OP- COP- BOOP Σ Α Παπίρης - PDF

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OP- COP- BOOP Σ Α Παπίρης Organizing pneumonia is a non-specific response to various forms of lung injury and is the pathological hallmark of the distinct clinical entity termed cryptogenic organizing

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OP- COP- BOOP Σ Α Παπίρης Organizing pneumonia is a non-specific response to various forms of lung injury and is the pathological hallmark of the distinct clinical entity termed cryptogenic organizing pneumonia Organizing pneumonia is one of the main reparative reactions to acute injury by the lung and reflects the incomplete resolution of inflammation within the alveoli, and to a lesser extent the distal bronchioles OP- COP- BOOP Organising pneumonia of determined cause Organising pneumonia of undetermined cause but occurring in a specific and relevant context Cryptogenic (idiopathic) organising pneumonia Causes of organizing pneumonia and associations with other conditions The typical COP syndrome Flu-likelike illness accompanied with fever, non-productive cough, malaise, anorexia and weight loss. Dyspnoea is common but usually mild and evident only on exertion. Less common symptoms are bronchorrhoea, haemoptysis (but severe haemoptysis is exceedingly rare), chest pain, arthralgia and night sweats. OP COP - BOOP Lange, a German pathologist, first described the pathological findings of BOOP in two autopsies in 1901 Davison AG, Heard BE, McAllister WAC, and Turner- Warwick ME. Cryptogenic organizing pneumonitis. Q J Med 1983; 52: Epler GR, Colby TV, McLoud TC, and Gaensler EA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med 1985; 312: Liebow & Carrington 1969 Katzenstein 1997 Müller & Colby 1997 ATS / ERS 2002 UIP UIP UIP UIP DIP DIP / RBILD DIP DIP /RBILD BIP BOOP COP AIP AIP AIP NSIP NSIP NSIP LIP LIP GCIP BOOP (COP) Κατάταξη των διάμεσων παρεγχυματικών νοσημάτων πνεύμονα Διάχυτα Παρεγχυματικά Νοσήματα Πνεύμονα Φάρμακα, Αυτοανοσία, Επαγγελματικά, Λοιμώδη, Κακοήθη κλπ ΙΔΠς Κοκκιωματώσεις Άλλα σπάνια IPF 55% Άλλες DIP 15% RBILD AIP 1% COP 3% NSIP 25% LIP 1% ATS/ERS Consensus classification of the IIPs AJRCCM 2002; 165: BOOP Επιδημιολογικά δεδομένα 6-77 ασθενείς / εισαγωγές σε μεγάλα νοσοκομεία Μη καπνιστές / καπνιστές: 2 / 1 Ομοιόμορφη κατανομή ανάμεσα στα 2 φύλα Μέση ηλικία εμφάνισης 55 έτη Alasaly K, et al. Medicine 1995; 74: Organizing pneumonia: the many morphological faces Cordier et al. divided patients with BOOP in to two groups based on radiographic patterns and used this classification to predict outcome in each group. Patients with localized disease were rarely symptomatic and had overall a good prognosis, whereas patients with diffuse disease were more often symptomatic, required treatment with corticosteroids and had variable outcomes Bronchiolitis obliterans organizing pneumonia in cancer A bar graph illustrating the relationship of radiographical patterns and the type of underlying malignancy in 43 patients with cancer and BOOP. Nodules ( ), mass ( ) and infiltrate ( ). BOOP (COP) treatment Corticosteroid therapy is the most common treatment. Complete clinical recovery, physiological improvement, and normalization of the chest film are seen in two thirds of patients Approximately one-third demonstrate persistent disease. In general, clinical improvement is rapid, within several days or a few weeks. Occasionally, recovery is quite dramatic Delay in treatment increases the risk of more severe disease and relapses BOOP (COP) treatment BOOP (COP) treatment The therapy of choice is prednisone,, 0.75 mg/kg kg/day with gradual tapering of dosage in the following several months Several day course of high-dose parenteral corticosteroid therapy may be needed in patients with rapidly progressive COP The usual duration of corticosteroid therapy is 6 to 12 months Relapse is seen in one-third of the patients if a short treatment course of less than 3 months of corticosteroid therapy is used Prednisone can eventually be given on an alternate day dosage. Some of these patients require low-dose maintenance prednisone therapy for several years to maintain stabilization with chronic symptoms start with 0.75 mg/kg/day of prednisone for 4 weeks, then 0.5 mg/kg/day for 6 weeks, then 20 mg/day for 6 weeks, then 5 mg/day for 6 weeks. The occurrence of relapses in COP could be regarded as a relatively benign and acceptable phenomenon, rather than a dangerous event requiring aggressive management. 1 delayed treatment increases the risk of relapses; 2 mild cholestasis identifies a subgroup of patients with multiple relapses; 3 relapses do not affect outcome, and prolonged therapy to suppress relapses appears unnecessary; 4 a standardized treatment allows a reduction in steroid doses. Difffuse Panbronchiolitis Cystic Fibrosis Bronchiectasis Chronic Sinusitis Chronic otitis media Nasal poliposis Chronic Bronchitis BOOP While the use of macrolide therapy for treatment of COP/BOOP is feasible, the decision to use it should be made on a case-by by-case basis. Before any definitive recommendations can be made, more information is needed, such as which patients are likely to respond to macrolide therapy, and the proper dosage and duration of macrolide therapy.
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