainly based on HRCT.

  Lung function The lung has two functions, one is ventilation function and the other is diffusion function. Ventilation function refers to the function of the lungs to inhale air into the alveoli, and the diffusion function refers to the function of oxygen in the air entering the blood vessels around the alveoli. Interstitial lung disease affects these two functions at the same time, leading to severe hypoxia, and ultimately causing respiratory failure and life-threatening.

  A series of blood tests Because there are many causes of interstitial lung disease, the process of diagnosis is a process of continuous verification and elimination of the cause. We must perform a series of blood tests to determine whether there are related causes of interstitial lung disease, and also to exclude other causes that may cause interstitial lung disease, such as rheumatic immune diseases that most commonly cause interstitial lung disease (including Rheumatoid arthritis, systemic sclerosis, myositis/dermatomyositis, etc.), which need to be determined or ruled out by checking rheumatic antibodies in the blood; check blood tumor markers to rule out tumors; check some pathogen-related antibodies to rule out infections Possible. All the causes have been ruled out. Idiopathic pulmonary fibrosis can be diagnosed only when HRCT meets the diagnostic conditions.

Interstitial lung disease treatment


  Interstitial lung disease is more difficult to treat. Mainly interstitial fiber filaments are more difficult to absorb and remove. The curative effect varies according to the cause of the disease. If it is caused by drug side effects, after removing the drug, the fiber can be loosened and cleared; rheumatoid immune diseases such as rheumatoid arthritis and pulmonary fibrosis caused by systemic sclerosis can be treated with hormones and immunosuppressants. Some The patient's curative effect is better. The most serious is idiopathic pulmonary fibrosis, the treatment effect is not good, the treatment is often ineffective, and only lung transplantation can be done in the end.

  Oxygen therapy is undoubtedly the most important treatment method for the treatment of interstitial lung disease. Because most interstitial lung diseases, especially idiopathic pulmonary fibrosis, currently lack effective drugs that can reverse the disease, it is important to relieve treatment that may cause damage to other organs in the body. The symptom of interstitial lung disease that affects the whole body is hypoxia. In patients with severe interstitial lung disease, all the organs of the whole body are soaked in the hypoxic blood, which will be damaged by hypoxia. The lungs are already diseased, and if other organ damage is added, it will be worse. Therefore, inhaling oxygen to maintain the oxygen concentration in the blood so that other organs are not damaged is an important measure to prolong life.

  The hormone glucocorticoids are commonly used drugs for the treatment of many types of interstitial lung diseases, and even the most effective drugs. For interstitial lung diseases such as collagen vascular disease-related interstitial pneumonia, non-specific interstitial pneumonia, and sarcoidosis, hormone therapy can be used to reverse or even cure the disease. However, the treatment course of the drug is long, and even requires 6 months or more of medication. And its long-term side effects are extremely great, which may lead to a decline in immunity, combined with rare bacterial infections, and even high blood pressure, diabetes, and femoral head necrosis. It is important to note that taking hormones for a long time may inhibit the secretion of their own glucocorticoids and cause adrenal atrophy. If the drug is suddenly reduced, it may lead to a sharp reduction of glucocorticoids in the body and a rebound of the disease. Therefore, the drug must be slowly reduced. .



  Acetylcysteine ​​Although there have been articles proving that acetylcysteine ​​is not effective in the treatment of common types of idiopathic pulmonary fibrosis in interstitial lung diseases, there are still many patients with other interstitial lung diseases who obtain it from the drug. Benefit. The drug mainly exhibits phlegm-reducing effect at normal doses, but has certain anti-oxidation and anti-fibrosis effects at high doses, and long-term use of some patients can maintain a stable condition. The drug needs to be taken for a long time or even for life, so it is also a longer treatment course.

  Pirfenidone and nintedanib Pirfenidone and nintedanib are currently two anti-fibrotic drugs clinically proven to control idiopathic pulmonary fibrosis. Observed for one year between patients using these drugs and patients in the control group, it was found that the rate of decline in lung function was significantly reduced, and the number of acute exacerbations in the next year was significantly reduced. However, these two drugs still cannot play a role in reversing the condition, but can only stabilize the condition. The long-term side effects are mainly photosynthesis, liver damage and other gastrointestinal reactions.

  The symptoms of interstitial lung disease with cough suppressants are mainly cough, which is very stubborn and even tends to stop until the lungs are coughed up. Using a good cough medicine to stop coughing can significantly improve the quality of life of patients with interstitial lung disease, while reducing the frequency of coughing, prolonging the duration of normal breathing, and alleviating the hypoxia caused by coughing. Normally, mild cough is mainly based on proprietary Chinese medicines, and strong cough suppressants, such as codeine, can be used when necessary. However, the drug is addictive and needs to be used with caution.

  Lung transplantation interstitial lung disease, especially idiopathic pulmonary fibrosis, is an important indication for lung transplantation. Lung transplantation is also an important measure to cure idiopathic pulmonary fibrosis. Both single-lung transplantation and double-lung transplantation can be used. At present, the technology of lung transplantation has been relatively mature. The success rate of lung transplantation in some hospitals has reached more than 80%, and most patients can benefit from it. Some patients who can only lie down and rely on ventilators to maintain their lives can even take care of themselves and participate in social activities after lung transplantation. Of course, not every type of interstitial lung disease is suitable for lung transplantation. Some interstitial lung diseases caused by rheumatic immune diseases progress rapidly. After transplantation, the new lung will still be invaded, and the prognosis is relatively poor. Of course, this is not absolute. Patients with interstitial lung disease caused by rheumatic immune diseases can still benefit from lung transplantation. It is best for willing patients to register and queue in advance at a hospital capable of lung transplantation, because most patients cannot have a donor lung immediately when they must be transplanted, and patients often lose their lives without waiting for the source of their lungs.

  Most of the interstitial lung diseases are chronic diseases, not only the disease develops slowly, the duration is long, and the treatment course is also relatively long, basically requiring more than half a year of treatment. Some of the therapeutic drugs, such as glucocorticoids, can receive relatively good results, but the long-term side effects are large, and the dose cannot be reduced or stopped arbitrarily.


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