Management of the idiopathic interstitial pneumonias. May 15, 2007 histopathologic subsets of idiopathic interstitial pneumonia iip exhibit different prognoses 19. Overview of idiopathic interstitial pneumonias pulmonary. In a clinical trial of over 600 adults who were treated for 52 weeks, those given nintedanib had less decline in lung function than those given placebo. Original article from the new england journal of medicine a common muc5b promoter polymorphism and pulmonary fibrosis. Listing a study does not mean it has been evaluated by the u.
Idiopathic pulmonary fibrosis is characterized by radiographically evident interstitial infiltrates predominantly affecting the lung bases and by progressive dyspnea and worsening of pulmonary func. He also spends time on idiopathic interstitial pneumonia and idiopathic pulmonary fibrosis. Classified into 8 histologic subtypes, all are characterized by varying. Usual interstitial pneumonia uip is the prototype of pulmonary fibrosis with socalled temporal heterogeneity. Idiopathic pulmonary fibrosis a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, occurring primarily in older adults, and limited to the lungs. Muc5b promoter variant and rheumatoid arthritis with interstitial. Watch the video lecture usual interstitial pneumonia uip. Idiopathic interstitial pneumonia iip, or noninfectious pneumonia are a class of diffuse lung diseases. A useful mnemonic for the american thoracic societyeuropean respiratory society atsers classification of iips is all idiopathic chronic lung disease are nonspecifically patterned. Idiopathic interstitial pneumonias lung and airway. Interstitial lung disease is predominantly a disease of adults, although it also occurs in children. Some items in this lecture may have come from the lecturers personal academic files or. In patients with idiopathic pulmonary fibrosis, nintedanib reduced the decline in. The diagnostic approach to patients with interstitial lung disease is presented elsewhere.
Idiopathic pulmonary fibrosis is the most common of the idiopathic interstitial pneumonias. The diagnosis and management of interstitial lung diseases. The term acute interstitial pneumonia aip describes an idiopathic clinicopathological condition, characterized clinically by an interstitial lung disease causing rapid onset of respiratory. However, regular lung biopsy in interstitial lung diseases will be necessary to confirm diagnoses, recommend lifelong therapy, and further our understanding of the pathogenesis of idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis is the most common type of idiopathic interstitial pneumonia. Patients with usual interstitial pneumonia present with progressive dyspnea, cough, and restrictive pulmonary function abnormalities. Interstitial lung disease 10 interstitial lung disease is a term that broadly describes a diverse collection of more than 200 lung disorders. They are characterized by cellular infiltration of the interstitial compartment of the lung with varying degrees of inflammation and fibrosis. Efficacy and safety of nintedanib in idiopathic pulmonary. Idiopathic pulmonary fibrosis ipf is the most common of the iips, and data from existing registries suggest that ipf accounts for 1737% of all interstitial lung disease ild diagnoses 2, 3. It requires early recognition and intervention with supportive care and pharmacologic agents to fo. The idiopathic interstitial pneumonias are a subset of. Demystifying idiopathic interstitial pneumonia pulmonary. Little is known about the response to pulmonary vasodilator.
The diagnosis of idiopathic pulmonary fibrosis was confirmed by either the finding of usual interstitial pneumonia on surgical lung biopsy or findings on. What every radiologist should know about idiopathic. Usual interstitial pneumonia an overview sciencedirect topics. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. Certain interstitial diseases such as sarcoidosis, pulmonary langerhans cell histiocytosis, and autoimmuneassociated lung diseases, tend to develop in young adults, whereas idiopathic pulmonary fibrosis ipf. Clinical features, highresolution computed tomography hrct 1014, and surgical lung biopsy slb all play a role in establishing a diagnosis.
Murray and nadels textbook of respiratory medicine sixth edition, 2016. The elusive goal of therapy for usual interstitial pneumonia. Idiopathic pulmonary fibrosis, defined pathologically as usual interstitial pneumonia, is a fatal disease that occurs most commonly among. In additional, clinical features of each type of idiopathic interstitial pneumonia are discussed. Depending on the specific disease, other compartments of the lung.
