1. Do patients with interstitial pneumonia need to use antibiotics for a long time? What are the side effects?
A: According to current theory, in idiopathic interstitial pneumonia, if there is no co-infection, there is no need to use antibiotics, so there is no discussion of long-term use of antibiotics, and of course there is no discussion of side effects.
2. If hormones are used, what are the side effects of hormone therapy for interstitial pneumonia? Is there any way to avoid them?
A: The side effects mentioned in the instruction manual of prednisone are: Cushing’s syndrome caused by long-term heavy use, induced neuropsychiatric symptoms as well as peptic ulcers, osteoporosis, suppressed growth and development, concurrent and aggravated infections.
Here is a slight explanation, no one gives an exact definition of what is long-term. Generally speaking, hormones are used for a short period of time, within 5 days, and regular doses of hormones do not cause significant side effects to the body. Beyond 1 week, adrenocortical function can be suppressed and side effects may be induced.
Cushing’s syndrome is commonly referred to as fat gain, caused by fat redistribution; induced neuropsychiatric symptoms are excitement, insomnia, and even psychiatric problems.
Perhaps a better understanding of side effects might be achieved by first looking at what the pharmacopoeia says about contraindications to hormones: 1. history of severe psychiatric disease; 2. active gastric and duodenal ulcers; 3. recent post-gastrointestinal anastomosis; 4. severe osteoporosis; 5. significant diabetes mellitus; 6. severe hypertension; 7. viral, bacterial, or fungal infections not controlled with antibacterial drugs; 8. hepatic insufficiency, as prednisone It needs to be metabolized by the liver to prednisolone before it can take effect.
Seeing this, you should understand that hormones can aggravate these diseases, or may have induced these diseases, that is, the side effects of hormones. Therefore, the pharmacopoeia also stipulates that it is better not to use or delay the use of hormones for the following diseases.
1. acute heart failure or other heart diseases; 2. diabetes mellitus; 3. diverticulitis; 4. emotional instability and psychotic tendencies; 5. systemic fungal infections; 6. glaucoma; 7. hyperlipoproteinemia; 8. hypertension; 9. hypothyroidism (when glucocorticoid action is enhanced); 10. osteoporosis; 11. gastric ulcer, gastritis or esophagitis; 12. renal impairment or stone Prednisone does not treat inflammatory infections; it reduces the inflammatory response and tends to mask the symptoms; adequate amounts of effective antibiotics must be applied along with prednisone. Prednisone should be increased for a short period of time in case of surgery or trauma. 20. Prednisone should not be used in surgical patients as it affects wound healing.
Of course, it should be noted that some side effects do not occur in all people, such as hypertension and diabetes, which can only be treated with follow-up observation and cannot be prevented, and if hormones can induce these diseases, they will inevitably appear as long as they are used, and they can only be treated according to the corresponding diseases.
However, some side effects, such as gastroduodenal ulcer, can be prevented with acid suppressants or mucosal protectors. All side effects require mutual communication between patients and doctors and close follow-up before the harm of side effects can be minimized. Therefore, when using hormones, care must be taken to consider the pros and cons. Not all idiopathic interstitial pneumonia requires hormone therapy, and even if it is used, it should be followed up and observed by an experienced doctor.
3.How to determine the routine dosage and course of hormone therapy for interstitial pneumonia?
A: For idiopathic interstitial pneumonia that can be treated with hormone therapy, the regular dosage of hormone varies according to the doctor’s own experience, and the doctors at Gulou Hospital will choose according to the patient’s specific condition and physical status, usually at 20-30mg/day, which can be given once or twice or three times a day. Since hormones have large side effects, all patients given hormone therapy must have good compliance and follow up regularly according to the doctor’s requirements.
4.Is it still effective to increase the dose if the disease recurs during the hormone reduction?
A: Regarding this question, it depends on what kind of idiopathic interstitial pneumonia is diagnosed.
If it is a type of mechanized pneumonia, some patients will have symptoms and imaging aggravated again during dose reduction or after discontinuation of the drug, then increase the hormone dose again, most patients are effective, but when the dose is reduced again to about the last recurrent dose, the subsequent dose reduction or discontinuation should be more cautious and closely followed, for very few patients may be given a small dose of hormone maintenance, that is, these patients cannot stop the drug.
For other types of idiopathic interstitial pneumonia (which may have structural changes), for example, if someone is trying hormone therapy for IPF, the fact that there is an increase in symptoms does not mean that the increased dose of hormone will be effective.
5.What is the difference between the combination of antibiotics and hormones and the effect of hormone therapy alone?
A: For idiopathic interstitial pneumonia, there is no need to use antibiotics, and the choice of hormone is not suitable for every patient, so there is no question of comparing the efficacy of hormone combined with antibiotics and hormone alone.
If a patient requires hormone therapy and also has a co-infection, the two can be used in combination, but of course the combination is more effective than the use of hormones alone, for example, if the patient has a combination of skin and soft tissue infection, how can the infection be controlled without the use of antibiotics?
If the patient has no evidence of infection and the diagnosis is not clear, and antibiotics are started just based on chest imaging, the doctor obviously has a problem with misuse of antibiotics.
If the diagnosis is clear that it is idiopathic interstitial pneumonia and the doctor gives antibiotics, again there is antibiotic abuse, or the doctor simply does not know how to treat idiopathic interstitial pneumonia, suggest that the patient change doctors or hospitals for treatment.