Desquamative interstitial pneumonia

　　How is desquamative interstitial pneumonia caused? Briefly described as follows:

　　First, Etiology

　　The etiology of desquamative interstitial pneumonia (DIP) is unknown to this day, and it is closely related to long-term smoking, just like respiratory bronchiolitis interstitial lung disease (RBILD). Literature reports that 85% to 90% of patients have a history of long-term smoking, but the factors are complex. Literature reports also indicate that it is related to the inhalation of various inorganic dusts and the inhalation of the smell of burning plastics. DIP caused by drugs has also been reported. Bone reported 2 cases due to long-term use of furantadine, confirmed by histopathology to cause the disease, and cured after stopping the drug and receiving adrenal corticosteroids. Some scholars have found a large number of inclusions in the nuclei of alveolar wall cells in DIP patients, suggesting that the etiology of the disease may be related to viral infection. Some patients have a history of respiratory tract infection before the onset of the disease, but lack more evidence of viral infection. Currently, it is believed that the virus may only be a triggering factor. Some people also believe that idiopathic DIP is an autoimmune disease because the cell infiltration in the alveolar spaces, alveolar walls, and interstitium is mainly lymphocytes and plasma cells, which are closely related to immunity. This is only a speculation, but lacks evidence-based data. Now, most scholars believe that the disease is related to many factors, and smoking is an important etiological factor.

　　Second, Pathogenesis

　　DIP's pathology is very similar to RBILD, the difference being that in addition to the histopathological changes of RBILD, a large number of brown pigment macrophages are also aggregated in the alveolar spaces. In 1984, Chinese scholars summarized the typical pathology of DIP into the following 9 points:

　　1. Type II alveolar cells are hyperplastic and hypertrophic;

　　2. A large number of macrophages containing brown pigment are aggregated in the alveolar spaces;

　　3. The alveolar structure is basically normal;

　　4. The surrounding interstitium has infiltration of lymphocytes and plasma cells;

　　5. There is no alveolar wall necrosis and hyaline membrane formation;

　　6. There is no obvious纤维素 exudation in the alveolar spaces;

　　7. No asbestos bodies or other crystalline dust substances are present;

　　8. Early and middle stages rarely see alveolar atresia;

　　9. In the late stage, interstitial fibrosis may also occur, and even some cases may have honeycomb lung.

　　In the late stage of desquamative interstitial pneumonia, pulmonary interstitial fibrosis may occur, accompanied by diseases such as bullae and spontaneous pneumothorax, which seriously affects people's daily life and endangers patients' health, so timely treatment is needed.

　　Most patients with desquamative interstitial pneumonia have a long history of smoking, so the male to female ratio is about 2:1. The disease is more common in middle-aged and elderly people, with subacute or relatively concealed onset. Patients often present with persistent or paroxysmal dry cough, shortness of breath and cyanosis after exercise as the main symptoms, 30% to 50% of patients have varying degrees of progressive dyspnea, mainly often heard in the base of both lungs, with crackles, about 50% have acrocytes.

　　How to prevent desquamative interstitial pneumonia? Briefly described as follows:

　　1. Avoid wind and cold, prevent upper respiratory tract infection; timely add clothes, eat more fresh fruits and vegetables to enhance personal resistance; do more aerobic exercise, rest adequately, etc.; and get vaccinated against influenza to prevent colds.

　　2. Actively improve the air quality of the living environment; avoid dust irritation, and pay attention to protective measures when going out.

　　3. Quit smoking and alcohol, change bad living habits. Do not drink alcohol, do not smoke, and avoid passive smoking. Have regular meals three times a day.

　　What examinations should be done for desquamative interstitial pneumonia? Briefly described as follows:

　　1. Routine blood tests show an increase in red blood cells and hemoglobin, with normal erythrocyte sedimentation rate. Pulmonary function tests show restrictive ventilatory dysfunction in patients with desquamative interstitial pneumonia, with mild to moderate hypoxemia, increased P(A-aDO2), and earlyArterial blood carbon dioxide partial pressure (. PaCO₂) decrease.

