Nonspecific interstitial pneumonia causes. Features of the course and treatment of interstitial pneumonia. Stages of development of the disease

The term "idiopathic interstitial pneumonia" is used to refer to a group of lung diseases with an unknown etiology. The diseases of this group differ from each other by the type of pathomorphological non-infectious inflammation and fibrosis in the interstitium of the lung. The difference is noticeable in the clinical course and prognosis. Diseases can be in an acute form and lead to death, but they can also be completely cured or form a chronic “honeycomb lung”.

Story

Idiopathic interstitial pneumonia was first diagnosed and classified in 1935. In 1964, the diagnosis of fibrosing alveolitis was first made. This is where the synonymous name "idiopathic pulmonary fibrosis" comes from. Also known as cryptogenic fibrosing alveolitis. The latter name is most common in Europe.

In 1965, the disease was first differentiated into five types: giant cell interstitial pneumonia, lymphoid interstitial pneumonia, bronchiolitis obliterans with interstitial pneumonia, desquamative interstitial pneumonia, and ordinary interstitial pneumonia.

Over time, the first two options left the group, as their etiological factors were established.

In 1998, D. Myers and A. Katzenstein identified four variants of the disease: nonspecific, acute, desquamative, and ordinary interstitial pneumonia. Bronchiolitis obliterans was not included in this classification because it is caused by viruses or inhaled toxins.

In the end, in 2001, according to international agreement, 7 types of pneumonia of interest to us were accepted. The classification includes: lymphoid interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis, acute interstitial pneumonia, cryptogenic organizing pneumonia, nonspecific interstitial pneumonia, idiopathic fibrosing alveolitis.

Spreading

Nowadays, only the spread of idiopathic fibrosing alveolitis is reliably known. According to statistics, they suffer from about 20 men out of a hundred thousand and 13 women out of the same number. With age, the risk of the disease increases. Most often they get sick after 60. Mortality is directly proportional to the age category. The older the patients, the higher it is. 3 people per 100 thousand of the population die from this disease. In turn, the average life expectancy of survivors of this type of pneumonia is from 2.5 to 5 years. It should be clarified that about 90% of cases of idiopathic interstitial pneumonia are a disease of idiopathic fibrosing alveolitis.

Diagnostics

Idiopathic interstitial pneumonia is classified according to the features of the clinical picture, pathomorphological and radiological signs. Pathological disorders for each individual form have not yet been identified. All patients have a decrease in lung volume due to physiological changes as a consequence of the disease. In patients, the results of laboratory tests inherent in all types of idiopathic diseases are distinguished.

Features of clinical and radiological manifestations of idiopathic fibrosing alveolitis

This species is characterized by increasing shortness of breath and an unproductive cough of a paroxysmal nature with refractoriness to antitussives. In a quarter of patients, deformation of the nail phalanges occurs. During auscultation, a “crack of cellophane” is heard, starting from the lower sections and ending with the upper ones. In later stages cor pulmonale is seen.

On radiography, darkening is most often observed in the basal regions. This is the reason for the decrease in the volume of the lower lobes and the formation of cellular changes in the lung tissue. The accuracy of diagnosis when using an X-ray image is 50%.

Computed tomography shows predominantly bilateral changes associated with traction bronchiectasis. In most cases, the phenomena of "honeycomb lung" are observed, less often - "frosted glass". Changes are seen mainly in the peripheral and basal parts of the lungs.

Features of clinical and radiological manifestations of nonspecific interstitial pneumonia

This disease develops very slowly. Often people go to the doctor 1.5-3 years after feeling the first symptoms. Shortness of breath and cough are not very pronounced and grow slowly. Temperature and changes in the nail plates appear no more often than in 10% of cases. The disease responds well to treatment.

The x-ray image shows bilateral infiltrative changes in the lower parts of the lungs. Areas with the effect of "frosted glass" are arranged symmetrically. In most cases, this is the only symptom of the disease. Repeated studies after treatment usually show a positive trend.

Features of clinical and radiological manifestations of cryptogenic organizing pneumonia

With this type of pneumonia, pathological changes occur in the alveolar passages and alveoli in combination with polypoid bronchiolitis. The symptoms are similar to the flu. The cough may be productive and produce clear sputum. Wheezing is heard. The shape of the nail phalanges never changes. In addition, a blood test also takes part in the diagnosis. HSC therapy leads to complete recovery of the patient.

X-ray examination most often shows unilateral darkening in the form of nodular shadows. The area of ​​the lungs can decrease up to 25%.

Computed tomography shows subpleural and peribronchial seals in the lower lobes of the lungs.

Features of clinical and radiological manifestations of acute interstitial pneumonia

With this type of disease, after the symptoms of a viral infection, shortness of breath develops rapidly. Later, cyanosis develops. Over time, the patient requires artificial ventilation of the lungs. Mortality exceeds 50%.

When radiography is strongly visible thickening of the walls of the central and peripheral bronchi, "frosted glass".

Features of clinical and radiological manifestations of desquamative interstitial pneumonia

Most often, the disease occurs in smokers and is characterized by a dry cough and increasing shortness of breath.

An x-ray shows a nodular ground-glass structure in the lower lobes of the lungs.

Features of clinical and radiological manifestations of lymphoid intertial pneumonia

Symptoms of the disease are weight loss, fever, arthralgia, and sometimes anemia.

X-rays may show both diffuse ground-glass lesions and mixed alveolar-interstitial infiltrates.

