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BMC Med
2015[Sep]; 13
(?): 245
PMID26407727
show ga
BACKGROUND: Interstitial lung diseases (ILDs) are disorders of the lung
parenchyma. The pathogenesis, clinical manifestations, and prognosis of ILDs vary
depending on the underlying disease. The onset of most ILDs is insidious, but
they may also present subacutely or require hospitalization for management. ILDs
that may present subacutely include acute interstitial pneumonia, connective
tissue disease-associated ILDs, cryptogenic organizing pneumonia, acute
eosinophilic pneumonia, drug-induced ILDs, and acute exacerbation of idiopathic
pulmonary fibrosis. Prognosis and response to therapy depend on the type of
underlying ILD being managed. DISCUSSION: This opinion piece discusses approaches
to differentiating ILDs in the hospitalized patient, emphasizing the role of
bronchoscopy and surgical lung biopsy. We then consider pharmacologic treatments
and the use of mechanical ventilation in hospitalized patients with ILD. Finally,
lung transplantation and palliative care as treatment modalities are considered.
The diagnosis of ILD in hospitalized patients requires input from multiple
disciplines. The prognosis of ILDs presenting acutely vary depending on the
underlying ILD. Patients with advanced ILD or acute exacerbation of idiopathic
pulmonary fibrosis have poor outcomes. The mainstay treatment in these patients
is supportive care, and mechanical ventilation should only be used in these
patients as a bridge to lung transplantation.
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