The idiopathic interstitial pneumonias iips encompass a subcategory of interstitial lung diseases ilds that pose significant diagnostic and management challenges. This group of diseases includes autoimmune ild, hypersensitivity pneumonitis, and idiopathic nonspecific interstitial pneumonia. Cop often affects adults in midlife 40 to 60 years of age. Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. The diagnosis of idiopathic interstitial fibrosis requires the exclusion of such conditions. Pneumonias are often thought of as infections, but these diseases do not appear to result from infection. The classification of the idiopathic interstitial pneumonias iips has recently been updated by the ats and ers 1 table 6. Nintedanib plus sildenafil in patients with idiopathic pulmonary. Classified into 8 histologic subtypes, all are characterized by varying degrees of inflammation and fibrosis and all. This page includes the following topics and synonyms. Usual interstitial pneumonia may be associated with other conditions such as connective tissue disorders and asbestosis. Idiopathic interstitial pneumonia, idiopathic pulmonary fibrosis, usual interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis, rbild, acute interstitial pneumonia, hammanrich disease, nonspecific interstitial pneumonia.
Idiopathic pulmonary fibrosis is a devastating, agerelated lung disease of unknown cause that has few treatment options. Fda oks treatment for progressive interstitial lung diseases. Idiopathic interstitial pneumonia pubmed central pmc. These diseases are classified together because they all affect the tissue and space around the alveoli air sacs, called the interstitium. There is seven entities in iips 7 entities in iips idiopathic pulmonary fibrosis. Interstitial lung disease etiology known etiology unknown aka idiopathic unclassifiable autoimmune disease ra, ssc, sjogrens, iim environmental ild hypersensitivity pneumonitis occupational ild asbestosissilicosis druginduced ild amiomtxchemo smokingrelated desquamative interstitial pneumonia respiratory bronchiolitisild.
Revealing the secrets of idiopathic pulmonary fibrosis. Pulmonary hypertension ph is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias iip. Flaherty, andrei, king, et al diagnosing idiopathic interstitial pneumonia 1055 patients underwent a history, physical examination, complete pulmonary function testing, hrct, and slb. A useful mnemonic for the american thoracic societyeuropean respiratory society atsers classification of iips is. Japanese idiopathic interstitial pneumonias registry.
Knowledge achieved in recent years has resulted in the publication of the new classification of idiopathic interstitial pneumonias, according to which there are three groups. A prospective, doubleblind, randomized placebocontrolled trial of 27 patients with idiopathic interstitial pneumonia compared azathioprine sodium plus prednisone with prednisone alone and showed no statistically significant difference in lung function at 1 year or in survival, although a trend favored the azathioprine group. There are seven recognized distinct subtypes of iip. Usual interstitial pneumonia uip and idiopathic pulmonary fibrosis ipf symptoms and treatments idiopathic pulmonary fibrosis ipf belongs to a group of diseases whose specific cause is not well known, which keeps clinicians and researchers worried. Idiopathic interstitial pneumonias iips constitute a heterogeneous group of acute or chronic pulmonary diseases of unknown etiology, caused by lesion of the pulmonary parenchyma, resulting in varying degrees of inflammation and fibrosis in 2002, the american thoracic societyeuropean respiratory society atsers proposed the inclusion of seven entities in the iip categoryacute. Classified into 8 histologic subtypes, all are characterized by varying degrees of inflammation and fibrosis and all cause dyspnea. Idiopathic interstitial pneumonias iips are interstitial lung diseases of unknown etiology that share similar clinical and radiologic features and are distinguished primarily by the histopathologic patterns on lung biopsy. Therefore, an accurate diagnosis is critical to the management of patients with iip. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary.
Respiratory bronchiolitisassociated interstitial lung disease could now be diagnosed without the need for biopsy. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. The mnemonic reflects the frustration of trying to differentiate them on plain film. Healthy tissue is replaced by altered extracellular matrix and alveolar architecture is destroyed, which leads to decreased lung compliance, disrupted gas exchange, and ultimately respiratory failure and death. Japanese idiopathic interstitial pneumonias registry full. It is characterized by progressive worsening of dyspnea and lung function and is associated with a poor prognosis. The novelty of the new classification comes from the fact. Idiopathic interstitial pneumonia what is the effect of. The diagnosis and management of idiopathic interstitial pneumonia have challenged physicians since its initial description more than a century ago. Rosane duarte achcar md, in idiopathic pulmonary fibrosis, 2019. Idiopathic interstitial pneumonia what is the effect of a.