Complete diagnosis

In modern medicine, a complete diagnosis can only be made with the help of a surgical lung biopsy. For different types of idiopathic intertial pneumonia, both open and videothoraxoscopic biopsy can be used. A complete diagnosis of this group of diseases makes it possible to avoid not only death from the disease itself, but also the consequences of improper treatment with difficult-to-tolerate drugs that are used due to the complexity of the disease.

Nonspecific interstitial pneumonia (NSIP, English NSIP) is the second most common morphological and pathological pattern of interstitial lung disease and is characterized by a histological pattern of uniform interstitial chronic inflammation of varying severity or fibrosis. NSIP is of two subtypes:

• fibrous (fibrotic) type: more frequent, worse outcome
• cellular (cellular) type: less frequent, but characterized by a better prognosis due to a better response to therapy

On imaging, the most common features are relatively symmetrical and bilateral ground-glass areas in association with subtle/fine reticular changes and decreased lung volume leading to traction bronchiectasis. Sparing of the immediate subpleural regions, if present, is considered very specific for NSIP.

Epidemiology

Pathology usually occurs in middle-aged men, 40-50 years old. Distributed in the European population.

Clinical picture

Symptoms are non-specific and include insidiously progressive dyspnea and dry cough with a restrictive pattern of decreased lung function and decreased gas exchange function.

Pathology

Spatial and temporal homogeneity in the material is the main feature of NSIP. Histologically, NSIP is divided into three groups; however, due to the similar outcome, groups II and III (mixed cellular and fibrous and, accordingly, predominantly fibrous) are now classified as fibrous type:

• fibrous(fibrotic, from English fibrotic): more frequent, thickening of the interstitium is more due to homogeneous fibrosis with an average severity of chronic inflammation, despite fibrotic changes, the architectonics of the lung tissue is preserved
• cellular(cellular, from English cellular) nonspecific interstitial pneumonia: less frequent; thickening of the interstitium is mostly secondary to inflammatory cell infiltration and type II pneumocyte hyperplasia. The architectonics of the lungs is preserved.

The absence of important histological features such as hyaline membranes, granulomas, invasion by microorganisms, signs of primary airway disease or organizing pneumonia, as well as eosinophils and gross fibrosis, indicates the absence of acute lung injury.

Combined pathology

NSIP is predominantly an idiopathic disease, but the morphological pattern can be associated with numerous diseases:

• connective tissue diseases
  • systemic lupus erythematosus
  • scleroderma
  • Sjogren's syndrome
  • polymyositis 5]
  • dermatomyositis 5]
• other autoimmune diseases
  • thyroid iodide Hashimoto
• drug-induced lung injury: especially drugs used in chemotherapy
• slow recovery from diffuse alveolar damage
• recurrent organizing pneumonia
• immunodeficiency (mainly with HIV)
• host versus graft reaction 13]
• Castleman's disease
• myelodysplastic syndrome 13]

Diagnostics

CT scan

Imaging features are similar in cellular, fibrous NSIP, and AIP in up to 30% of cases. The temporal progression of changes during repeated HRCT examination in 28% of cases makes it possible to change the preliminary diagnosis from AIP to NSIP. Changes affect, as a rule, the peripheral sections (with compression of the directly subpelural ones), which are generally symmetrical with a cranio-caudal gradient severity. Isolated or predominant involvement of the upper lobes, or rare unilateral involvement, makes the diagnosis of NSIP less likely.

Common manifestations include:

• reduction of airiness by the type of frosted glass
  • usually the dominant feature: may be symmetrical or diffusely distributed throughout all departments or localized mainly in the basal regions
  • sparing of the directly subpelural regions is a relatively specific sign of NSIP
  • in most cases bilateral and symmetrical (~86%), but may be bilateral asymmetrical (in 10% of cases), and rarely unilateral (3%)
  • most in peripheral areas (~68%) but may be chaotic (21%), diffuse (8%), and rarely in central lung (3%)
• reticular densities and irregular linear densities (sometimes minimal subpleural reticular changes) mainly in fibrous NSIP
• thickening of the axial interstitium / bronchovascular bundles: in fibrous NSIP
• traction bronchiectasis: seen in fibrous NSIP
• decrease in lung volume: mainly lower lobes
• with pronounced flow

Respiratory diseases can cause many inconveniences and problems. In addition, they can be life-threatening. For example, interstitial pneumonia is not very common, but if not properly treated, it can cause serious complications, up to a lung abscess and death. Therefore, when the first symptoms appear, you should definitely consult a doctor.

What is a disease

Interstitial pneumonia is characterized by the fact that it is a complication of a pathology such as influenza. This inflammation occurs in the connective tissue of the lungs. Naturally, pathology is fraught with many dangers. Destructive processes that begin in tissues are very dangerous if the disease is not treated or therapy is started very late.

It should be noted that this disease occurs under the influence of certain viruses. Its development is not fleeting. You will have to be treated for this disease in a hospital, and for a long time. Diffuse in this case is seriously disturbed, the walls of the alveoli thicken. The course of the pathology is quite severe and requires mandatory hospitalization.

Causes of the appearance of pathology

There are many factors that can lead to these. Among them are the following:

Bacterial or viral infection (although it is not contagious).

Weakness of immunity, general fatigue.

Any past respiratory diseases, after which the body did not have time to fully recover.

Wrong nutrition.

Smoking.

Insufficient physical activity, which contributes to the stagnation of sputum in the lungs and bronchi.

Signs and symptoms of the disease

Now let's see how interstitial pneumonia manifests itself. So, this disease is characterized by such signs:

1. Rise in temperature. Moreover, it may not be too strong (up to 37.5 degrees), but it keeps stable and for a long time.

