The Progress In Diagnosis And Treatment Of The Diffuse Interstitial Lung Disease (DILD) In2011

Patients with diffuse interstitial lung diseases (DILDs) come tomedical attention mainly because of the onset of progressive exertionaldyspnea or a persistent, nonproductive cough. Hemoptysis, wheezing, andchest pain may be present. Often, the identification of interstitial opacitieson chest x-ray focuses the diagnostic approach toward one of theDILDs.DILDs represent a large number of conditions that involve theparenchyma of the lung—the alveoli, the alveolar epithelium, thecapillary endothelium, and the spaces between these structures, as well asthe perivascular and lymphatic tissues. This heterogeneous group ofdisorders is classified together because of similar clinical,roentgenographic, physiologic, or pathologic manifestations. Thesedisorders are often associated with considerable morbidity and mortality,and there is little consensus regarding the best management of most ofthem.DILDs have been difficult to classify because>200knownindividual diseases are characterized by diffuse parenchymal lunginvolvement, either as the primary condition or as a significant part of amultiorgan process, as may occur in the connective tissue diseases(CTDs). One useful approach to classification is to separate the ILDs intotwo groups based on the major underlying histopathology:(1) thoseassociated with predominant inflammation and fibrosis, and (2) thosewith a predominantly granulomatous reaction in interstitial or vascular areas. Each of these groups can be further subdivided according towhether the cause is known or unknown. For each DILD there may be anacute phase, and there is usually a chronic one as well. Rarely, some arerecurrent, with intervals of subclinical disease.The DILDs arenonmalignant disorders and are not caused by identified infectious agents.The precise pathway(s) leading from injury to fibrosis is not known.Although there are multiple initiating agent(s) of injury, theimmunopathogenic responses of lung tissue are limited, and themechanisms of repair have common features.As mentioned above, thetwo major histopathologic patterns are a granulomatous pattern and apattern in which inflammation and fibrosis predominate.Although thecourse of DILD is variable, progression is common and often insidious.All treatable possibilities should be carefully considered. Since therapydoes not reverse fibrosis, the major goals of treatment are permanentremoval of the offending agent, when known, and early identification andaggressive suppression of the acute and chronic inflammatory process,thereby reducing further lung damage. In this article,we made an analysisfrom hundreds of Chinese and English literature in2011in order toexplore new ideas for new research.