Chinese medicine treatment of interstitial pulmonary fibrosis?

Treatment of acute and severe diseases

The acute exacerbation of pulmonary fibrosis and severe pneumonia are mutually dependent, and can rapidly lead to respiratory failure

, circulatory failure and other severe diseases, and the principles of treatment for both are the same.

Symptomatic supportive therapy

Oxygen therapy

Patients usually require appropriate concentrations of oxygen to maintain transcutaneous oxygen saturation (SpO2) above 90%. When oxygen consumption increases with activity, patients with pulmonary fibrosis tend to become hypoxemic

Patients are advised to monitor their own oxygen saturation, prepare fixed and mobile oxygen devices, and administer oxygen therapy over a long period of time.

Prevention of deep vein thrombosis (VTE) formation

Hypoxic, bedridden patients are at increased risk for venous thromboembolism, and preventive measures include compression stockings, intermittent use of bilateral lower-extremity pneumatic compression pumps, and application of low-molecular-weight heparin.

Mechanical ventilation

Currently, invasive mechanical ventilation is not thought to benefit patients with acute exacerbations of pulmonary fibrosis, but noninvasive positive pressure ventilation is feasible in some patients with respiratory failure.

Medication

Glucocorticoids

Hormones may be used as appropriate to treat patients with acute exacerbations.

Anti-infective therapy

Patients with pulmonary fibrosis who have co-infections may be treated with anti-infective therapy. Anti-infective drugs are first empirically selected to cover the pathogenic microorganisms that may be causing the infection, and then the anti-infective regimen is adjusted if a specific pathogen is identified by culture or testing.

General treatment

Smoking cessation

Patients who smoke must be counseled and helped to quit.

Oxygen therapy

Oxygen therapy improves hypoxia in patients. Hypoxemic individuals, i.e., patients with pulmonary fibrosis who have an arterial partial pressure of oxygen PaO2 ≤ 55 mmHg or an arterial oxygen saturation SaO2 ≤ 88%, should receive prolonged oxygen therapy, which lasts > 15 hours/day.

Pulmonary rehabilitation

Pulmonary rehabilitation consists of respiratory physiotherapy, muscle training (whole-body exercise and respiratory muscle exercise), nutritional support, psychiatric treatment, and education, and needs to be carried out under the guidance of a specialized rehabilitation therapist.

Medication

There is currently no medication to reverse pulmonary fibrosis, and the following medications should be taken under the supervision of a specialist.

Glucocorticosteroids

Commonly used drugs include prednisone

, methylprednisolone

. The side effects of hormones should be noted during treatment, and the dosage should be reduced slowly over several weeks to months, with close follow-up to prevent recurrence of the disease.

Immunosuppressants

are often used in conjunction with hormones, and commonly used drugs include cyclophosphamide

, azathioprine, methotrexate, mertiomaxolate

, hydroxychloroquine, cyclosporine

and sirolimus. Side effects of hormones should be noted during treatment, as well as prevention of infection.

Anti-fibrotic drugs

Pirfenidone

has anti-inflammatory, anti-fibrotic and anti-oxidant properties, which can delay the decline of lung function and improve the survival of patients.

It is indicated for patients with idiopathic pulmonary fibrosis with mild to moderate lung function impairment and has a favorable safety profile.

Major adverse reactions include photosensitivity, rash, malaise, gastric upset, and anorexia.

Nidanib

This is a multi-targeted tyrosine kinase inhibitor that blocks fibroblast proliferation, migration and transformation, thereby inhibiting the development of pulmonary fibrosis.

It is indicated for pulmonary fibrosis due to idiopathic pulmonary fibrosis, or systemic sclerosis-associated interstitial pneumonitis

(disease progression).

The main adverse reactions are diarrhea, nausea, and elevated liver enzymes, and are contraindicated in patients with moderate or severe liver injury.

Antacids