2. Difficulty in breathing.

3. General weakness and malaise.

4. High level of sweating.

5. Significant weight loss.

6. Mild cough and shortness of breath.

7. Pale skin.

This pathology may be accompanied by other minor symptoms. Naturally, only a doctor can make an accurate diagnosis after examining and examining the patient.

Stages of development of the disease

Interstitial pneumonia can not make itself felt for a long time, which is the greatest danger. There are several stages of development:

1. First. Usually it lasts only a day and is characterized by compaction of the lungs and filling of the alveoli with exudate.

2. Second. The lungs thicken even more and become red.

3. Third. Fibrin accumulates in the exudate, and red blood cells begin to break down. The lungs at the same time change color to gray-brown.

4. Fourth. Fibrous exudate begins to dissolve, and the walls of the alveoli are restored.

These stages of pneumonia are characteristic of almost all types of pathology. The only difference is the duration of each stage and the severity of changes in the lungs.

How to correctly diagnose

It should be noted that you cannot do this yourself. Since the examination is based on the delivery of certain tests and the use of hardware equipment. For example, if you are suspected of having pneumonia, an x-ray will help determine the extent and extent of lung damage. Without this study, it is impossible to make an accurate diagnosis. In addition, x-rays help to see other respiratory diseases that can be more dangerous and have similar symptoms (tuberculosis).

There are also such tests for pneumonia: a general and biochemical blood test. It makes it possible to establish or exclude the presence of a bacterial (viral) infection in the body, which can cause the development of the disease. That is, this study helps to determine the method of treatment.

Such tests for pneumonia as sputum culture are also considered mandatory. Thanks to this study, the doctor will be able to determine the amount of exudate in the alveoli, as well as obtain additional information about the type of pathology and the stage of its development.

What complications are possible

I must say that severe pneumonia can be fraught with serious consequences. For example, local complications are characterized by such pathologies as: pleural empyema (inflammation of the pleural sheets, which is accompanied by the formation of pus), atelectasis (falling of all or part of the lung), and abscess (inflammation of the tissue with the formation of necrotic cavities).

Pneumonia (X-ray is mandatory) can contribute to the development of other pathologies: endocarditis, purulent arthritis, meningitis, nephritis, peritonitis, thrombophlebitis, brain abscess, toxic shock. That is, it can negatively affect all body systems.

Polysegmental and pathology characteristics

There are other types of disease that are no less severe and require inpatient treatment. For example, polysegmental pneumonia, which is characterized by the accumulation of exudate in the alveoli of all segments of the body. That is, the patient may have several foci of inflammation. A distinctive feature of the pathology is the rapid progression. Therefore, therapy should begin immediately. Polysegmental pneumonia requires complex treatment, which can last several weeks. In the absence of therapy, a person may die from lung failure or other complications.

Aspiration pneumonia is a special type of inflammation that is not caused by bacteria or a virus, but by small elements of food or digestive juice that enters the bronchi from the oral cavity. This can happen if a person chokes. The most common treatment is bronchoscopy. In addition, seriously ill patients can be connected to a lung ventilator. Aspiration pneumonia has a positive prognosis. However, if the disease is running, then the chances of a full recovery are reduced.

Traditional Therapy

So, you already know that therapy should be complex. First of all, it is necessary to eliminate those diseases that accompany inflammation, as well as eliminate the cause of the development of pathology: a virus, an infection. It is imperative to remove the process of inflammation in the lungs. Most often, quite strong antibiotics from a number of penicillins are used for this purpose. For example, Amoxicillin, Cefotaxime.

To eliminate exudate from bronchioles and alveoli, antitussive drugs are prescribed: Lazolvan, Bromhexine, ACC. In addition, bronchodilator medications may be needed: Berodual. Naturally, the patient will also have to use anti-inflammatory drugs, as well as multivitamins to support the body and restore it.

Proper nutrition during treatment is very important. It should contain all the necessary micro and macro elements that will strengthen the immune system and speed up recovery. However, food should not be heavy. Naturally, it is necessary to support other body systems, especially the cardiovascular system, which is the first to suffer complications.

In severe cases, surgical intervention and bronchoscopy are used. In this case, the doctor decides whether to remove the affected and destroyed parts of the lung or you can restore them.

Other ways to deal with the disease

Interstitial pneumonia, which should be treated immediately after the first symptoms are detected, can be eliminated with the help of physiotherapy and alternative methods. Naturally, this must be agreed with the doctor, since these methods can be complementary.

Among the physiotherapeutic methods, the most effective are the following:

Electrophoresis.

Water and thermal procedures.

Therapeutic exercise and shower.

As for folk recipes, the following will be useful:

1. Steam one large spoonful of coltsfoot with a glass of boiling water and insist. After that, the mixture is filtered and taken up to 6-8 times a day for a tablespoon. This remedy provides good expectoration of sputum.

2. Viburnum berries must be insisted for 7 hours on hot honey. This remedy has anti-inflammatory properties.

3. Mix two tablespoons of birch buds with 70 g of butter. Next, the product must be melted over low heat, while it is not recommended to boil it. After an hour, remove the mixture from the heat, cool slightly, squeeze and strain. In the resulting product, add about 200 g of honey and stir. Take the medicine should be 4 times a day for a tablespoon.

Disease prevention

The prevention of pathology is much better than its subsequent treatment. Therefore, it is better to take such preventive measures:

First of all, try to quit smoking.

Get vaccinated against respiratory diseases annually.

