Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Abstract

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonia. Idiopathic pulmonary fibrosis is often seen in elderly men who smoke. A diagnosis of IPF is based on a combination of a detailed clinical history, specific physical examination, laboratory findings, pulmonary function tests, high-resolution computed tomography (HRCT) of the chest, and histopathology. Idiopathic pulmonary fibrosis has a heterogeneous clinical course, from an asymptomatic stable state to progressive respiratory failure or acute exacerbation (AE). Acute exacerbation of IPF has several important differential diagnoses, such as heart failure and volume overload. The International Working Group project proposed new criteria for defining AE of IPF in 2016, which divides it into triggered and idiopathic AE. On the basis of these criteria, physicians can detect AE of IPF more easily. The recent international IPF guidelines emphasized the utility of chest HRCT. In addition, two antifibrotic agents have become available. We should focus on both the management and prevention of AE. The diagnostic process, laboratory findings, typical chest imaging, management, and prognosis of AE are comprehensively reviewed in this article.

Perioperative Pulmonary Support of the Elderly

“…Idiopathic pulmonary fibrosis (IPF) is a well-known type of ILD marked by interstitial inflammation with permanent and progressive scarring of pulmonary tissues [10]. The majority of IPF patients are males over the age of 60, and again, a history of smoking is often seen [11]. Acute exacerbations of IPF are associated with poor prognosis and have been seen following surgical procedures on the lungs to include biopsies, lobectomies, and bronchoalveolar lavage.…”

Complications in Idiopathic Pulmonary Fibrosis: Focus on Their Clinical and Radiological Features

“…Clinical manifestations include the onset of new dyspnea and symptoms such as cough, fever, flu-like [53][54][55], severe hypoxemia and respiratory failure, which requires mechanical ventilation, are commonly found in these patients. Imaging is used to evaluate acute exacerbation in patients with IPF; chest X-rays may reveal a reticular shadow on the lower lobes, obviously better appreciated in the comparison with previous films [56]. HRCT has been introduced in the IPF guidelines, due to the fact that it may reveal the coexistence of the IPF model with the appearance of new parenchymal opacities-after an accurate exclusion of alternative causes (for example, infections, left heart failure or identifiable lung lesions) [57].…”

“…At clinical evaluation, a decreased vesicular murmur and wheezes in the basal-middle areas were found. comparison with previous films [56]. HRCT has been introduced in the IPF guidelines, due to the fact that it may reveal the coexistence of the IPF model with the appearance of new parenchymal opacities-after an accurate exclusion of alternative causes (for example, infections, left heart failure or identifiable lung lesions) [57].…”

Cigarette Smoking: The Only Risk Factor of a Case with Chronic Mesenteric Ischemia

“…Approximately 3 months before admission, fine crackles were audible in bilateral lower lung fields. White blood cell count (WBC), lactate dehydrogenase (LDH), C-reactive protein (CRP), and Krebs von den Lungen (KL)-6 levels, known to indicate the activity of IP (5,6), were 10,280/µL, 222 U/L (normal range, <229 U/L), 0.20 mg/dL (normal range, <0.3 mg/dL), and 388 U/mL (normal range, <500 U/mL), respectively. O2 saturation by pulse oximetry (SpO2) was 96% in room air at rest.…”