Interstitial lung disease associated with respiratory bronchioles

　　The main pathological manifestations of interstitial lung disease (ILD) associated with respiratory bronchioles are inflammatory changes involving membranous and respiratory bronchioles. Macrophages with brownish pigment deposition are characteristic and may be related to viral infection; bronchioles can dilate due to mucus accumulation, with slightly thickened walls, and it is often seen that the bronchiolar epithelium extends into adjacent alveoli; this may be related to chronic infection or allergy and chronic irritation; in patients with明显 obstructive emphysema, it may be related to smoking, poisoning, or atmospheric pollution reactions, etc.

　　Common complications of interstitial lung disease (ILD) associated with respiratory bronchioles are pulmonary infections, which can induce respiratory failure and even death, and should be treated actively. Hypoxemia is common, and it may exist in the absence of obvious causes, such as PaO2 < 7.33 kPa (55 mmHg), home oxygen therapy should be performed. In the late stage, when pulmonary heart disease and right heart failure occur, treatment for heart failure should be given. Recurrent pneumothorax can be treated with pleural adhesion surgery.

　　The typical clinical manifestations of interstitial lung disease (ILD) associated with respiratory bronchioles include progressive exertional dyspnea, dry cough, inspiratory crackles or moist rales in the lower lungs, and clubbing. Chest X-rays show diffuse reticular shadows in both lungs. Ultimately, it can lead to severe pulmonary fibrosis (cystic lung) and respiratory failure. The specific clinical manifestations are described as follows.

　　1. Dyspnea

　　Dyspnea is the most common initial symptom, often concealed, starting during moderate to vigorous activity, gradually worsening, often accompanied by shallow rapid breathing. Many patients have a marked sense of fatigue. Most ILD patients have a cough, mainly dry cough. Some cases have a small amount of white sputum or frothy sputum. Chest pain is rare, and some patients with nodular disease report a hidden pain behind the sternum, which can also be seen in patients with ILD and pleural lesions. Wheezing is rare, mainly seen in patients with extrinsic allergic alveolitis or eosinophilic pneumonia. Hemoptysis is also rare, mainly seen in diffuse alveolar hemorrhage syndrome, pulmonary vascular lesions, and pulmonary malignant lesions.

　　2. Increased respiratory rate

　　Increased respiratory rate is often the earliest manifestation of ILD. Many patients show a significant increase in respiratory rate (>24 times/min) after slight activity. Bilateral lower lung crepitations or wet rales are more pronounced at the end of inspiration or appear, especially in idiopathic pulmonary fibrosis cases. However, certain diseases (such as sarcoidosis) may have few wet rales or crepitations. Clubbing (of fingers or toes) is mainly seen in patients with idiopathic pulmonary fibrosis and ILD caused by lung cancer. In ILD caused by other reasons, clubbing (of fingers or toes) is not common.

　　When collecting clinical history, attention should be paid to detailed inquiries about past history of occupation, hobbies, medication, etc. Some cases may have been exposed to chemicals or minerals 10 or more years ago and may develop into ILD. The progression of the disease is also very important. For example, idiopathic pulmonary fibrosis can show obvious fibrosis within a few weeks; while common interstitial pneumonia often has obvious fibrosis after several years.

　　The occurrence of interstitial lung diseases related to respiratory bronchioles is related to viral infections, and those with relatively obvious obstructive emphysema may be related to smoking, poisoning, or atmospheric pollution. Therefore, the prevention of this disease should be targeted at the cause. The specific preventive measures are described as follows.

　　1. Pay attention to keeping warm and preventing colds. Pay attention to rest and gradually increase the amount of activity, reduce and avoid strenuous exercise, and avoid overfatigue.

　　2. Quitting smoking is very important for the prevention of this disease.

　　3. Avoid long-term contact with strongly irritating gases, such as chlorine, ammonia, carbon dioxide, formaldehyde, and various acid mists, radioactive substances, etc.

