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Monday, July 24, 2017
Desquamative interstitial lung disease
I was diagnosed with DIP September 2006 by lung biopsy. I have found very little in my research pertaining to this particular type of Pulmonary Fibrosis. The "Pulmonary Fibrosis Foundation" Handbook on page 10, states, "Remission occurs in approximately 20% of patients with smoking cessation. 75% will respond to corticosteroids and COMPLETE RECOVERY IS POSSIBLE" (capitals mine). Can DIP easily go into remission and be stopped? Other things I have read said this type, though it has a longer mortality rate of about 10 years, compared to Idiopathic Interstitial Lung Disease which only has 3-5 years is still 100%terminal. Another question I have is that everything I have read about DIP says it is caused from smoking or being around passive smoking. I smoked at age 16 for about 6 months and did not even inhale. I am now 57 years old and never had any issues with my lungs before. Is it possible that this was caused by something else? My pulmonologist wants me to start Prednisone at 60mg. But since I am obese, have major depression, hypertension and Reflex Sympathetic Dystrophy, "Transient" RA, Osteoarthritis as well as GERD, I am worried about the side effects worsening some or all of these conditions. How well does DIP respond to Prednisone or is there some other medication that might be more effective? Thank you so much for any information about this disease. I am scared but want to try to live as healthy as possible for as long as possible.
DIP is most commonly due to tobacco smoking; smoking 40 years ago would likely not be related. In a minority of patients, it can occur in non-smokers. Environmental smoke can also cause DIP if there is high exposure on a regular basis.
It is very difficult to make a confident diagnosis of DIP without a surgical lung biopsy and even then, confident diagnosis sometimes requires consultation with a pulmonary pathology specialist. The first step is to be sure of the diagnosis. This is especially true because there are a number of rheumatoid-associated interstitial lung diseases that could be a factor in your specific case.
If there are minimal symptoms and minimal changes on the pulmonary function tests, then eliminating smoke exposure alone may be sufficient. In other patients, medications may be necessary. If corticosteroids (eg, prednisone) cannot be used, then other immunosuppressive medications such as Imuran and Cytoxan can be used as alternatives.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University