Respiratory bronchiolitis interstitial lung disease

　　Respiratory bronchiolitis interstitial lung disease mainly occurs in populations with heavy smoking, exposure to the environment, and industrial pollutants. It may be a non-specific cellular response to inhaled irritants.

　　Respiratory bronchiolitis interstitial lung disease (RBILD) commonly complicates with pulmonary infection, which can trigger respiratory failure and even lead to death, and should be treated actively. Hypoxemia is common and may even exist without obvious causes, such as PaO2 < 7.33 kPa (55 mmHg), and home oxygen therapy should be considered. In the late stage, when combined with pulmonary heart disease and right heart failure, treatment for heart failure should be followed. Recurrent pneumothorax may require pleural adhesion surgery.

　　Patients with respiratory bronchiolitis interstitial lung disease (RBILD) are all smokers, and the age of onset is usually between 30～40 years old, with an insidious onset. There have been no reported cases of children. Most patients are asymptomatic or have only mild symptoms, including mild cough and dyspnea. However, there have also been reported cases of severe dyspnea, active hypoxemia, and hemoptysis. Therefore, severe impairment of pulmonary function cannot be used as a basis for excluding the diagnosis of RBILD. Inspiratory crackles at the end of inspiration can be heard at the lung base. Clubbing is rare.

　　The occurrence of respiratory bronchiolitis interstitial lung disease is related to heavy smoking, exposure to the environment, and industrial pollutants. 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 the disease.

　　2. Avoid long-term contact with strong irritant gases such as chlorine, ammonia, carbon dioxide, formaldehyde, and various acid mists, radioactive substances, etc.

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

　　Routine laboratory tests for respiratory bronchiolitis interstitial lung disease (RBILD) are non-specific. The total white blood cell count in bronchoalveolar lavage fluid may be elevated, but the cell classification is similar to that of ordinary smokers or smokers with desquamative interstitial pneumonia (IPF). The specific examination methods are described as follows.

　　1. Chest X-ray film

　　More than 2/3 of patients show reticular or nodular shadows infiltrating the lung base on chest X-ray, but the lung volume is often normal. A few patients have normal chest X-rays.

　　2. Chest CT

　　High-resolution CT of the chest (HRCT) shows diffused or patchy ground-glass changes, mainly seen in the lower lungs; also, atelectasis, interlobular or interlobar interstitial thickening, emphysema, and peripheral lung bullae may be seen.

　　3. Pulmonary function

　　It is usually restrictive or mixed ventilatory dysfunction and mild reduction in diffusion capacity. Occasionally, there may be normal pulmonary function. Increased lung volume suggests gas trapping in obstructed bronchioles. There may be mild hypoxemia at rest or during activity.

　　4. Pulmonary biopsy

　　Pulmonary biopsy pathology examination can be used to diagnose the disease.

　　Patients with respiratory bronchiolitis interstitial lung disease should eat foods that enhance immunity, have anti-inflammatory and diuretic effects. Avoid spicy foods; avoid foods that cause eruptions; avoid bitter-tasting foods. The specific dietary precautions are as follows.

　　1. Abstain from smoking

　　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 tobacco.

　　2, Avoid cold and cool foods

　　The course of this disease is long, most of them have insufficient Yang of spleen, lung, and kidney, and have a large 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 aggravating 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 attacked by cold, the transformation and transportation are impaired, leading to the internal generation of sputum turbidity, blocking the airways, and increasing asthma and coughing.

　　3, Avoid fried and spicy刺激性 foods

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

　　4, Avoid seafood and other irritants

　　Fish, shrimp, salmon, yellow croaker, hairtail, smelt, crab, and poultry eggs, fresh milk or dairy products are common allergens, and these foods should be avoided. In addition, it is also necessary to avoid alcohol, eggs, pumpkin, rapeseed, rice lees, winter melon, sake, etc.

　　5, One-day Reference Diet

　　Breakfast Glutinous rice, coix seed, wheat flour, eggs, etc., such as coix seed porridge, flower rolls, boiled eggs; snack: apples.

　　Lunch Rice, tomatoes, crucian carp, mushrooms,油菜, etc., such as rice, tomato fish slices, mushroom and油菜; snack: pears.

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

　　The preferred treatment for Respiratory Bronchiolitis Interstitial Lung Disease (RBILD) is glucocorticoids, followed by immunosuppressants. Adrenal cortical hormones can regulate the inflammatory and immune processes, reduce the content of immune complexes, inhibit the proliferation of alveolar macrophages and the function of T lymphocyte factors, and can improve the absorption of lung X-ray shadows and significantly improve clinical symptoms and lung function in some patients when applied during the stages of alveolitis and cell exudation.

　　Quitting smoking is crucial for RBILD patients. After quitting, the clinical symptoms and lung function of the patients will improve. Glucocorticoid therapy is effective. It should be avoided to use unnecessary cytotoxic drugs. About 22% of patients can partially or completely relieve symptoms without any treatment.