　　4. Keep the indoor air fresh, maintain a temperature of 20℃～24℃, and keep the humidity between 50％～65％. Ventilate twice a day, each time for about 15～30min, and avoid odor stimulation.

　　Routine laboratory tests for interstitial lung diseases related to respiratory bronchioles are not helpful. Chest X-rays, high-resolution CT, pulmonary function tests, and arterial blood gas analysis are helpful for the examination of this disease, and the specific examination methods are described as follows.

　　1. Chest X-rays show diffuse fine reticular shadows, or (rarely) nodular interstitial shadows, usually with normal lung volume. Other characteristics include thickened bronchial walls, prominent bronchovascular spaces, small regular or irregular shadows, and small peripheral annular shadows.

　　2. High-resolution CT (HRCT) scans often show hazy shadows.

　　3. Pulmonary function tests are often obstructive and restrictive mixed ventilation disorders.

　　4. There may be a single increase in residual air volume, with arterial blood gas showing mild hypoxemia.

　　Patients with interstitial lung diseases related to respiratory bronchioles should consume foods that enhance immunity, reduce inflammation, and have diuretic effects. It is禁忌 to eat spicy foods; it is also禁忌 to eat irritant foods; and it is also禁忌 to eat foods that are too bitter. The specific dietary precautions are as follows.

　　1. Avoid smoking

　　The harmful substances in cigarettes can directly stimulate the respiratory tract. Cigarettes are not only an important cause of chronic bronchitis in smokers themselves, but the smoke can also harm the health of the respiratory tract of people around them. Therefore, patients should completely refrain from smoking.

　　2. Avoid cold and cool foods

　　The disease has a long course, and most patients have insufficient Yang in the spleen, lung, and kidney, and have a strong reaction to cold and cool foods. Overeating cold and cool foods can cause tracheal spasm, which is not conducive to the excretion of secretions, thus exacerbating coughing and asthma, making it difficult to cough out phlegm. In addition, cold and cool foods damage the Yang of the spleen and stomach, and when the spleen and stomach are cold, the transformation and transportation are impaired, leading to the formation of phlegm turbidity inside, blocking the airway, and exacerbating asthma and coughing.

　　3. Avoid fried and spicy foods

　　Fried and greasy foods are difficult to digest, easy to generate internal heat, and can help dampness produce phlegm, block the lung channels, and lead to increased coughing and asthma. Spicy foods such as chili, onions, raw garlic, black pepper, etc., can help heat and produce phlegm after eating, and can also stimulate the bronchial mucosa, causing local edema and increased coughing and asthma.

　　4. Avoid seafood and irritants

　　Fish, shrimp, salmon, yellow croaker, herring, smelt, crab and poultry eggs, fresh milk or dairy products are common allergens, and these foods should be avoided. In addition, it is also advisable to avoid alcohol, eggs, pumpkin, mustard greens, rice lees, rapini, rice wine, etc.

　　5. One-day Reference Diet

　　Breakfast Glutinous rice, coix seed, wheat flour, eggs, etc., such as coix seed porridge, steamed rolls, boiled eggs; Snack: apple.

　　Lunch Rice, tomatoes, crucian carp, mushrooms,油菜, etc., such as rice, tomato fish slices, fried mushrooms with cabbage; Snack: pear.

　　Dinner Wheat flour, beef, cabbage, carrots, etc., such as steamed buns, steamed beef with flour, cabbage and carrots.

　　Respiratory bronchiolitis-related interstitial lung diseases can be treated with antibiotics and corticosteroids. Quitting smoking is crucial for patients with respiratory bronchiolitis-related interstitial lung diseases, as quitting smoking can improve the clinical symptoms and pulmonary function of patients. Corticosteroid treatment is effective. It should be avoided to use unnecessary cytotoxic drugs as much as possible. About 22% of patients can partially or completely remit without any treatment.