1, drug therapy:
glucocorticoid
Glucocorticoid can inhibit inflammation and immune process, which is effective for some patients and can improve symptoms and lung function, but it is ineffective for cases of extensive interstitial fibrosis. In addition, glucocorticoid is a double-edged sword in the treatment of interstitial lung disease, because long-term use of glucocorticoid will cause obvious adverse reactions.
Immune inhibitor
Azathioprine (Aza), cyclophosphamide (CTX), methotrexate (MTX) and cyclosporine A(CsA) are commonly used, which can inhibit the immune response and reduce the dosage of hormones. For patients with extensive interstitial fibrosis, there are still few convincing data to explain the effects of these drugs.
Oxidation inhibitor
N- acetylcysteine has antioxidant effect, which may delay the decline of lung function in patients with pulmonary fibrosis, but it needs further confirmation in clinical trials. Leukotriene receptor antagonists, endothelin receptor antagonists, proline homologues, etc. It has been found that it has anti-alveolitis and anti-fibrosis effects in vitro, but it needs further study if it is used in clinic.
Antifibrosis preparation
As a new anti-pulmonary fibrosis drug, pirfenidone and Nidani can delay the decline of lung function and reduce the times of acute exacerbation of pulmonary fibrosis to some extent, and have been applied in clinic.
Cytokine antagonist
At present, it is still in clinical trial treatment, and the effect is not ideal.
2, surgical treatment:
In the end-stage pulmonary fibrosis represented by idiopathic pulmonary fibrosis, lung transplantation has become the most effective treatment because there is no effective treatment drug at present. After lung transplantation, the quality of life of most patients with idiopathic pulmonary fibrosis has been improved, and the 5-year survival rate after transplantation is over 50%. For patients with idiopathic pulmonary fibrosis or other end-stage pulmonary fibrosis, lung transplantation can be evaluated in a qualified lung transplantation center, and lung transplantation can be considered as a treatment option. Indications of lung transplantation in patients with pulmonary fibrosis;
Chronic pulmonary fibrosis, lung function is seriously damaged (such as diffuse, that is, the diffusion of carbon monoxide in the lung is lower than 35% of the expected value; Forced vital capacity decreased within 6 months 10% or more, and pulmonary carbon monoxide diffusion decreased15%); The pulse oxygen saturation of 6-minute walking test is less than 88%; Chest high-resolution CT has a high fibrosis score.
Standardized medical care is invalid.
The estimated survival time is shorter than 2~3 years.
Can cooperate with rehabilitation training.
Good nutritional status and stable psychological quality.
3, Chinese medicine treatment:
Because there is no effective drug treatment in western medicine so far, the toxic and side effects of hormones and immunosuppressants limit its clinical application. The combination of traditional Chinese and western medicine provides a new medical approach for this worldwide refractory disease, but as far as the current domestic research situation is concerned, it is still in its infancy. Treatment should be based on nourishing lung and kidney, promoting blood circulation and removing blood stasis, detoxifying and resolving phlegm, and making treatment plans according to individual conditions.
4. Other treatments:
Oxygen therapy
indicate
Breathe indoor air at rest, with oxygen partial pressure (PAO 2)≤55 mmHg or oxygen saturation (SAO 2)≤88%.
PaO255~60mmHg or SaO2≤89%, accompanied by congestive heart failure, edema of lower limbs or hematocrit >: 55%.
In addition, if there is pulmonary hypertension, pulmonary heart disease and hypoxia at night, oxygen therapy should be carried out even if the blood oxygen is normal during the day.
Family oxygen therapy
Breathe oxygen at least 15 hours a day. Commonly used home oxygen therapy equipment is mainly oxygen generator and compressed oxygen cylinder, both of which have their own advantages and disadvantages. The oxygen generator is suitable for long-term use. Its disadvantages are limited oxygen flow, large volume and power demand, and it is not suitable for moving, especially when going out for activities. Oxygen cylinders provide a wide range of oxygen flow, which can meet the demand of oxygen inhalation. The disadvantage is that they need to be filled and replaced by the manufacturer.
Domestic oxygen inhalation devices are mainly nasal catheters, and masks are rarely used. Nasal catheter is cheap and comfortable, and can eat, talk and cough at the same time, but its oxygen concentration is affected by the depth and frequency of the patient's breathing, and the oxygen concentration provided is limited, which is wasted when the patient exhales. On this basis, the oxygen storage nasal catheter increases the oxygen storage space, which can store the oxygen between each breath of the patient, improve the oxygen concentration, reduce waste and save oxygen consumption. The same is true for mask oxygen inhalation, but it is generally less used for home oxygen therapy.
repair
Limb function exercise and respiratory function exercise include dumbbells, treadmills, rowing machines and other commonly used fitness equipment, as well as active and passive trainers for upper and lower limbs, inspiratory and expiratory resistance trainers and other medical equipment.
The rehabilitation treatment of patients with pulmonary interstitial diseases should be carried out by professional doctors, preferably under the supervision and guidance of medical staff, especially those who receive rehabilitation treatment for the first time.
Before receiving rehabilitation treatment, it is necessary to carefully evaluate the patient's cardiopulmonary function, including vital signs, electrocardiogram, color Doppler echocardiography, routine pulmonary function, arterial blood gas and cardiopulmonary exercise test. According to the results of cardiopulmonary exercise test, the target threshold and safety range of patients' exercise are determined, and the demand for oxygen therapy during exercise is understood, so as to make a personalized rehabilitation exercise plan for each patient, including exercise intensity and time, exercise equipment, oxygen flow and so on.
In the follow-up exercise training, it is necessary to continuously monitor the patients' cardiopulmonary function (mainly including electrocardiogram and pulse oxygen saturation) and give real-time feedback to adjust the exercise plan and oxygen flow. A rehabilitation treatment cycle is at least 8 weeks. After a cycle, reevaluate the cardiopulmonary function and then adjust the plan. In addition, rehabilitation treatment should not be carried out in the acute exacerbation period, and generally begins at least 1 week after the condition is relieved and stable.