　　2. Chest X-ray shows characteristic changes. About 75% of patients have very similar lung shadows, mainly manifested as a triangular shadow, extending from the hilum along the heart to the base of both lungs, with the base on the side and the tip at the cardiac diaphragmatic angle. The shadow is blurred and glassy, with明显增粗的纹理 from the hilum downward, representing dilated pulmonary vessels. The shadow is denser at the heart border, and the periphery of the lung becomes shallow and reduced. This typical shadow can sometimes last for 4 to 6 years without change, and some may change or gradually absorb within a few months. 25% of patients may show diffuse and blurred spots of lung shadows, or in addition to the lung base triangular shadow, there are also radiating lines and patchy blurred shadows from the hilum to the upper lung fields, giving the overall lung field a 'dirty lung' appearance.High-resolution CT (. HRCT) shows 50% to 70% of ground-glass opacities, and may also have focal or patchy shadows; the main lesions are distributed in the lower and middle lung fields; 50% to 60% have varying degrees of fibrosis, and rarely have honeycomb lung.

　　What should be paid attention to in the diet and health care of patients with desquamative interstitial pneumonia? Briefly described as follows:

　　I. Eat

　　Eat more fruits, drink more water, and eat high-protein, easy-to-digest, or semi-liquid foods.

　　II. Avoid

　　Avoid salty, spicy, greasy, and hot foods; do not eat sweet and warm fruits such as apricots, peaches, oranges, plums, etc., to prevent heat and phlegm; spices such as pepper, chili, Sichuan pepper, and mustard should not be added to the diet; quit smoking and drinking.

　　III. Diet for desquamative interstitial pneumonia

　　1. Take 200 grams of fresh banana root, mash and squeeze juice, cook with a little salt, and take it for consumption. It has the effect of clearing heat and moistening the intestines. Suitable for elderly pneumonia and patients with dry stools.

　　2. Take 1-2 loquats, 30 grams of black beans. Wash the loquat and slice, add an appropriate amount of water, add black beans, simmer with low heat until cooked, and eat when it is cooked. Suitable for elderly pneumonia patients with lung and kidney deficiency.

　　3. Take 6 grams of bird's nest, 9 grams of silver ear, and an appropriate amount of rock sugar. Soak the bird's nest and silver ear in hot water, wash clean, add rock sugar, steam until cooked, and take it for consumption. Suitable for elderly pneumonia.

　　4. Take one pig's lung without washing, with 49 peeled sweet almonds, 15 grams of Fritillaria thunbergii (heart removed), 1 teaspoon of ginger juice, 30 grams of honey, four ingredients inserted into the lung tube and tied up, cooked in boiling water, eat the soup together. Suitable for elderly pneumonia.

　　5. Take 30 grams of purple garlic (peeled, boiled in boiling water for 1 minute and taken out), 60 grams of rice, and 5 grams of Bletilla striata powder. Boil the rice and Bletilla striata powder in water, then add the garlic and cook into porridge, eat regularly for breakfast and dinner.

　　6. Use 200 grams of new lily, blend with honey and steam until soft, eating regularly has the effect of moistening the lungs and stopping cough. Suitable for elderly patients with dry cough and little phlegm due to pneumonia.

　　What are the treatment methods for desquamative interstitial pneumonia? Briefly described as follows:

　　I. Treatment

　　1. Quit smoking, which helps the recovery of the lesions;

　　2. Adrenal corticosteroids, 0.5mg/(kg·d) prednisone orally for the first 4 weeks; then changed to 0.25mg/(kg·d);

　　3. Chinese herb Chuanxiong 20-30mg/(kg·d) diluted and intravenously infused, course of 2-3 weeks, can be repeated after intervals;

　　4. Symptomatic treatment, such as oxygen inhalation, cough suppression, and other treatment measures.

　　II. Prognosis

　　The prognosis of this disease is good. After systematic treatment, 60% to 70% of the lung lesions will be absorbed to varying degrees, even cured; about 70% of the patients can survive for more than 10 years.