Strengthen your immune system with multivitamin complexes, as well as proper nutrition.

Temper the body, lead an active lifestyle.

Go swimming, running, walking and other sports.

Try to treat emerging infectious respiratory diseases in a timely manner.

Follow standard hygiene standards: wash your hands, do not go to public places during flu epidemics.

In the case of home treatment of pathology, the patient must necessarily observe bed rest.

That's all the features of the course, treatment and prevention of pneumonia. Be healthy!

Interstitial pneumonia involves inflammatory damage to the lung interstitium.
Edema develops in the focus of inflammation, as a result, gas exchange is disturbed. This is a serious pathology of the lungs.

find the answer

What

Pneumonia is the scourge of modern humanity, experts are finding new secrets and mysteries regarding this disease. It is impossible to run away from her, and if she overtook you, you will have to be treated.

Pneumonia is a disease of an infectious-inflammatory nature, in which some lung tissue or a lobe or all of the lung is affected. Ordinary mortals and movie stars, Egyptian pharaohs and financial magnates - no one is immune from the risk of getting sick with it.

In addition to the usual pneumonia, which is characterized by a classic course, other types of pneumonia predominate in medicine.

Idiopathic interstitial pneumonia is a complex of inflammatory diseases of the lungs, the etiology of which is not fully understood. All have the same clinical features. Obscure origins aren't everything.

This group of diseases is characterized by damage to the interstitium - connective tissue cells. This pathology contains inexplicable mysteries. Its danger, in addition to the inflammation itself, is based on a latent form of leakage.

It can be detected by such studies as a biopsy, computed tomography (CT) or x-ray. Scientists are still guessing and everyone is thinking about what caused it.


Most professionals are inclined to believe that its appearance is provoked by an allergy or an infection.

The interstitial form of pneumonia appears due to:

• Past illness of a viral nature;
• Cancer neoplasms;
• HIV infection;
• Severe tuberculosis;
• Complications after surgery;
• Frequent use of antibiotics, anticancer drugs.

Nonspecific type of pathology

Nonspecific interstitial pneumonia (NIP) is a separate nosological form that develops slowly but surely.

This pathology is accompanied by symptoms, and before doctors make a correct diagnosis, it can take 2 years, or even more.

At risk of contracting this unpleasant disease are people in the age range of 40-50 years. Many associate NPI with smoking, but this is a complete misconception.

The pathology is characterized by slowly increasing shortness of breath and cough. These symptoms may not let the patient go for many months and even years.

Patients are weak, they cannot play sports for a long time, they complain of weight loss. More than half of those infected noted a decrease in body weight of at least 6 kg.

Diagnostic measures are difficult because symptoms can fluctuate for a long time. It is rare to observe an increase in body temperature.

If this pathology is suspected, an x-ray should be taken. Doctors reassure the patient with a favorable prognosis.

The result of microscopic examination can be found out using the NIP stage. At the first stages of the development of the disease, foci of inflammation with interstitial macrophages can be observed.

Stromal edema is a characteristic manifestation of pneumonia. Coarse-fibrous connective tissue covers the lung tissue in the advanced form of the disease.

With the help of CT, it is possible to get a detailed picture of the lungs. If a doctor has high-resolution CT at his disposal, then the image quality will not be “limping”. Then the doctor will be able to make an accurate diagnosis.

The frequency and prevalence of NIP have not yet been elucidated.

But information is leaking onto the Internet that this form of the disease is in second place among all forms of idiopathic interstitial pneumonia. More often, the etiology of the disease remains undiscovered.

Features of the desquamative form

To stumble upon a person with desquamative pneumonia is an accident, because such a disease is rare. More often it affects adults with a long history of smoking.

In 90 percent of cases, patients smoke, and therefore they tend to develop this disease more pronounced. Most often, men 30-40 years old suffer from this disease.


In children, it actively develops after suffering pneumonia. An insidious disease takes away strength, develops slowly, secretly and so imperceptibly. There is a strong malaise, which can be explained by the negative effects of smoking.

In addition to inflammation itself, exfoliation of cells can be observed, and the chance of an increase in the walls of the alveoli is not ruled out. The structure of the lungs is modified, this can be seen on the X-ray.

Symptoms characteristic of desquamative interstitial pneumonia are identical to those observed in idiopathic pulmonary fibrosis.

Along with smoking cessation, cytotoxic agents or glucocorticoids are taken, then the state of health will improve.

How idiopathic and other forms of the disease develop

The disease develops gradually, and this is the greatest danger.

There are several stages in the development of pathology:

1. First phase. It only took a day. At this time, the lungs are compacted, and the alveoli begin to rapidly fill with exudate.
2. Second phase. The lungs are compacted to the maximum, acquire a reddish tint.
3. Third phase. Fibrin begins to form actively in the exudate, red blood cells are destroyed. Instead of red, the lungs are now grey-brown.
4. Fourth stage. Fibrous exudate slowly resolves. The walls of the alveoli return to normal.

Video

X-ray and CT features

Depending on the amount of tissue affected, pneumonia is classified into:

1. Focal. A certain area is inflamed, limited by a focus in the lung.
2. Drain. It is represented by an inflammatory process in the lung. There is a fusion of small foci of inflammation into a larger one, focal pneumonia progresses.
3. Segmental. Inflammation is limited to one or more segments of the lung.
4. Equity. The inflammation is limited to a lobe of the lung.
5. Total. Everything easy is affected.

To make a correct diagnosis, your doctor may refer you for an x-ray. But x-rays may not be very reliable.

Computed tomography is more informative than radiography.