Interstitial lung disease european respiratory society. Potential causes see table causes of interstitial lung disease are assessed systematically. Nintedanib is an approved treatment for idiopathic pulmonary fibrosis ipf. Ipf idiopathic interstitial pneumonia, nsip nonspecific interstitial pneumonia, rbilddip respiratory bronchiolitis interstitial lung diseasedesquamative interstitial pneumonia. Uip is the most common pattern of idiopathic interstitial pneumonia a type of interstitial lung disease and usually represents idiopathic pulmonary fibrosis. Familial interstitial pneumonia is defined as two or more family members with an idiopathic interstitial pneumonia. Foci of fibroblastic activity and honeycomb change are hallmarks of the uip pattern. In over 40% of these families there is more than one type of fibrosis in affected members, suggesting a shared genetic susceptibility. Idiopathic pulmonary fibrosis is a prototype of chronic, progressive, and fibrotic lung disease. Acute management of interstitial lung disease author.
Although the disease has been considered rare, it occurs with similar frequency to that of stomach, brain, and testicular cancers. Idiopathic interstitial pneumonia mnemonic radiology. Signs and symptoms may include flulike symptoms such as cough, fever, malaise, fatigue and weight loss. Idiopathic interstitial pneumonias iips constitute a heterogeneous group of acute or chronic pulmonary diseases of unknown etiology, caused by lesion of the pulmonary parenchyma, resulting in varying degrees of inflammation and fibrosis. Much has changed in our understanding of idiopathic interstitial pneumonia during the past decade, most important being our appreciation of the clinical relevance of histopathology. Nov 23, 2015 idiopathic pulmonary fibrosis ipf is a chronic, progressive fibrosing lung disorder of unknown aetiology whose diagnosis involves the careful exclusion of secondary causes for pulmonary fibrosis and the presence of a pattern of usual interstitial pneumonia uip at either high. Introduction diffuse interstitial lung disease ild is a generic term encompassing a broad range of largely unrelated conditions that share the propensity to cause breathlessness andor cough associated with bilateral abnormal opacities of various types on conventional chest radiographs or computed tomographic ct scans algorithm 1. Mcnemar tests were subsequently used to test whether two probabilities of agreement conducted during. The most common idiopathic interstitial pneumonia is idiopathic pulmonary fibrosis ipf, a chronic, progressive, fibrotic interstitial lung disease. Aug 18, 2017 the classification of the idiopathic interstitial pneumonias iips has recently been updated by the ats and ers 1 table 6. Data collection a standard form was used to collect clinical information, including. Classification of idiopathic interstitial pneumonias. Interstitial lung diseases are a group of diffuse parenchymal lung disorders associated with substantial morbidity and mortality.
Acute exacerbations of iips were more well defined. Histopathologic subsets of idiopathic interstitial pneumonia iip exhibit different prognoses 19. A placebocontrolled trial of interferon gamma1b in. Pulmonary hypertension in idiopathic interstitial pneumonias. Idiopathic interstitial pneumonias radiology reference. In less than a decade, understanding of the pathogenesis and management of this disease. Idiopathic pulmonary fibrosis idiopathic pulmonary fibrosis appears to be increasing in incidence.
Aip is similar in presentation to the acute respiratory distress syndrome ards and probably. Idiopathic pulmonary fibrosis ipf is a chronic, progressive fibrosing lung disorder of unknown aetiology whose diagnosis involves the careful exclusion of secondary causes for pulmonary fibrosis and the presence of a pattern of usual interstitial pneumonia uip at either high. Jul 15, 2019 idiopathic pulmonary fibrosis ipf is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, primarily occurring in older adults, limited to the lungs, and associated with the histopathologic andor radiologic pattern of usual interstitial pneumonia uip. The general diagnostic approach to these disorders is discussed elsewhere in this textbook chapter 54, as is the diagnosis and management of idiopathic pulmonary fibrosis ipf. Japanese idiopathic interstitial pneumonias registry jips the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Usual interstitial pneumonia an overview sciencedirect. Interstitial lung disease ild, or diffuse parenchymal lung disease dpld, is a group of lung diseases affecting the interstitium the tissue and space around the alveoli air sacs of the lungs.
