What Is Interstitial Pulmonary Fibrosis?

Diffuse pulmonary interstitial fibrosis is an inflammatory disease of the interstitial lung caused by a variety of causes. The lesion mainly affects the interstitial lung, and can also involve alveolar epithelial cells and pulmonary blood vessels. The cause is either clear or unknown. The specific causes are aspiration of inorganic dust such as asbestos and coal; organic dust such as mold dust and cotton dust; gases such as soot and sulfur dioxide; viruses, bacteria, fungi, parasite infections; drug effects and radiation damage. The disease belongs to the categories of "cough", "asthmatic syndrome" and "pulmonary fistula" in traditional Chinese medicine.

Chinese name: Pulmonary interstitial fibrosis

Foreign name: monary interstitial fibrosis
Department: Respiratory Medicine

Causes and common diseases of pulmonary interstitial fibrosis :

1. Pulmonary interstitial fibrosis is mostly caused by viruses, mainly adenovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, measles virus, etc. Among them, interstitial pneumonia caused by adenoviruses and influenza viruses are more common and severe. Necrotizing bronchitis and bronchial pneumonia often form, and the prolonged course of disease tends to become chronic pneumonia.

2. After mycoplasma pneumoniae invades through the respiratory tract, it mainly invades the bronchioles and surrounding bronchial tissues. Since there is no destructive lesion, it can be completely recovered.

3. Allergic pneumonia is a non-asthmatic allergic lung disease caused by inhalation of dust containing fungal spores, bacterial products, animal proteins or organic matter. It is characterized by diffuse pulmonary interstitial disease and can be cured without leaving sequelae. . Relatively rare, such as complications of Streptococcus pneumoniae pneumonia, Staphylococcus aureus pneumonia, purulent inflammation spread to interstitial tissue, causing purulent interstitial pneumonia. If the inflammation continues to develop, lung abscesses, empyema, etc. may occur; if the lesions stop developing, they will turn to recovery, but pulmonary fibrosis may also form.

The pathogenesis of the disease is a disease process caused by the reaction of connective tissue production and secretion of various inflammatory factors to cause lung epithelial and endothelial cell damage, fibrotic cell proliferation, and inflammation.

Differential diagnosis of pulmonary interstitial fibrosis :

The main symptoms are: dyspnea, labor dyspnea and progressive aggravation, shallow breathing, nasal fan movement and auxiliary muscles can participate in breathing, but most of them do not sit breath. No cough in the early stage of cough and sputum, and there may be a dry cough or a small amount of mucus in the future. Prone to secondary infection, mucopurulent sputum or purulent sputum, occasionally blood sputum. Systemic symptoms may include weight loss, fatigue, loss of appetite, joint pain, etc., which are generally rare. Acute type can have fever.

Pulmonary interstitial fibrosis :

(1) Hematological examination:

Increased erythrocyte sedimentation and increased immunoglobulin have no discriminative significance. However, the examination of various immune indicators of collagen vascular disease is conducive to its diagnosis and differential diagnosis.

(B) Chest X-ray plain film:

Early patients can show a blur of double lower lung fields, such as increased ground-glass density and shadows, suggesting that the pathological basis of alveolar infiltrative lesions is a characteristic feature of alveolitis X-ray. As the course of the disease progressed, linear stripe-like textures appeared in the lung field, intricately like a fine mesh, called reticular shadows. In the later stage, thick lines and thick reticulate lines appear. When the alveoli are closed, the bronchioles are compensated to expand into a cystic shape, and when surrounded by a large amount of fibrous connective tissue, honeycomb lungs appear on the chest radiograph. Most have no mediastinal, hilar lymphadenopathy, and the pleura is not invaded, but pneumothorax often occurs due to ruptured bullae.

(3) High-resolution CT (HRCT):

Interstitial fibrosis in the lung with no abnormal manifestations can be found on the chest radiograph, and it is helpful to analyze the shape, distribution and severity of the lesions. HRCT showed irregular linear changes with small cystic airspace. When the patchy alveolar exudative fuzzy shadow appears, reflecting the activity of inflammatory lesions, interlobular thickening of the pleura is also a common sign.

(IV) Lung function test:

General routine ventilatory function tests can be found about restrictive ventilatory dysfunction, and some airway obstructions are very helpful in distinguishing from airway obstructive diseases. Pulmonary interstitial fibrosis is characterized by restricted ventilation disorder.

