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Fibroziruyushchy alveolitis

Epidemiology

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.

Classification

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

medicines

Features

Azathioprinum

In 1,5 — 24 months of reception

Bleomycinum

Dose> 450 mg

Busulfan

Dose> 600 mg

Hlorambutsil

Dose> 2 g

Cyclophosphamide

In several years after the beginning of reception

Melphalanum

In several years after the beginning of reception

Mitomitsin

In weeks, months after the beginning of reception

Vasoconstrictive medicines for topical administration (nasal sprays)

Years of the use

Amiodaronum

In several months after the beginning of reception> 400 mg/days

Carbamazepine

Months, years of the use

Kromoglitsiyevy acid

Aerosol, long use

Diphenyl

Months, years of reception

D-Penicillaminum

Reception during 2 — 3

Nitrofurans

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.

Differential diagnosis

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.

Complications and side effects of treatment

Side effects of GKS see. "Acute bronchiolitis. Complications and side effects of treatment".

Mistakes and unreasonable appointments

Use of Prednisolonum at an easy and medium-weight current can be followed by a process aggravation after its cancellation.

Forecast

The forecast in most cases a serious, fibroziruyushchy alveolitis can be complicated by a fluid lungs. Severe forms are characterized by the progressing current.

 
"Rinosinusit   Chronic respiratory insufficiency"