Pneumonia can be disguised as any other disease of the lung. If you have at least a fraction of doubt, then do not hesitate to visit a doctor.

The main CT sign of any pulmonary inflammation is a decrease in the degree of airiness of the lung tissues due to the filling of the respiratory sections with exudate. Pneumonic infiltration is characterized by fuzzy contours of compacted zones.

Infiltration of lung tissue extends to bronchopulmonary segments.

Computed tomography reveals a symmetrical lesion, more often in the peripheral region in the form of inflammatory foci of the "frosted glass" type.

Pathological changes in the blood

If you suspect pneumonia, you need to take a blood test, in which the number of leukocytes is counted, the leukocyte formula is established.

If pneumonia in a child slowly flows into a chronic form, then an increase in red blood cells in the blood is guaranteed. This happens as a result of dehydration.

If you are a carrier of pneumonia, your white blood cell count will be elevated.

Leukopenia is a decrease in the level of leukocytes in the blood, which occurs with a viral infection.

If, according to the leukocyte formula, you have a reduced number of neutrophils and a high percentage of lymphocytes, then this is a sure sign of the presence of viral pneumonia.

Bacterial pneumonia has a terribly low lymphocyte count. In a patient with pneumonia, the number of basophils, monocytes, eosinophils is reduced.

ESR is a criterion that reflects the intensity of the manifestation of the inflammatory process - and inflammation of the lungs.

If you have pneumonia, then the ESR will jump the mark of 30 mm / h. In men, the normal ESR is 1-10 mm / h, in women - 2-15 mm / h. The child has an ESR level of 1-8 mm/h.

In the interstitial form of pneumonia, there are no characteristic changes in blood tests.

Modern treatment of this disease

During treatment, it is necessary to strictly follow measures aimed at eliminating the inflammatory process. Combined therapy will bring a better effect.

It is necessary to do away with diseases associated with inflammation. By defeating the cause of the development of pathology, we can get rid of it itself.

Inflammation in the lungs also needs to be removed. Treatment is carried out with the help of "Cefotaxime" or "Amoxicillin".

On the part of the buyers, cough medicines such as Bromhexine or Lazolvan were praised, and ACC also helps. These drugs are aimed at eliminating exudate from the alveoli. Effective bronchodilator drugs, "Berodual".

There is a reason to use corticosteroids, because they will help cure interstitial inflammation of the lungs. If the patient's body does not respond to corticosteroid therapy, then cytostatics are prescribed.

Cyclophosphamide, methotrexate are more commonly used. Second-line drugs target pneumonia (colchicine or cyclosporine).

To maintain the body in a normal state, you will have to regularly use anti-inflammatory drugs, enrich your body with multivitamins.

Proper nutrition plays an important role in promoting health. The food you eat should contain many useful microelements and vitamins. Heavy food is not appropriate here.

The interstitial form of pneumonia can be eliminated by non-methods, you need:

1. Give up smoking. It can only aggravate your health condition.
2. Go to LFC. Breathing exercises bring invaluable benefits to the body.
3. Make a massage, electrophoresis.
4. Get oxygen therapy.

Folk remedies help:

1. Pour the dried flowers of the coltsfoot with boiling water and leave for about an hour. Strain the prepared mixture and take 8 times a day, 1 tbsp. spoon. A folk remedy, consisting of natural ingredients, provides excellent expectoration of sputum.
2. Fragrant viburnum berries insist 7 hours on hot natural honey. The anti-inflammatory effect is guaranteed.

Possible consequences and complications

If you let the disease take its course and went to the doctor too late, then serious complications can develop that endanger a person's life.


Against the background of interstitial lung inflammation, complications more often occur:

• Fibrosis leads to a violation of gas exchange in tissues, as a result, everything can be crowned with irreversible sclerotic changes in the affected tissues;
• Signs of heart failure;
• respiratory failure;
• bacterial infection;
• If the disease proceeds in a chronic form and nothing can be corrected, then lung cancer develops.

Severely flowing pneumonia can promise sad consequences.

Possible complications such as:

1. Empyema of the lungs.
2. Atelectasis.
3. Abscess.

Pneumonia can be a provocateur of the occurrence of such diseases:

• Peritonitis;
• thrombophlebitis;
• Purulent arthritis;
• toxic shock;
• Endocarditis;
• Purulent arthritis;
• Nephritis.

Simply put, inflammation has a bad effect on the body.

Prevention

Prevention of the occurrence of pneumonia is based on constant monitoring of the state of one's health.

It is better to take action in time than to regret the missed chance later.

To avoid becoming a carrier of pneumonia, follow these golden tips:

1. Quit smoking forever. Well, if you really can’t do anything with yourself, then at least give up smoking for a while.
2. Strengthen your immune system. Take multivitamins.
3. Proper nutrition is the key to a speedy recovery. The diet should contain more fresh vegetables, fruits, which give a surge of vitality, energy and a feeling of satiety for the whole day.
4. Go swimming, walking, running.
5. You must be on the side of a healthy and active lifestyle.
6. Stick to good hygiene habits: wash your hands with soap and avoid visiting public places during flu outbreaks.
7. Try to eliminate infectious respiratory diseases in time.

The group of interstitial lung diseases (ILD) includes several dozen separate nosological forms that differ in etiology, pathogenesis and morphological features, with different clinical presentation and prognosis. The terminological and classification approaches to these diseases have been repeatedly changed, further complicating the already difficult diagnostic work with this category of patients. Even today, despite the existence of a generally accepted classification of ILD, the term “interstitial pneumonia” is associated by a doctor with a viral infection rather than with a disease that requires mandatory morphological verification and has a rather serious prognosis.