Pulmonary interstitial fibrosis treatment principles:

Most of the early stage is coexisting of alveolitis and partial fibrosis, and its alveolitis is completely reversible. The repair process of the alveoli invaded by inflammation is the process of absorption and fibrosis. Whether it restores normal lung tissue or fibrosis depends on whether the necrotic tissue fragments can be completely absorbed. If not, it will be replaced by fibrous tissue. Therefore, standardized treatment should be carried out as soon as possible after lung damage occurs, so as to avoid more irreversible fibrotic tissues and causing damage to lung function.

Interstitial Fibrosis Treatment

Treating pulmonary interstitial fibrosis is just as much engineering as treating other difficult diseases. The purpose of treatment: fight for reversible parts and time, control the development of the disease, improve symptoms, and improve quality of life. Clinically the most common are alveolitis and interstitial fibrosis associated with autoimmune diseases. It can occur before autoimmune disease, or it can appear years after the onset of autoimmune disease. It is often treated early as a lung infection.

It is worth noting that when pulmonary fibrosis is diagnosed, people suspect its reversibility and often give up treatment efforts. In fact, most of the early stage is coexisting of alveolitis and partial fibrosis, and its alveolitis can be completely reversed. The repair process of the alveoli invaded by inflammation is the process of absorption and fibrosis. Whether it restores normal lung tissue or fibrosis depends on whether the necrotic tissue fragments can be completely absorbed. If not, it will be replaced by fibrous tissue. Therefore, standardized treatment should be carried out as soon as possible after lung damage occurs, so as to avoid more irreversible fibrotic tissues and causing damage to lung function. This is equally important for doctors and patients.

Hormone treatment: prednisone 30-40 mg, orally divided into 2-3 times, and gradually reduced to a maintenance amount, 5-lO mg, once a day.

Treatment of complications: anti-infective treatment, antibiotics are selected according to the pathogen.

Bronchodilators: aminophylline, Shuchuanling, etc.

oxygen therapy: suitable for advanced patients.

Pulmonary interstitial fibrosis prevention and nursing

1. Pay attention to avoiding cold and keeping warm to prevent cold and cold.

2. Avoid contact with well-known foreign bodies.

3. Pay attention to diet and nutrition.

4 Ginseng, Toad, Chuanbei powder, safflower, Cordyceps sinensis, research powder human capsules, take appropriate amount, or eat 2-3 walnut kernels daily. We can see that the thoracic breathing movement is weakened, and the two lungs can hear fine rales or twisting sounds. There are different degrees of cyanosis and clubbing fingers. Later signs of right heart failure may appear.

Causes of pulmonary interstitial fibrosis

Environmental factors: Inhalation of inorganic dust such as asbestos and coal; organic dust such as mold dust and cotton dust; and inhalation of toxic gases such as smoke and sulfur dioxide.

Repeated infections caused by viruses, bacteria, fungi, parasites, etc., are often the cause of acute outbreaks of this disease, and they are conditions that make them worse.

Drug effects and radiation damage.

Secondary to autoimmune diseases such as lupus erythematosus.

Pulmonary interstitial fibrosis pathology

Complex pathogenic factors stimulate various cytokines, histamines, proteases, oxidants, etc. to form immune complexes and alveolar macrophages, neutrophils, lymphocytes and fibroblasts collectively accumulate in the interstitial lung and form the interpulmonary Stromal inflammation causes pulmonary interstitial fibroblasts and excess collagen to be deposited, resulting in scarring and destruction of lung tissue, which eventually results in pulmonary interstitial fibrosis. The disease is chronically progressive and exacerbated, which is a difficult and serious disease in the pulmonary system. The cause of pulmonary hypertension in the late stages is different from hypertension. It is generally believed that the cause of pulmonary hypertension is pulmonary arteriolar spasm, but from the clinical manifestations of the patient, it should be caused by pulmonary capillary passage obstacles. The total area of the alveolar area of a normal person is about 100 square meters, about the size of a tennis court, and it is responsible for the exchange of oxygen and carbon dioxide throughout the body. Its ability to pass with the capillaries of other tissues and organs throughout the body should be balanced. Whether it is alveolitis or fibrosis, this diffuse damage reduces the permeability of the capillaries of the alveoli, and the blood pumped from the right ventricle cannot smoothly pass through the alveoli to complete gas exchange, breaking the balance of small and large circulation blood volume , Resulting in increased pulmonary artery pressure, which can develop into right ventricular failure in severe cases.

