波兰呼吸学会诊断和治疗进行性纤维化间质肺疾病(非特发性肺纤维化)指南

IF 1.8 Q3 RESPIRATORY SYSTEM Advances in respiratory medicine Pub Date : 2022-10-01 DOI:10.3390/arm90050052
W. Piotrowski, M. Martusewicz-Boros, A. Białas, A. Barczyk, B. Batko, K. Błasińska, P. Boros, K. Górska, P. Grzanka, E. Jassem, D. Jastrzębski, Janina Kaczyńska, O. Kowal-Bielecka, E. Kucharz, J. Kuś, B. Kuźnar-Kamińska, B. Kwiatkowska, R. Langfort, K. Lewandowska, B. Maćkiewicz, S. Majewski, J. Makowska, J. Miłkowska-Dymanowska, E. Puścińska, A. Siemińska, M. Sobiecka, Renata Soroka-Dąda, M. Szołkowska, E. Wiatr, D. Ziora, P. Śliwiński
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引用次数: 4

摘要

波兰呼吸学会(PTChP)工作组制定了PF-ILD的诊断和治疗指南。主要发现是什么?进行性肺纤维化的诊断和治疗应由多学科团队参与。尼达尼布单独或联合免疫调节药物被推荐用于治疗PF-ILD,特别是当早期单独免疫调节治疗无效时。主要发现的含义是什么?本文件是波兰医疗人员参与诊断和治疗PF-ILD的指南。该指南将为波兰的卫生保健组织者提供帮助,帮助他们优化ILD的诊断和治疗过程,并改善患者获得现代治疗的机会。这些建议是为了回答以前制定的关于日常诊断和治疗挑战的问题。它们是基于使用GRADE方法对当前文献的回顾而开发的。专家建议,PF-ILD的诊断应结合不同的标准,如症状的加重、放射学病变的进展和肺功能测试参数的恶化。专家们建议对潜在疾病进行精确诊断,同时对自身免疫性疾病进行血清学检测。最终诊断应由多学科小组(MDT)作出。对于不符合进行性纤维化表型标准的IPF以外的间质性肺病患者,应监测其进展情况,对于患有全身性自身免疫性疾病的患者,应定期监测间质性肺病的迹象。在管理与自身免疫性疾病相关的间质性肺疾病患者时,应考虑MDT的意见。如果推荐的治疗潜在疾病的方法无效,则应采用尼达尼布而不是吡非尼顿,但在某些情况下,可以在不进行早期免疫调节治疗的情况下开始抗纤维化治疗。同时使用免疫调节和抗纤维化药物也是允许的。在PF-ILD治疗期间除IPF外出现明显进展的情况下,没有建议支持或反对终止抗纤维化治疗。专家建议,非药物治疗和姑息治疗以及肺移植资格的原则应适用于除IPF患者外的间质性肺疾病伴进行性纤维化患者。
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Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis
Highlights The working group of the Polish Respiratory Society (PTChP) developed guidelines for diagnosis and treatment of PF-ILD. What are the main findings? A multidisciplinary team should be involved in the diagnosis and treatment of progressive pulmonary fibrosis. Nintedanib alone or in combination with immunomodulatory drugs is recommended for the treatment of PF-ILD, especially when an earlier solely immunomodulatory treatment was ineffective. What are the implications of the main finding? This document is a guide for Polish medical personnel involved in the diagnosis and treatment of PF-ILD. The guidelines will serve as an aid for healthcare organizers in Poland on how to optimize the diagnostic and therapeutic processes for ILD and improve the access of patients to modern therapy. Abstract The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.
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来源期刊
Advances in respiratory medicine
Advances in respiratory medicine RESPIRATORY SYSTEM-
CiteScore
2.60
自引率
0.00%
发文量
90
期刊介绍: "Advances in Respiratory Medicine" is a new international title for "Pneumonologia i Alergologia Polska", edited bimonthly and addressed to respiratory professionals. The Journal contains peer-reviewed original research papers, short communications, case-reports, recommendations of the Polish Respiratory Society concerning the diagnosis and treatment of lung diseases, editorials, postgraduate education articles, letters and book reviews in the field of pneumonology, allergology, oncology, immunology and infectious diseases. "Advances in Respiratory Medicine" is an open access, official journal of Polish Society of Lung Diseases, Polish Society of Allergology and National Research Institute of Tuberculosis and Lung Diseases.
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