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Vol. 45. Issue S3.
Controversias de formación en neumología
Pages 3-8 (March 2009)
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Vol. 45. Issue S3.
Controversias de formación en neumología
Pages 3-8 (March 2009)
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Aspectos relevantes en el manejo de la enfermedad pulmonar intersticial difusa
Key features in the management of diffuse interstitial pulmonary disease
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13958
David Iturbe Fernándeza, Ricardo Peris Sánchezb, Alicia Ferreira Morenoc, Estrella Fernández Fabrellasb,
Corresponding author
fernandez_est@gva.es

Autor para correspondencia.
a Hospital Universitario Marqués de Valdecilla, Santander, España
b Hospital Universitario Dr. Peset, Valencia, España
c Hospital General Universitario Gregorio Marañón, Madrid, España
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Resumen

Las enfermedades pulmonares intersticiales difusas (EPID) son un grupo heterogéneo de entidades en las que el denominador común es la afectación de la zona anatómica existente entre la membrana basal del epitelio alveolar y el endotelio capilar, conocido como espacio intersticial. El abordaje diagnóstico, las complicaciones que pueden aparecer en la historia natural de estas enfermedades y sus escasas alternativas terapéuticas hacen de ellas un auténtico reto para el clínico. En esta breve revisión se incidirá en los aspectos más relevantes del manejo de las EPID como son los factores pronósticos, las opciones terapéuticas, incluido el papel del trasplante pulmonar, y el diagnóstico y tratamiento de dos complicaciones de trascendental relevancia en su evolución, como son las exacerbaciones y la hipertensión pulmonar asociada.

Palabras clave:
Enfermedad pulmonar intersicial difusa
Exacerbación
Factores pronósticos
Opciones terapéuticas
Abstract

Diffuse interstitial lung disease is a heterogeneous group of diseases in which the common denominator is involvement of the area between the basement membrane of the alveolar epithelium and the capillary endothelium, known as the interstitial space. Diffuse interstitial lung disease poses a tremendous challenge to the clinician due to the diagnostic approach, the complications that can appear in the natural history of these entities, and the scarcity of available therapeutic resources. This brief review discusses key features of the management of diffuse interstitial pulmonary disease, such as prognostic factors, the therapeutic options –including the role of lung transplantation– and the diagnosis and treatment of two complications with crucial impact on the clinical course of the disease: exacerbations and associated pulmonary hypertension.