Symptoms of pulmonary interstitial fibrosis

About 15% of IPF cases are acute, often due to upper respiratory tract infections, and progressive dyspnea worsens, dying from respiratory failure within 6 months. The vast majority of IPFs are chronic (there may be intermediate subacute types). Although called chronic, the average survival time is only 3.2 years. The chronic type does not appear to have evolved from the acute type, and the exact relationship is unknown.

Common signs: dyspnea and cyanosis. Dilatation of thorax and reduction of diaphragm activity. Velcro rales in the lower and middle lungs have certain characteristics. clubbing fingers and toes. Corresponding signs of end-stage respiratory failure and right heart failure.

Characteristics of pulmonary interstitial fibrosis

Pulmonary interstitial fibrosis is the most common form of IIP (accounting for about 65%). It is more common in adults over 50 years of age. About two-thirds of patients are older than 60 years, and more men than women. The clinical manifestations are dry cough, dyspnea, etc. Most patients can hear inspiratory popping sounds, most obvious at the bottom of both lungs, and more than a third of patients can see clubbing fingers. Pulmonary dysfunction is mainly moderate to severe restrictive ventilation dysfunction and / or diffuse dysfunction. Laboratory tests are not characteristic, and serum antinuclear antibodies (ANA) and rheumatoid factor (RF) are positive in 10% to 25% of patients.

Pulmonary interstitial fibrosis

Most pneumonia is not contagious. Streptococcus pneumoniae is the most common bacterial infection in adults. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, and other Gram-negative bacilli. These pathogens may be transmitted through contact between people, or through contact between people and things, but even if they are infected, as long as their autoimmunity is sound, they will not get pneumonia. Often, when the body's resistance decreases, pathogens will multiply and cause illness.

Pulmonary interstitial fibrosis

1, to ensure adequate rest, but also to keep warm, avoid cold, prevent various infections. Pay attention to climate change, especially in the winter and spring seasons, when the temperature changes drastically, add and remove clothing in time to avoid exacerbating the illness after the cold.

2. Have a comfortable living environment. The room should be quiet, clean and hygienic. The air should be fresh, moist, and circulating. Avoid irritating factors with strong smells such as smoke, perfume, and air fresheners. Also avoid inhaling air that is too cold, dry, or humid.

3. In terms of diet, the diet should be light and easy to digest, mainly liquid or semi-liquid, eat more fruits and vegetables, drink plenty of water, and avoid eating pungent, sour, hemp, spicy, fried food and eggs, fish, shrimp And other foods that can easily induce asthma. Do not eat irritating food. In general, the characteristics of the diet should be: the diet must be diversified, properly matched, nutritious, proportionate, and suitable for digestion and absorption.

4. Keep a happy and optimistic mood mentally to prevent mental stimulation and mental stress. This requires you to have an open and cheerful attitude towards life, that is, to maintain a happy spirit, you must cultivate the "satisfaction and constant joy" of thinking, but the excessive pursuit of fame and enjoyment must be experienced "more than less than more than" It makes sense to feel life and psychological satisfaction. Keep your spirits up and enjoy your daily routine.

5. Keep away from exogenous allergens, such as: some flowers and plants (especially those who are allergic to pollen), bedding, pillows, birds, animals (pets or experimental breeders) filled with allergic items such as feathers or old cotton wool, Wood (sequoia dust, cork processing), sucrose processing, mushroom farming, cheese, wine processing, moldy straw exposure, water sources (hot water pipes, air conditioners, humidifiers, saunas) and agricultural pesticides or herbicides.

Pulmonary interstitial fibrosisMood conditioning

Let the people around you know: When you feel uncomfortable, there is a limit to what you can do.

Don't set yourself too high a goal.

Be good at seeking and accepting the help of others when encountering difficulties. If you tell people your needs, people will be happy to help you.

Be good at relief when you encounter unpleasant things, such as laughing, listening to music, etc.

Treat yourself kindly, know how to enjoy a happy life, and reward yourself for your achievements from time to time.

