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Abstract: The patient presented with chest tightness and shortness of breath with no obvious cause 2 years ago and was seen at the Chest Hospital, where he was diagnosed with right pleural effusion, given anti-inflammatory and hormonal treatment, and discharged. The patient was discharged from the hospital.
Basic information】Male, 73 years old
Disease Type】Idiopathic interstitial pulmonary fibrosis, secondary infection
Hospital】Respiratory Medicine Department of the Second Affiliated Hospital of Harbin Medical University
Date of consultation】March 2022
【Treatment plan】Medication (moxifloxacin hydrochloride sodium chloride injection + amiloride hydrochloride oral solution + acetylcysteine solution for inhalation)
Treatment period】Inpatient treatment for 14 days, 3-month outpatient follow up
Treatment effect] The disease has been controlled
I. Initial consultation
The patient was diagnosed with pleural effusion and was discharged after anti-inflammatory treatment. Since then, she often had chest tightness and shortness of breath, but no fever, joint pain in the limbs, dry mouth and eyes, hair loss, skin rash, light allergy and other manifestations. He came to our hospital in March this year. On examination at admission, pulse: 110 beats/min, respiration: 20 breaths/min, fair general condition, moderate nutrition, free position, and cooperative examination. The skin and mucous membranes were not yellowish, the superficial lymph nodes were not enlarged, the lips and mouth were mildly cyanotic, and the jugular veins were not angry. The thorax was symmetrical bilaterally, the percussion was clear, the breath sounds of both lungs were weak, scattered dry rales could be heard, and popping sounds and wet rales could be heard in the back of both lungs and axillae. The heart border was not large on percussion, and no pathological murmurs were heard in the valves and auscultatory areas. The abdomen was flat and soft, and the liver and spleen were not detected. The spine and extremities were normal, and there was no swelling in both lower extremities. History of hepatitis and tuberculosis was denied, along with a history of drug allergy. To further clarify the cause, the patient was recommended to be admitted to the hospital.
Lung function
II. Treatment history
After admission, the patient was given relevant examinations. The routine blood tests showed WBC: 8.8X10^9/L, RBC: 4.6X10^9/L; PLT: 273X10^9/L; biochemical examinations were normal. Pulmonary CT showed fibrosis in the middle lobe of the right lung and interstitial lung of both lungs with secondary infection and pleural hypertrophy on both sides. The patient was diagnosed with idiopathic interstitial pulmonary fibrosis with secondary infection. Considering that the patient had precursor symptoms of cold, timely control of respiratory tract infection in interstitial fibrosis was a non-negligible part of the treatment. Moxifloxacin hydrochloride sodium chloride injection was given for the infection as a sedative, while tranylcypromine hydrochloride oral solution was used for cough and cough to stop cough and resolve sputum, and acetylcysteine solution for inhalation was used for antioxidant and anti-fibrosis. Finally, general treatment includes bed rest and adequate protein, calorie and vitamin supplementation.
III. Treatment effect
The patient’s clinical symptoms were significantly relieved after the combined drug treatment. Under the treatment of moxifloxacin hydrochloride sodium chloride injection and amiloride hydrochloride oral solution, the patient’s cough and sputum symptoms improved significantly, and the patient’s chest tightness and shortness of breath also disappeared significantly when he was hospitalized for 14 days, and he was subsequently discharged from the hospital.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but since idiopathic interstitial lung fibrosis cannot be completely reversed once it has formed, the patient should also be informed of the usual precautions.
1. face the disease scientifically, follow up regularly at outpatient clinics, and make sure to seek medical examination promptly if uncomfortable symptoms appear.
2, pay attention to warmth, because autumn and winter is a high incidence of lung infections, so you need to pay attention to climate change in advance to avoid aggravating the disease after cold. Prevention of various infections, as secondary infections are often the main cause of deterioration and death.
3. Although the cause of the disease is somewhat unknown, inhalation of inorganic dust, such as asbestos, coal and organic dust, can lead to viral, bacterial and fungal infections and aggravate the disease.
V. Personal insight
Through the understanding of this patient’s symptoms, interstitial pulmonary fibrosis will repeatedly worsen with age and predisposing factors, and if poorly controlled, will gradually develop pulmonary hypertension and even chronic pulmonary heart disease. In addition, because bronchiectasis is usually caused by chronic inflammation of the bronchi and surrounding lung tissues, resulting in destruction of the bronchial wall structure and causing bronchial deformation, it is important to tell this patient that this disease cannot be completely cured, but can be controlled. In addition, the following points need to be noted to control the progress of the disease at ordinary times.
1, strengthen exercise, enhance physical fitness. Avoid colds, which can induce bronchiectasis to reoccur. For patients with low immunity, drugs that increase immunity can be used.
2. patients can prevent colds by getting influenza vaccine, or pneumonia vaccine, at the change of seasons.
3, for patients with more sputum usually pay attention to the drainage of sputum, you can choose the position of drainage, such as choosing the head-low-foot-high position when lying down, you can also take appropriate oral phlegm medicine.
4, do not use antibiotics indiscriminately to prevent drug resistance and the combination of other pathogens infection.