Keywords:
Diffuse interstitial lung disease
Exacerbation
Prognostic factors
Therapeutic options
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Bibliografía
[1.]
American Thoracic Society/European Respiratory Society.
International multidisciplinary consensus classification of the idiopathic interstitial pneumonias.
Am J Respir Crit Care Med, 165 (2002), pp. 277-304
[2.]
M. Demetds, A.U. Wells, J.M. Antó, U. Costabel, R. Hubbard, P. Cullinan, et al.
Interstitial lung diseases: an epidemiological overview.
Eur Respir J, 18 (2001), pp. S2-S16
[3.]
A. Xaubet, J. Ancochea, R. Blanquer, C. Montero, F. Morell, E. Rodríguez Becerra, Grupo de Investigación en Enfermedades Pulmonares Intersticiales Difusas, et al.
Área de Técnicas y Trasplante. SEPAR. Diagnóstico y tratamiento de las enfermedades pulmonares intersticiales difusas.
Arch Bronconeumol, 39 (2003), pp. 580-600
[4.]
H.R. Collard, B.B. Moore, K.R. Flaherty, K.K. Brown, R.J. Kaner, T.E. King Jr, et al.
Acute exacerbations if idiopathic pulmonary fibrosis.
Am J Respir Crit Care Med, 176 (2007), pp. 636-643
[5.]
J.G. Parambil, J.L. Myers, J.H. Ryu.
Diffuse alveolar damage. Uncommon manifestation in patients with connective tissue diseases.
Chest, 130 (2006), pp. 553-558
[6.]
I.N. Park, D.S. Kim, T.S. Shim, C.M. Lim, S.D. Lee, Y. Koh, et al.
Acute exacerbation of interstitial pneumonia other than idiopathic pulmonary fibrosis.
Chest, 132 (2007), pp. 214-220
[7.]
D.S. Kim, H.R. Collard, T.E. King Jr.
Classification and natural history of the idiopathic interstitial pneumonias.
Proc Am Thorac Soc, 3 (2006), pp. 285-292
[8.]
J. Behr, J.H. Ryu.
Pulmonary hypertension in interstitial lung disease.
Eur Respir J, 31 (2008), pp. 1357-1367
[9.]
J.H. Park, D.S. Kim, I.N. Park, S.J. Jang, M. Kitaichi, A.G. Nicholson, et al.
Prognosis of fibrotic interstitial pneumonia.
Am J Respir Crit Care Med, 175 (2007), pp. 705-711
[10.]
A.U. Wells, C.M. Hogaboam.
Update un diffuse parenchimal lung disease 2006.
Am J Respir Crit Care Med, 175 (2007), pp. 655-660
[11.]
A.U. Wells, N. Hirani.
Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. 63, 2008.
Thorax, 63 (2008), pp. V1-V58
[12.]
J.A. Barberá, P. Escribano, P. Morales, M.A. Gómez, M. Oribe, A. Martínez, et al.
Estándares asistenciales en hipertensión pulmonar. Documento de consenso elaborado por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) y la Sociedad Española de Cardiología (SEC).
Arch Bronconeumol, 44 (2008), pp. 87-99
[13.]
S.B. Venkateshiah, T.D. Yan, T.L. Bonfield, M.J. Thomassen, M. Meziane, C. Czich, et al.
An open-label trial of granulocyte macrophage colony stimulating factor therapy for moderate symptomatic pulmonary alveolar proteinosis.
Chest, 130 (2006), pp. 227-237
[14.]
D.P. Tashkin, R. Elashoff, P.J. Clements, J. Goldin, M.D. Roth, D.E. Furst, et al.
Cyclophosphamide versus placebo in scleroderma lung disease.
N Engl J Med, 354 (2006), pp. 2655-2666
[15.]
A.J. Gerbino, C.H. Goss, J.A. Molitor.
Effect of mycophenolate mofetil on pulmonary function in scleroderma-associated interstitial lung disease.
Chest, 133 (2008), pp. 455-460
[16.]
H.R. Collard, J.H. Ryu, W.W. Douglas, M.I. Schwarz, D. Curran-Everett, T.E. King Jr, et al.
Combined corticosteroid and cyclophosphamide therapy does not alter survival in idiopathic pulmonary fibrosis.
Chest, 125 (2004), pp. 2169-2174
[17.]
M. Demedts, J. Behr, R. Buhl, U. Costabel, R. Dekhuijzen, H.M. Jansen, et al.
High-dose acetylcysteine in idiopathic pulmonary fibrosis.
N Engl J Med, 353 (2005), pp. 2229-2242
[18.]
T.J. Williams, J.W. Wilson.
Challenges in pulmonary fibrosis: 7-Novel therapies and lung transplantation.
Thorax, 63 (2008), pp. 277-284
[19.]
A. Ferreira, C. Garvey, G.L. Connors, L. Hilling, J. Rigler, S. Farrell, et al.
Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response.