You can maintain your brain's nerve balance by changing your eating habits, because a healthy and nutritious diet can help your brain function properly. Pay attention to a balanced diet, eat more foods rich in protein and vitamins, and eat less and eat more.

Don't use alcohol to sorrow. Borrowing sorrow can help you temporarily relax, but it also inhibits the central nervous system, thereby increasing depression, and it will make people lose their sense of handling things, and only make things worse.

Get enough sleep.

Choose your favorite exercise, and be careful not to over-exercise. The purpose of exercise is to enhance confidence, not to exhaust yourself. Forming the habit of exercise will give more thought to positive things, rather than indulging in unhelpful pessimism.

Pulmonary interstitial fibrosis

Hematological examination: Erythrocyte sedimentation rate is increased, immunoglobulin is increased, there is no distinguishing significance. However, the examination of various immune indicators of collagen vascular disease is conducive to its diagnosis and differential diagnosis.

Chest X-ray plain film changes Early IPF patients can show blurring of the two lower lung fields, such as increased ground-glass density, and shadows, suggesting the pathological basis of alveolar infiltrating lesions, which is a characteristic feature of alveolitis X-ray. As the course of the disease progressed, linear stripe-like textures appeared in the lung field, intricately like a fine mesh, called reticular shadows. In the later stage, thick lines and thick reticulate lines appear. When the alveoli are closed, the bronchioles are compensated to expand into a cystic shape, and when surrounded by a large amount of fibrous connective tissue, honeycomb lungs appear on the chest radiograph.

Most have no mediastinal, hilar lymphadenopathy, and the pleura is not invaded, but pneumothorax often occurs due to ruptured bullae.

Chest CT Because CT does not overlap in tissue structure and has high resolution, CT has also been used in the diagnosis of IPF in recent years, especially high-resolution CT (HRCT), which has significantly better results than chest radiography and conventional CT. Interstitial fibrosis in the lung without abnormal findings was found on the chest radiograph, and it was helpful to analyze the morphology, distribution and severity of the lesions. HRCT should be done with selective scanning, generally 3 levels, that is, aortic arch level, tracheal bifurcation, and 1 cm above the diaphragm, which can represent the lesions in the 3 lung fields to reduce the radiation dose. HRCT showed irregular linear changes with small cystic airspace. When the patchy alveolar exudative fuzzy shadow appears, reflecting the activity of inflammatory lesions, interlobular thickening of the pleura is also a common sign of IPF. Because CT can clearly show the mediastinum and pleura, it can provide a basis for differential diagnosis with some interstitial diseases that are easy to invade. CT can see small, medium and nodular nodules, and sometimes large, high-density lesions, which can be seen with twisted or expanded bronchial images containing gas. Honeycomb lungs appear late. Localized emphysema can be seen near large areas of fibrosis, manifested by increased local air content and sparse pulmonary vascular shadow. The pleura is thickened irregularly, especially in the lower and middle lungs.

Pulmonary function test General routine ventilation function test can find relevant restrictive ventilation dysfunction, and some airway obstruction, which is helpful in distinguishing from airway obstructive disease. IPF pulmonary function tests are characterized by restricted ventilation disorders.

Causes of pulmonary interstitial fibrosis

Pulmonary interstitial fibrosis is mostly caused by viruses, mainly adenovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, measles virus and so on. Among them, interstitial pneumonia caused by adenoviruses and influenza viruses are more common and severe. Necrotizing bronchitis and bronchial pneumonia often form, and the prolonged course of disease tends to become chronic pneumonia.

Mycoplasma pneumoniae can also cause pulmonary interstitial fibrosis. After mycoplasma invades through the respiratory tract, it mainly invades the bronchioles and the tissues around the bronchi. Since there is no destructive lesion, it can completely recover.

Allergic pneumonia is a non-asthmatic allergic lung disease caused by inhalation of dust containing fungal spores, bacterial products, animal proteins or organic matter. It is characterized by diffuse pulmonary interstitial disease and can be cured without leaving sequelae. Relatively rare, such as complications of Streptococcus pneumoniae pneumonia, Staphylococcus aureus pneumonia, purulent inflammation spread to interstitial tissue, causing purulent interstitial pneumonia. If the inflammation continues to develop, lung abscesses, empyema, etc. may occur; if the lesions stop developing, they will turn to recovery, but pulmonary fibrosis may also form.