We recall the main definitions.

Pneumonia is a group of acute infectious (mainly bacterial) diseases characterized by focal lesions of the respiratory sections of the lungs with the obligatory presence of intraalveolar exudation. The category “pneumonia” excludes diseases caused by physical (radiation pneumonitis) or chemical (“gasoline” pneumonia) factors, as well as allergic (“eosinophilic pneumonia”) or vascular (pulmonary infarction due to PE) origin. Inflammatory processes in the lungs with measles, rubella, influenza, etc. are considered not under the heading "pneumonia", but within the framework of the corresponding nosological forms.

Pneumonitis (alveolitis) is an inflammatory process, often of an immune, non-infectious nature, affecting mainly the parenchymal interstitium (alveolar walls) and extra-alveolar connective tissue of the lungs without obligatory intra-alveolar exudation. A number of authors distinguish between the concepts of "pneumonitis" and "alveolitis", suggesting that with alveolitis the inflammatory process is localized mainly in the alveoli, and with pneumonitis inflammation also affects other structures of the lung parenchyma, however, such a division has no practical significance, and the terms are often used as synonyms.

The term "pneumonitis" reflects not a specific nosological form, but the features of the pathological process. Lung damage of the type of pneumonitis (alveolitis) can develop in a variety of diseases: idiopathic interstitial pneumonia, drug-induced lung lesions, systemic connective tissue diseases, hypersensitivity pneumonitis, sarcoidosis, etc. It should be noted that in each of these diseases, pneumonitis is mandatory, but far from not the only manifestation of lung damage. Causes, clinical manifestations, directions of treatment and prognosis for these diseases are different, therefore, when identifying signs of pneumonitis, morphological verification and further nosological diagnosis are of great importance.

From the modern point of view, ILD is a heterogeneous group of diseases, the common features of which are damage to the interstitial lung tissue in the form of productive pneumonitis, followed by the formation of fibrosis, progressive dyspnea on exertion, non-productive cough, crepitus, diffuse changes in X-ray and computed tomography of the lungs, restrictive ventilation disorders, decreased diffusion capacity of the lungs and progressive respiratory failure.

Currently, in most countries, including Russia, the ISL classification adopted by the Conciliation Commission of the American Thoracic Society and the European Respiratory Society (ATS / ERS, 2002) is used. According to this classification, four groups of ILDs are distinguished: ILD of known etiology, granulomatosis, idiopathic interstitial pneumonia, and other ILDs (Fig.).

Idiopathic interstitial pneumonias (IIPs) are typical representatives of the ILD group of unknown etiology, which have many similar clinical, radiological, and functional signs, but fundamentally different morphological patterns that determine the clinical features, response to therapy, and prognosis. The principle of constructing the clinicopathological classification of ATS/ERS is the correspondence of each clinical form of IIP to a certain histological variant of IIP (Table 1).

Clinical features of patients with various types of IIP are given in Table. 2.

Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is one of the most common IIP diseases. A synonym for IPF is "idiopathic fibrosing alveolitis" - a term traditionally used in our country.

The disease most often occurs in patients over the age of 50 years. The main complaints of patients are increasing shortness of breath and unproductive cough. The onset of the disease is usually imperceptible, the disease progresses rather slowly, patients have time to adapt to their shortness of breath and at the time of treatment have a history of the disease lasting up to 1-3 years. Fever and hemoptysis are not typical for patients with IFL. Other symptoms may be general weakness, arthralgia, myalgia, changes in the nail phalanges in the form of "drumsticks". A typical auscultatory phenomenon in IPF is inspiratory crepitus, which has been compared to "cellophane crackling". As the disease progresses, signs of respiratory failure and cor pulmonale appear, weight loss up to cachexia. Laboratory findings are nonspecific. IPF refers to restrictive pulmonary diseases, therefore, the characteristic functional features of the disease are a decrease in static lung volumes, detected by body plethysmography. One of the early signs of the disease is a decrease in DL CO. Spirometry FEV 1 /FVC is within normal limits or elevated.

The most common radiographic signs of IPF are bilateral reticular changes, more pronounced in the lower lung. In the early stages of the development of the disease, only a slight decrease in the volume of the lung fields and a decrease in the transparency of the lungs according to the "frosted glass" type can be observed. With the progression of the disease, the reticular pattern becomes coarser, heavy, rounded cystic lucencies appear, reflecting the formation of a “honeycomb lung”. To clarify the x-ray picture, it is advisable to conduct a multislice computed tomography of the chest organs.

Since the possibilities of diagnosing IIP are limited, and examination data are not always specific, the "gold" diagnostic standard for all IIP is a lung biopsy: open or thoracoscopic. A special need for performing a biopsy arises in cases where the clinical and / or radiological picture is not quite typical, the patient is less than 50 years old, there are systemic signs of the disease, and the disease is rapidly progressing. A necessary condition is the predominance of the benefits of making a correct diagnosis over the risk of surgical manipulation.

There is a diagnostic approach that makes it possible to establish the diagnosis of IPF with a high probability in cases where biopsy is not possible. This requires that the patient has four of the four major criteria and at least three of the four minor criteria.

Big Criteria

1. Exclusion of other ILDs due to known causes, such as drug-induced injury, TCTD, etc.
2. Changes in the function of external respiration, including restrictive changes and impaired gas exchange.
3. Bilateral reticular changes in the basal parts of the lungs with minimal ground glass changes according to high resolution computed tomography.
4. Transbronchial biopsy or bronchoalveolar lavage showed no evidence of an alternative diagnosis.

