Epidemiological researches on studying of prevalence of a fibroziruyushchy alveolitis were not conducted. Medicinal damage of lungs occurs at 5 — 10% of the patients receiving cytostatic therapy and Amiodaronum.
Carry to risk factors of development of the fibroziruyushchy alveolitis caused by use of Amiodaronum and cytostatic medicines: • advanced age; • chronic diseases of a respiratory organs (chronic obstructive pulmonary disease); • oxygen therapy. Besides, the risk of development of SP against reception of cytostatic medicines increases in case of carrying out: • the previous radiation therapy; • the combined chemotherapy.
On a current allocate an acute, subacute and chronic current of a fibroziruyushchy alveolitis, the caused medicine.
Etiology and pathogeny of a disease
In a pathogeny intersticial lekarstvenno caused by a fibroziruyushchy alveolitis a part is played by immune responses, direct toxic impact on a lung and free radical processes, medicines or their metabolites damage an endothelium, epithelial structures, a pulmonary interstitium.
Medicines which most often lead to development of a fibroziruyushchy alveolitis
In 1,5 — 24 months of reception
Dose> 450 mg
Dose> 600 mg
Dose> 2 g
In several years after the beginning of reception
In several years after the beginning of reception
In weeks, months after the beginning of reception
Vasoconstrictive medicines for topical administration (nasal sprays)
Years of the use
In several months after the beginning of reception> 400 mg/days
Months, years of the use
Aerosol, long use
Months, years of reception
Reception during 2 — 3
In 6 months — 7 years of reception in a dose of 25 — 50 mg/days
Cytotoxic reactions induce an inflammation that is characterized by accumulation of the macrophages, lymphocytes and other immunocompetent cells including possessing fibrogenny activity. As a result in lungs pathological types of collagen collect, the sclerosis develops, there is a remodeling (reorganization) of pulmonary fabric.
Clinical signs and symptoms of an illness
At an acute current condition of patients heavy. Are characteristic: • the expressed asthma; • cough; • pneumorrhagia; • fever. At a subacute form the beginning of a disease erased however quickly enough accrues respiratory insufficiency. The chronic form of a fibroziruyushchy alveolitis meets most often. As a rule, an asthma is not expressed, unproductive cough is noted, fever is absent. Clinical manifestations of the fibroziruyushchy alveolitis caused by use of Amiodaronum: • asthma; • unproductive cough. Are less often observed: • fervescence; • weakness; • decrease in body weight; • thorax pain. This form of a fibroziruyushchy alveolitis is usually combined with the following clinical symptoms: • gray-blue coloring of integuments; • photodermatitis; • hyper - or a hypothyroidism; • defeat of a cornea; • dyspepsia; • peripheral neuropathy; • extrapyramidal symptoms; • abnormal liver functions; • hemopoiesis oppression; • bradycardia. At the patients accepting Amiodaronum the risk of development of a respiratory disstress-syndrome when carrying out thoracic surgeries increases, a pulmonary angiography.
The diagnosis and the recommended clinical trials
Beam methods of research
The most informative noninvasive diagnostic method of a fibroziruyushchy alveolitis is KT. Changes in lungs have asymmetric character; prevail in upper shares. The diffusion infiltration, a symptom of "opaque glass", sclerosis sites come to light. Research of function of external respiration Disturbances on restrictive type come to light. Morphological verification of the diagnosis The transbronchial or transthoracic biopsy of a lung is applied. At research of a bioptat reveal the following changes: • damage of alveoluses; • inflammatory infiltration; • pulmonary fibrosis; • the alveolar macrophages containing fatty inclusions (at the fibroziruyushchy alveolitis caused by Amiodaronum). Maintaining the patients accepting Amiodaronum provides regular (in 3 — 6 months) the inspection including: • research of function of external respiration; • analysis of gas composition of blood (diffusion of gases); • X-ray inspection or KT of lungs.
The differential diagnosis with the disseminated processes in easy for not medicinal etiology (tuberculosis, a tumor, intersticial pulmonary diseases) is carried out.
General principles of treatment
Easy and medium-weight current There is enough medicine cancellation. Heavy current Glucocorticoids for system use are appointed: Prednisolonum in 1 mg/kg + Prednisolonum 300 in/in mg/days before stopping of symptoms After achievement of clinical effect: Prednisolonum inside 1mg/kg with a dose decline on 5 mg/week before full cancellation At the remaining radiological changes perhaps more prolonged use of Prednisolonum, up to constant: Prednisolonum in 15 mg/days
Assessment of efficiency of treatment
Criterion of efficiency of treatment is positive clinicoradiological dynamics. Considering a long elimination half-life of Amiodaronum (to 45 — 60 days), even timely cancellation of this medicine allows to stop its side effects not at once.