Chest, 135 (2009), pp. 442-447
[20.]
J.B. Orens, M. Estenne, S. Arcasoy, J.V. Conte, P. Corris, J.J. Egan, et al.
International guidelines for the selection of lung transplant candidates: 2006 update. A consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.
J Heart Lung Transplant, 25 (2006), pp. 745-755
[21.]
L. Schachna, T.A. Medsger, J.H. Dauber, F.M. Wigley, N.A. Braunstein, B. White, et al.
Lung transplantation in scleroderma compared with idiopathic pulmonary fibrosis and idiopathic pulmonary arterial hypertension.
Arthritis Rheum, 54 (2006), pp. 3954-3961
[22.]
V. Ambrosini, A. Cancellieri, M. Chilosi, M. Zompatori, R. Trisolini, L. Saragoni, et al.
Acute exacerbation of idiopathic pulmonary fibrosis: report of a series.
Eur Respir J, 22 (2003), pp. 821-826
[23.]
A. Churg, N.L. Muller, C.I. Silva, J.L. Wright.
Acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias.
Am J Surg Pathol, 31 (2007), pp. 277-284
[24.]
D.S. Kim, J.H. Park, B.K. Park, J.S. Lee, A.G. Nicholson, T. Colby.
Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features.
Eur Respir J, 27 (2006), pp. 143-150
[25.]
H. Kubo, K. Nakayama, M. Yanai, T. Suzuki, M. Yamaya, M. Watanabe, et al.
Anticoagulant therapy for idiopathic pulmonary fibrosis.
Chest, 128 (2005), pp. 1475-1482
[26.]
S. Nathan, P.W. Noble, M. Tuder.
Idiopathic pulmonary fibrosis and pulmonary hypertension. Connecting the dots.
Am J Respir Crit Care Med, 175 (2007), pp. 875-880
[27.]
C.J. Lettieri, S.D. Nathan, D. Barnett, S. Ahmad, A.F. Shorr.
Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis.
Chest, 129 (2006), pp. 746-752
[28.]
K. Hamada, S. Nagai, S. Tanaka, T. Handa, M. Shigematsu, T. Nagao, et al.
Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis.
Chest, 131 (2007), pp. 650-656
[29.]
T. Handa, S. Nagai, S. Miki, Y. Fushimi, K. Ohta, M. Mishima, et al.
Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis.
[30.]
S. Trad, Z. Amoura, C. Beiglman, J. Haroche, N. Costedoat, T.H. Boutinle, et al.
Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease.
Arthritis Rheum, 54 (2006), pp. 184-191
[31.]
R. Condliffe, D.G. Kiely, A.J. Peacock, P.A. Corris, J.S. Gibbs, F. Vrapi, et al.
Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era.
Am J Respir Crit Care Med, 179 (2009), pp. 151-157
[32.]
G. Dauriat, H. Mal, G. Thabut, J.F. Mornex, M. Bertocci, F. Trouc, et al.
Lung transplantation for pulmonary Langerhans’ cell histiocytosis: a multicenter analysis.
Transplantation, 81 (2006), pp. 746-750
[33.]
D. Polomis, J.R. Runo, K.C. Meyer.
Pulmonary hypertension in interstitial lung disease.
Curr Opin Pulm Med, 14 (2008), pp. 462-469
[34.]
Ryu JH, McGoon MD. Pulmonary hypertension associated with interstitial lung disease. 2007, UpToDate.
[35.]
N. Milman, C.M. Burton, M. Iversen, R. Videbaek, C.V. Jensen, J. Carlsen.
Pulmonary hypertension in end-stage pulmonary sarcoidosis: therapeutic effect of sildenafil?.
J Heart Lung Transplant, 27 (2008), pp. 329-334
[36.]
H.R. Collard, K.J. Anstrom, M.I. Schwarz, D.A. Zisman.
Sildenafil improves walk distance in idiopathic pulmonary fibrosis.
Chest, 131 (2007), pp. 897-899
[37.]
T.E. King, J. Behr, K. Brown, R.M. Du Bois, L. Lancaster, J.A. De Andrade, et al.
BUILD-1: A randomized placebo-controlled trial of bosentan in idiopathic pulmonary fibrosis.
Am J Respir Crit Care Med, 177 (2008), pp. 75-81
[38.]
T.P. Fitton, T.R. Kosowski, C.J. Barreiro, V. Chan, N.D. Patel, M.C. Borja, et al.
Impact of secondary pulmonary hypertension on lung transplant outcome.
J Heart Lung Transplant, 24 (2005), pp. 1254-1259
[39.]
T.P. Whelan, J.M. Dunitz, R.F. Kelly, L.B. Edwards, C.S. Herrington, M.I. Hertz, et al.
Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis.
J Heart Lung Transplant, 24 (2005), pp. 1269-1274
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