Efficacy of Early Steroid Therapy in Acute Interstitial Pneumonia

Lee, Kye Young; Jee, Young Koo; Kim, Youn Seup; Myong, Na Hye; Park, Jae Seuk

Abstract

BACKGROUND: Steroid therapy has been shown to improve the clinical outcome in acute respiratory distress syndrome (ARDS) patients wit histological evidence of fibroproliferation in the lung tissue and no identifiab le soure of infection. Because the histopathological features of acute interstitial pneumonia (AIP) are identical with that of ARDS, early steroid therapy was used in AIP patients who had histological evidence of fibroproliferation in the lung tissue and no identifiable source of infection. We analyzed seven years of our experience to evaluate the efficacy of early steroid therapy in AIP.
METHODS
A retrospective review was performed on AIP patients who received steroid therapy within 7 days of mechanical ventilatory support in Dankook University Hospital between May 1995 and May 2002. AIP was diagnosed clinically by ARDS without a known cause of the etiology and pathologically by a lung biopsy showing a fibroproliferative stage of diffuse alveolar damage. The clinical response and physiologic parameters were evaluated during steroid therapy.
RESULTS
Five AIP patients received intravenous methylprednisolone (1-2mg/kg every 6 hours) after 0.6+/-1.7 days of mechanial ventilatory support. Lung biopsies were performed after 1.8+/-0.4 days of mechanical ventilatory support. Four patients(80%) survived and were extubated after 2.8+/-0.4 days of steroid therapy with improvement in the PaO2 ration (127.4+/-10.1 at day 0 to 223.8+/-37.6 at day 7) by steroid therappy. However, one patient(20%) died of respiratory failure after 15 days of steroid therapy.
CONCLUSION
Early steroid therapy sppears to be beneficial in AIP patients without evidence of infection. However, as our study group was too small, futher large scale studies to define the effectiveness of steroids are required.