Respiratory bronchiolitis interstitial lung disease
Introduction
Introduction to respiratory bronchiolitis interstitial lung disease Respiratory bronchiolitis-associated interstitial ungdisease (RBILD) was recognized in the early 1980s. The patients were either smokers or former smokers. It was originally thought to be a disease similar to desquamative interstitia lpneumonia (DIP) in pathology; however, it is now believed that RBILD and DIP are the manifestations of different severity of smoking in small airways and lung parenchymal lesions, ie the same Two different outcomes of the disease; even advocate the replacement of DIP with RBILD. This opinion is still inconsistent. basic knowledge The proportion of illness: 0.3% - 0.5% Susceptible people: good for people aged 30 to 40 Mode of infection: non-infectious Complications: respiratory failure
Cause
Causes of respiratory bronchiolitis interstitial lung disease
(1) Causes of the disease
RBILD is mainly found in large numbers of people who smoke, exposure to environmental and industrial pollutants, and may be non-specific cellular responses to inhaled stimuli.
(two) pathogenesis
There are many macrophage infiltration in the respiratory bronchioles of RBILD patients. This change is patchy at low magnification, distributed around the bronchioles, and macrophage infiltration in adjacent alveoli. The macrophage cytoplasm Rich, containing fine-grained, yellow-brown pigment from complex phagolysosomes, and most of them are mononuclear, while lymphocytes and tissue cells are scattered around the submucosa and bronchioles, and bronchioles are also seen. Mild fibrosis, and extended to the adjacent alveolar septum, distributed in a star shape, the latter often covered with proliferating type II cells and columnar bronchiole epithelium, airway epithelial abnormalities, goblet cell hyperplasia, columnar epithelial metaplasia often extended By the alveolar septum and around the alveolar sac, the bronchioles may expand due to mucus accumulation. The lung parenchyma away from the airway is usually normal and may be slightly over-expanded, but these pathological changes are often so light that they may be neglected during routine examinations. The pathological section helps to detect abnormal changes, and smoking cessation is important to reduce pathological damage. Compared with typical DIP, RBILD has more macrophages. Filled with bronchioles and alveolar spaces, showing patchy aggregates; RBILD tissue fibrosis is milder than DIP and is limited to the periphery of bronchioles, even absent, no lung tissue changes, due to the accumulation of macrophages, sometimes RBLID is easy to Pulmonary hemorrhagic syndrome is confused, and negative iron staining contributes to the diagnosis of RBILD.
Prevention
Respiratory bronchiolitis for prevention of interstitial lung disease
Smoking patients should quit smoking immediately, which is conducive to the recovery of the disease. Stopping smoking is critical for patients with RBILD, and the clinical signs and lung function of patients after smoking cessation will improve. Glucocorticoid therapy is effective. Avoid using unnecessary cytotoxic drugs as much as possible. Approximately 22% of patients have partial or complete remission without any treatment. Due to the symptoms of dyspnea and shortness of breath caused by this disease, the high-risk group for this disease should take the family as the unit, take the health care function as the community, and carry out regular health education and health consultation.
Complication
Respiratory bronchiolitis interstitial lung disease complications Complications, respiratory failure
Pulmonary infection is a common complication, can induce respiratory failure, and even lead to death, should be actively treated, hypoxemia is common, there may be no obvious incentives, such as PaO2 <7.33kPa (55mmHg), Home oxygen therapy should be performed. In the late stage of pulmonary heart disease with right heart failure, according to cardiac insufficiency treatment, pneumothorax may occur repeatedly for pleural adhesions.
Symptom
Respiratory bronchiolitis, interstitial lung disease symptoms Common symptoms Fatigue dry cough, exhalation difficulty, mucous gland hypertrophy, shortness of breath, chest pain, small bronchial mucosa, edema, pulmonary fibrosis, hemoptysis, respiratory failure
All RBILD patients are smokers, the age of onset is usually 30 to 40 years old, the onset is concealed, children are not seen, most patients are asymptomatic or only mild symptoms, including mild cough and shortness of breath, but also severe urgency, activity Cases of hypoxemia and hemoptysis have been reported, so severe impairment of lung function cannot be used as a basis for the diagnosis of RBILD. The bottom of the lungs can be heard and the end of inspiratory bursts, and the clubbing is rare.
Examine
Examination of respiratory bronchiolitis with interstitial lung disease
Routine laboratory tests are non-specific, and the total number of white blood cells in bronchoalveolar lavage fluid may increase, but the cell classification is similar to that of a normal smoker or a smoker with IPF.
1. X-ray films of patients with chest X-ray film more than 2/3 showed infiltration of reticular shadow or reticular nodules, but the lung volume was normal, and a few patients had normal chest radiographs.
2. Chest CT high-resolution chest CT (HRCT) showed diffuse or patchy ground-glass changes, mainly seen in the lower lung; also showed atelectasis, interstitial or interlobular interstitial thickening, emphysema and Peripheral lung bullae.
3. Pulmonary function is often limited or mixed ventilatory dysfunction and mild decrease in diffuse volume. Occasionally, normal lung function, increased lung volume suggests gas trapping in the blocked bronchioles, may exist at rest or activity Mild hypoxemia.
Diagnosis
Diagnosis and diagnosis of respiratory bronchiolitis with interstitial lung disease
According to the patient's large smoking history, clinical symptoms and signs, imaging examination of suspected diagnosis of RBILD, the diagnosis of lung biopsy pathology is still required.
Sometimes RBLID is easily confused with pulmonary hemorrhagic syndrome, and negative iron staining contributes to the diagnosis of RBILD.