Small Criteria

1. Age over 50 years.
2. Imperceptible, gradual onset of dyspnea during exercise.
3. The duration of the disease is more than 3 months.
4. Inspiratory crepitus in the basal regions of the lungs.

Modern IPF therapy is based mainly on anti-inflammatory therapy (corticosteroids and cytostatics (CS)), i.e., drugs that can affect the inflammatory and immunological links in the development of the disease. The basis of this approach is the assumption that chronic inflammation precedes and inevitably leads to fibrosis and that aggressive suppression of inflammation can block the subsequent formation of fibrotic changes.

Three regimens of anti-inflammatory therapy are widely used: monotherapy with glucocorticosteroids (GCS), the combination of GCS with azathioprine, and the combination of GCS with Cyclophosphamide. ATS/ERS recommends combined modes as the preferred mode. Therapy is carried out for at least 6 months. Be sure to carefully monitor the side effects of therapy. When prescribing cytostatics, monitoring of patients should include a complete blood count weekly for the first month, then once every 2-4 weeks; Cyclophosphamide therapy requires weekly urinalysis for hematuria.

In the case of choosing GCS monotherapy, the initial daily dose of prednisolone is 1 mg / kg of ideal weight per day (up to a maximum of 80 mg / day). After 4 weeks, the tolerability of such therapy is assessed. If there was an improvement or stabilization of functional indicators, then over the next 3 months, the daily dose of prednisolone is reduced. If there is no response to steroids, azathioprine is added.

An alternative approach focused on reducing excess matrix deposition in the lungs or accelerating collagen breakdown is antifibrotic therapy. Antifibrotic drugs include D-penicillamine, colchicine, interferon gamma-1 b, pirfenidone.

An increase in the effectiveness of therapy has been proven when N-acetylcysteine ​​is added to anti-inflammatory drugs at a dose of 600 mg 3 times a day. Currently, leading experts in the treatment of IPF favor a regimen that includes prednisolone, azathioprine, and N-acetylcysteine.

In addition to drug therapy, as in other lung diseases, oxygen therapy is used in the development of hypoxemia. With the development of pulmonary hypertension, in addition to oxygen therapy, it is possible to use vasodilators. The development of infections of the tracheobronchial tree requires the use of antibacterial and antifungal drugs. Regular vaccination with influenza and pneumococcal vaccines is recommended for all patients with IPF.

Other idiopathic interstitial pneumonias (non-IPF)

Nonspecific interstitial pneumonia(NIP), along with IPF, is one of the most common forms of IIP. NIP can be idiopathic, it is this form that is included in the IIP group. However, the morphological picture corresponding to the NIP pattern also occurs with lung damage in patients with CTD, hypersensitivity pneumonitis, radiation pneumonitis, etc.

Clinical, laboratory and functional parameters in NIP are nonspecific. Chest x-ray most often reveals bilateral ground-glass changes and reticular changes in the lower lung.

The prognosis of patients with NIP is more favorable than with IPF. The clinical course and survival of patients depend on the severity of pulmonary fibrosis. The 10-year survival rate for NIP is about 35%. Spontaneous cases of recovery without treatment with NIP are unknown, GCS therapy without or with the addition of cytostatics leads to improvement or stabilization in approximately 75% of patients.

Cryptogenic organizing pneumonia

Synonyms for cryptogenic organizing pneumonia (COP) are the terms bronchiolitis obliterans with organizing pneumonia and proliferative bronchiolitis. COP has clear clinical and morphological differences from "isolated" obliterating bronchiolitis: along with the defeat of the bronchioles, the alveoli are involved in the inflammatory process with the presence of organized exudate in their lumen. COP in most cases is idiopathic, i.e. the cause remains unknown. Among the established causes, the most important are CTD (rheumatoid arthritis, etc.), complications of drug therapy (amiodarone, gold preparations, etc.).

The disease most often develops in people aged 50-60 years, men and women get sick equally often. COP is characterized by an acute or subacute course, the clinical picture often resembles bacterial pneumonia. The average duration of symptoms before diagnosis is 2-6 months. Routine laboratory tests reveal peripheral blood leukocytosis (50%), an increase in ESR and C-reactive protein (70-80%).

A typical radiological sign of COP is the presence of patchy, bilateral (rarely unilateral) dense foci of consolidation of subpleural localization. With COP, the migration of pulmonary infiltrates is described, most often from the lower to the upper sections. The differential diagnosis of COP, in addition to bacterial pneumonia, is carried out with chronic eosinophilic pneumonia, bronchoalveolar cancer and lung lymphoma.

Spontaneous improvement in COP has been described but is rare. The therapy of choice for COP is oral corticosteroids. Clinical improvement occurs within 1-3 days from the start of the first dose, radiological changes usually disappear after a few weeks, the total duration of GCS therapy is from 6 to 12 months. With a decrease in the dose of GCS, relapses of the disease occur quite often, in such a situation, the dose of steroids is again increased. The prognosis for COP is usually favorable, most patients are completely cured when taking corticosteroids. However, in rare cases, there is a poor response to steroids and a steadily progressive course of COP. In such patients, the use of cytostatics is recommended.

Desquamative interstitial pneumonia

Desquamative interstitial pneumonia (DIP) is a fairly rare IIP disease. More than 90% of all patients with DIP were smokers. In addition, rare cases of DIP associated with other conditions - CTD, reactions to drugs, exposure to environmental factors are described.

