TY - JOUR
T1 - Nonspecific Interstitial Pneumonia
T2 - What Is the Optimal Approach to Management?
AU - Tomassetti, Sara
AU - Ryu, Jay H.
AU - Piciucchi, Sara
AU - Chilosi, Marco
AU - Poletti, Venerino
N1 - Publisher Copyright:
© 2016 by Thieme Medical Publishers, Inc.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - We reviewed current aspects of the clinical and pathogenic profile of nonspecific interstitial pneumonia (NSIP), to better elucidate the complex issue of management and treatment options for NSIP patients. Recent findings suggest that idiopathic NSIP is a complex clinical entity with a disease spectrum that includes at least three different phenotypes: NSIP associated with autoimmune features, emphysema, and familial interstitial lung disease. This distinction, based mainly on clinical findings, may be of critical importance when it comes to making a decision on patients' management. This hypothesis warrants further studies. Currently, two major radiologic-pathologic different profiles have been well established. First, the inflammatory type characterized by prominent lymphocytic inflammation both on biopsy and bronchoalveolar lavage (BAL), and high-resolution computed tomography (HRCT) with mixed NSIP/organizing pneumonia pattern that tends to have a better response to corticosteroid and immunosuppressive treatment. Second, the highly fibrotic subgroup that shows prominent reticular changes and traction bronchiectasis by HRCT, high fibrotic background on biopsy, and no lymphocytosis on BAL. The latter fibrotic NSIP is the subgroup with less potential to respond to immunosuppressive treatment and a marginal risk to evolve into full-blown idiopathic pulmonary fibrosis. The management of patients with fibrotic, progressive, and immunosuppressive treatment, refractory NSIP remains uncertain, and further studies are needed to address the role of antifibrotic drug in this settings. Oxygen therapy, pulmonary rehabilitation, and lung transplantation are of importance in the current management of severe, progressive, and refractory NSIP patients.
AB - We reviewed current aspects of the clinical and pathogenic profile of nonspecific interstitial pneumonia (NSIP), to better elucidate the complex issue of management and treatment options for NSIP patients. Recent findings suggest that idiopathic NSIP is a complex clinical entity with a disease spectrum that includes at least three different phenotypes: NSIP associated with autoimmune features, emphysema, and familial interstitial lung disease. This distinction, based mainly on clinical findings, may be of critical importance when it comes to making a decision on patients' management. This hypothesis warrants further studies. Currently, two major radiologic-pathologic different profiles have been well established. First, the inflammatory type characterized by prominent lymphocytic inflammation both on biopsy and bronchoalveolar lavage (BAL), and high-resolution computed tomography (HRCT) with mixed NSIP/organizing pneumonia pattern that tends to have a better response to corticosteroid and immunosuppressive treatment. Second, the highly fibrotic subgroup that shows prominent reticular changes and traction bronchiectasis by HRCT, high fibrotic background on biopsy, and no lymphocytosis on BAL. The latter fibrotic NSIP is the subgroup with less potential to respond to immunosuppressive treatment and a marginal risk to evolve into full-blown idiopathic pulmonary fibrosis. The management of patients with fibrotic, progressive, and immunosuppressive treatment, refractory NSIP remains uncertain, and further studies are needed to address the role of antifibrotic drug in this settings. Oxygen therapy, pulmonary rehabilitation, and lung transplantation are of importance in the current management of severe, progressive, and refractory NSIP patients.
KW - cyclophosphamide
KW - idiopathic nonspecific interstitial pneumonia
KW - interstitial lung diseases
KW - rituximab
UR - http://www.scopus.com/inward/record.url?scp=84971300431&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84971300431&partnerID=8YFLogxK
U2 - 10.1055/s-0036-1583176
DO - 10.1055/s-0036-1583176
M3 - Article
C2 - 27231862
AN - SCOPUS:84971300431
SN - 1069-3424
VL - 37
SP - 378
EP - 394
JO - Seminars in Respiratory and Critical Care Medicine
JF - Seminars in Respiratory and Critical Care Medicine
IS - 3
ER -