Idiopathic interstitial pneumonia should be suspected in any patient with unexplained interstitial lung disease. Aip is classified as an idiopathic interstitial pneumonia iip, and among the iips, it has the most acute onset and rapidly progressive course. Acute interstitial pneumonia aip is a rare and fulminant form of diffuse lung injury originally described by hamman and rich in 1935. The idiopathic interstitial pneumonias iips are diffuse interstitial lung diseases of unknown cause. Cryptogenic organizing pneumonia cop is a form of idiopathic interstitial pneumonia characterized by lung inflammation and scarring that obstructs the small airways and air sacs of the lungs alveoli. Idiopathic interstitial pneumonias are a subgroup of interstitial lung diseases of unknown etiology and are associated with variable radiologic features, response to therapy, and clinical course. Acute interstitial pneumonia, also commonly referred to as hammanrich syndrome, is a fulminant lung disease of unknown etiology occurring in previously healthy patients.
Idiopathic interstitial pneumonia, idiopathic pulmonary fibrosis, usual interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis, rbild, acute interstitial pneumonia, hammanrich. The elusive goal of therapy for usual interstitial pneumonia nejm. These diseases typically affect the pulmonary interstitium, although some also have a component affecting the airways for instance, cryptogenic organizing pneumonitis. Idiopathic pulmonary fibrosis ipf is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, primarily occurring in older adults, limited to the lungs, and associated with the histopathologic andor radiologic pattern of usual interstitial pneumonia uip. Temporal heterogeneity refers to the variegated appearance of the lung biopsy in uip, where areas of advanced fibrosis are seen adjacent to entirely normal lung, with interspersed areas of active fibroblastic proliferation known as fibroblastic foci. It may occur when an injury to the lungs triggers an abnormal healing. Clinicians, radiologists, and pathologists should exchange information to determine the diagnosis in individual patients. Rad idiopathic interstitial pneumonias iips idiopathic interstitial pnemonias iips published in 2002 diagnosed based on clinicalradiologicpathologic. It was recognized that idiopathic pulmonary fibrosis ipf can have a heterogeneous clinical course. Idiopathic interstitial pneumonias iips are diffuse interstitial lung diseases of unknown cause. Patients without an hrct scan or an slb were excluded.
The word idiopathic means of unknown cause, so when the cause of interstitial lung disease is not identified, idiopathic interstitial pneumonia is diagnosed. Usual interstitial pneumonia and chronic idiopathic. Should know about idiopathic interstitial pneumonias presented by. Pulmonary hypertension in patients with chronic fibrosing idiopathic interstitial pneumonias article pdf available in plos one 1012. Idiopathic pulmonary fibrosis, defined pathologically as usual interstitial pneumonia, is a fatal disease that occurs most commonly among persons who are 60 years of age or older and in otherwise g. Pdf pulmonary hypertension in patients with chronic. A common muc5b promoter polymorphism and pulmonary. Interstitial lung disease american thoracic society. Idiopathic interstitial pneumonia do community and academic physicians agree on diagnosis. There is progressive pulmonary fibrosis and the median survival is 35 years. A familial component is seen in at least 20% of cases of idiopathic pulmonary fibrosis. Idiopathic pneumonia syndrome ips is defined as an idiopathic syndrome of pneumopathy after hsct, with evidence of widespread alveolar injury and in which infectious etiologies and cardiac dysfunction, acute renal failure, or iatrogenic fluid overload have been excluded.
Usual interstitial pneumonia uip is a histologic pattern characterized by nonuniform, lower zone, subpleural, and paraseptal predominant lung injury defined by geographic heterogeneity and architectural distortion. Idiopathic interstitial pneumonias other than idiopathic. This disease was once thought to be a chronic inflammatory process, but current evidence indicates that the fibrotic response is driven by abnormally activated alveolar epithelial cells aecs. Atsers consensus statement, am j resp crit care med 161, 2000 2. Survival of patients with biopsyproven usual interstitial pneumonia and nonspecific interstitial pneumonia.
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