A 61-year-old male presents with increasing shoness of breath. A chest x-ray reveals a diffuse pulmonary infiltrate, while a transbronchial biopsy reveals fibrosis of the walls of the alveoli, many of which contain sheets of "desquamated" cells. Which of the following would be the best therapy for this patient?
) Interstitial pulmonary fibrosis (IF) may be a slowly progressive disease with no recognizable etiology. This disease entity has many names, such as chronic interstitial pneumonitis and diffuse fibrosing alveolitis, but the common name is usual interstitial pneumonitis (UIP). The form of this disease that progresses very rapidly is called Hamman-Rich syndrome. The pathogenesis of UIP involves damage to type I pneumocytes with the subsequent proliferation of type II pneumocytes and secretion of factors by macrophages that cause fibrosis. The end-stage form of IF is characterized by large cysts with intervening fibrosis, which impas the gross appearance of a "honeycomb lung." There are several subtypes of IF, which are characterized by their histologic appearance. Lymphocytic interstitial pneumonitis (LIP) has numerous lymphocytes, Giant cell interstitial pneumonitis (GIP) has giant cells, and plasma cell interstitial pneumonitis (PIP) has numerous plasma cells. LIP is seen in patients with Sjogren's syndrome or AIDS and is associated with an increased risk of developing lymphoma. An impoant subtype is desquamative interstitial pneumonitis (DIP), which is characterized histologically by sheets of cells within the alveoli. This type of IF may respond to the use of steroids. UIP, in contrast, does not respond to therapy, and therefore treatment is symptomatic treatment only. Theophylline is used to treat asthma, antibiotics are used to treat bacterial infections, and INH is used in combination with other drugs to treat tuberculosis Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
Theophylline
Steroids
Antibiotics
Isoniazid
miscellaneous