Background The ILD Interstitial lung disease family includes a heterogeneous group of many lung diseases that have in common extensive damage to the lung tissue as a result of inflammatory filtration and fibrosis and scarring.
As a result, lung activity is impaired, and patients suffer from shortness of breath, cough, impaired quality of life, exertion limit, and even respiratory failure. The disease is characterized by a thickening of the space between the normal air bubbles, which are supposed to absorb the oxygen in the lungs.
In most cases, this disease breaks out as a result of various stimuli such as exposure to substances or inflammation, after which irreversible scars form inside the lung. Many of these diseases are more common in men in old age, starting at age 50 and they can appear in different configurations in different patients. Smoking can certainly be a background for the development of fibrosis. Some interstitial lung diseases are considered idiopathic diseases.
It is common to divide interstitial lung diseases into those whose cause is known versus idiopathic (whose cause is unknown), or among those with limited lung disease to which involve additional systems. The accepted division separates several main categories.
Exposure to an external factor, such as environmental, occupational, drug or radiation exposure.
Interstitial lung disease as part or as a single manifestation of systemic autoimmune disease.
1. Idiopathic interstitial lung diseases – diseases whose causes and risk factors are unknown, so it is difficult to know who is at risk of developing the disease.
2. The most common disease in this group is IPF (Idiopathic Pulmonary Fibrosis), in addition there are a number of other diseases in this group, which differ in course and radiological appearance.
3. Pulmonary fibrosis can also appear as a complication of severe pulmonary injury for any reason, or pulmonary infections, and there are also reports of pulmonary fibrosis following corona virus.
Interstitial diseases pose a diagnostic challenge
Most smokers are diagnosed with lung disease, and in many cases the initial tendency is to diagnose them as blue with COPD or emphysema, but it is very important in all these cases, to deepen the clarification and make sure it is not fibrosis. Anushmate exposed to asbestos and other substances like silica in the marble industry can certainly, too, be at risk for fibrosis with the development of healthy scars. Also people suffering from collagen diseases like scleroderma, rheumatoid arthritis and the like. Joint diseases can also trigger an autoimmune reaction in which the body attacks the lungs until inflammation develops, after which healthy scars may also form.
Symptoms
Fibrosis causes a dry cough which is a prominent symptom of the disease. Another symptom is shortness of breath, which initially appears as part of severe exertion and as the disease worsens, shortness of breath appears in increasingly light and routine efforts around simple daily activities. These cases can certainly result from other lung diseases as well, and tests like lung function and imaging confirm the diagnosis. Examination of the disease begins with an examination of the patient, regarding the substances to which he is exposed in his workplace and residence, such as a massive presence of ions on the window of the house, the secretions of ions cause an allergic reaction and healthy scars.
Also, a physical examination of the patient is performed when it is important to check for the presence of clubbing (nail fouling) which is considered as one of the hallmarks of people suffering from severe lung diseases like cystic fibrosis and pulmonary fibrosis. When listening to the lungs, it will be possible to hear dry wheezing, unique to interstitial diseases. Later, a high-resolution chest and CT scan of the lungs will be performed, which allows the scars to form healthy to be seen. A lung function test should be performed, in which a decrease in the volume of the lung and a decrease in the oxygen level during exertion can be seen.
In cases where the diagnosis is not significant, a biopsy is performed in which a sample is taken from the lungs using a bronchoscopy and a biopsy in the freezer.
Professor Mordechai Kramer, Director of the Lung Department at Rabin Campus Beilinson Medical Center: “One of the leading diseases for lung transplantation in Israel is pulmonary fibrosis – a disease in which health scars form, for various reasons, which are usually unknown. There are several types of lung transplantation – one lung can be transplanted, two lungs Or two lungs with the heart. “
“To date, 885 lung transplants have been performed at Beilinson Medical Center, about a third of them due to pulmonary fibrosis. When there is fibrosis disease, a single lung transplant is sufficient, which works well. However, not every person is suitable for transplantation, for example, a patient with other diseases such as heart failure. “Or a liver or a diabetic, even when it’s an older patient, over the age of 75, his chances of success are less good unless the patient is in excellent biological condition.”
Prof. Kramer also says, “When there is no cooperation on the part of the patient or he does not take the medication regularly. After the transplant, the patient” replaces “the previous disease that was most severe, with a” mild “disease, ie the transplant. “To ensure that the body does not reject these drugs weaken the immune system and the patient remains exposed to infections, so antibiotics and vaccines are required. With all the difficulty, the patient returns to normal life, travels, travels abroad and in fact, gets his life back.”
“Since the first transplants in the 60s the doctors’ experience has increased significantly, and today we are talking about a 85-90% chance of success after a year from the transplant, but over the years the body still tries to reject the implant, because it is a foreign organ, so after 5 years the chance is 70% and after 10 years, they are 50%. For a person whose life was in danger and was about to die within a few months, this is a huge gain. “Oxygen can return to normal life and high function after the transplant. The transplant actually offers both an extension of life and an improvement in the quality of life.”