The clinical picture of the disease is typical for IIP. Laboratory, functional and radiological parameters in DIP do not provide additional information.

Lung biopsy is recommended to rule out more aggressive forms of ILD if the picture is questionable.

Smoking cessation is the first step in the treatment of DIP, as it has been shown to often reverse the disease. For most patients with DIP, the main treatment is prednisolone at a dose of 40-60 mg/day. The initial dose of prednisolone is usually prescribed for a period of 1-2 months, and then the dose of the drug is gradually reduced over 6-9 months. Against the background of corticosteroid therapy, clinical improvement or stabilization of the course of the disease is observed in approximately two-thirds of patients with DIP. The significance of cytostatics in this form of IIP is not yet clear. The 5- and 10-year survival rates for DIP are 95.2% and 69.6%, respectively.

Respiratory bronchiolitis associated with interstitial lung disease

Respiratory bronchiolitis associated with interstitial lung disease (RP-ILD) is a disease from the IIP group, in which respiratory bronchiolitis is combined with damage to the alveoli and pulmonary interstitium.

This disease occurs in smokers with a smoking history of more than 30 packs / years. The average age of patients ranges from 30 to 40 years. The clinical picture and laboratory and instrumental examination data are typical for IIL.

Often smoking cessation leads to complete resolution of the disease; in some cases, small doses of corticosteroids may be required. The prognosis for RB-ILD is more favorable than for IPF, but still, this disease in some cases can have a steadily progressive course and cause death in patients.

Lymphocytic interstitial pneumonia

Lymphocytic interstitial pneumonia (LIP) is one of the most rare IIP diseases. As the name implies, the disease is based on widespread homogeneous lymphocytic infiltration of the pulmonary interstitium. The morphological diagnosis of LIP is very difficult, since some diseases associated with massive lymphocytic infiltration of lung tissue have a similar histological picture: pseudolymphoma, primary lymphoma, lymphomatous granulomatosis, etc.

LIP occurs most often in women, usually between the ages of 40 and 60. Most patients with LIP are non-smokers. The onset of the disease is most often imperceptible, gradual. The X-ray picture of LIP is nonspecific.

The diagnosis of LIP in all cases requires an open lung biopsy. The basis of LIP therapy is corticosteroids. Doses and duration of therapy are approximately the same as for other cellular forms of IIP, such as DIP. Against the background of anti-inflammatory therapy, improvement or stabilization of the disease is noted in the majority of patients (about 80%), although a small group of them has a slow but steady progression of the disease. In addition to corticosteroids, in patients with LIP, attempts were made to treat with azathioprine, cyclophosphamide, methotrexate, and cyclosporine.

Acute interstitial pneumonia

The first mention of AIP dates back to 1935, when Hamman and Rich described four patients with rapidly progressive respiratory failure, leading to the death of patients within 6 months from the onset of the disease. Autopsy revealed severe widespread pulmonary fibrosis. For a long time, diseases with a chronic course (primarily IPF) were also called Hammen-Rich syndrome, but at present, only AIP can be attributed to Hammen-Rich syndrome.

In modern guidelines, AIP is considered as a disease characterized by progressive respiratory failure, leading in most cases to death. The clinical picture resembles acute respiratory distress syndrome (ARDS), however, in AIP, the cause of the disease is unknown and there is no involvement of other body systems in the process (multiple organ failure). Currently, about 150 cases of AIP have been described in the world literature, which is associated not so much with the rarity of the disease, but with the complexity of its diagnosis.

OIP is characterized by a very rapid increase in the symptoms of the disease. The period from the onset of the first symptoms to seeking medical help in most patients is no more than 3 weeks and very rarely exceeds 2 months. The disease can develop at any age and occurs equally often in men and women. The most common symptoms of AIP are non-productive cough and dyspnea, fever, myalgia, headache, and weakness. On examination, attention is drawn to tachypnea, tachycardia, cyanosis. On auscultation, crepitus is heard, less often - dry wheezing.

Functional tests are non-specific and reveal a pattern characteristic of other IIPs, however, a full-fledged functional study is not always possible. A characteristic sign of AIP is severe hypoxemia, often refractory to oxygen therapy, so most of the patients described in the literature required mechanical ventilation.

The X-ray picture in AIP reveals bilateral spotty reticulonodular shadows, extending to almost all lung fields, with the exception of the costophrenic sinuses, and dense infiltrates (consolidation). Typical findings of computed tomography of the lungs are areas of reduced transparency of the parenchyma of the "ground glass" type, dilatation of the bronchi and impaired pulmonary architectonics. Ground-glass changes most often have a patchy distribution ("geographic map").

For morphological verification of the diagnosis, it is possible to conduct an open or thoracoscopic lung biopsy. However, unfortunately, due to the extreme severity of patients with AIP, this diagnostic procedure is most often impossible. All morphological changes in AIP described in the literature are based on autopsy data or open lung biopsy performed during mechanical ventilation in patients.

The disease is characterized by a fulminant course, the prognosis is poor, the mortality rate in patients with AIP is extremely high and averages 70%. The differential diagnosis of AIP is most often made with bilateral bacterial pneumonia or ARDS. In ARDS, the cause is usually known (sepsis, trauma, shock, etc.); in addition, ARDS is most often one of the components of multiple organ failure.

There is currently no effective therapy for PIP. Mandatory components of AIP therapy are oxygen therapy and respiratory support.

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M. V. Vershinina,Candidate of Medical Sciences, Associate Professor

GBOU VPO OmGMA of the Ministry of Health and Social Development of Russia, Omsk