Acta clinica Croatica, Vol. 40 No. 3, 2001.
Original scientific paper
Interstitial Lung Diseases: Algorithm, Treatment and Follow-Up
Davor Jurman
Abstract
Interstitial lung diseases and related difficulties that a clinician encounters in daily practice are presented. The disease may be of known origin, such as postirradiation pneumonitis, pneumoconioses, allergic alveolitis, etc., or of unascertainable origin, such as sarcoidosis and systemic diseases with multiple organ involvement, e.g., Goodpasture's syndrome. In the article, particular reference is made to sarcoidosis and cryptogenic fibrosing alveolitis. Interstitial diseases are still classified and referred to as (abbrev.) UIP, NSIP, DIP, LIP, BOOP and AIP. Both AIP and UIP are considered to have poor prognosis. This is a modification of Liebow's classification. The World Association of Sarcoidosis and Other Granulomatous Disorders have proposed guidelines for the follow-up of patients with these diseases. The recommended methods include bronchoalveolar lavage, angiotensin-converting enzyme determination, gallium scan (of the whole body or of the lungs), and high-resolution computed tomography. These parameters, along with clinical evaluation, and immunologic and functional tests, should prove adequate in most cases, while the rest of unresolved cases should be considered for either bronchoscopic transbronchial or surgical (thoracoscopic or open lung) biopsy. Most of our patients were treated with steroids, and only some 25% of them improved without this therapy. The patients treated with steroids responded to treatment without major side effects, with the exception of two patients who failed to respond favorably to this therapy. One of these two patients, however, had to be treated with low-dose steroids for more than ten years. New methods such as high-resolution computed tomography, along with the established ones such as gallium scan, help in the diagnosis of early stages of interstitial involvement, so that steroid therapy can be initiated on time, which is of crucial importance for prevention of the disease progression to the irreversible fibrotic stage. Prospective trials are needed to find new diagnostic and therapeutic methods based on novel concepts on the disease etiology.
Keywords
Lung diseases, interstitial, classification; Lung diseases, interstitial, diagnosis; Lung diseases, interstitial, therapy
Hrčak ID:
14864
URI
Publication date:
3.9.2001.
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