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Lungengerüsterkrankungen

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Therapie innerer Krankheiten

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Zusammenfassung

Die neue pathologische Klassifikation der idiopathischen interstitiellen Pneumonien von Katzenstein u. Myers (1998) hat auch die therapeutische Vorgehensweise bei dieser Erkrankungsgruppe verändert. Durch die Definition von pathohistologi-schen Entitäten, denen klinische Krankheitsbilder mit unterschiedlicher Prognose zugeordnet werden können, wurde eine Differenzierung der Behandlungsstrategien ermöglicht. Für die Entitäten DIP („desquamative interstitial pneumonia“), RBILD („respiratory bronchiolitis interstitial lung disease“) und NSIP („nonspecific interstitial pneumonia“) ist die konventionelle immunsuppressive Therapie unter Einsatz von Corticosteroiden und Zytostatika wie Azathioprin oder Cyclophospha-mid erfolgversprechend mit Aussicht auf eine mittelfristig relativ günstige Prognose. Im Gegensatz dazu profitieren von diesem Behandlungsansatz nach objektiven Kriterien nur zwischen 11 und 32% der Patienten, bei denen eine UIP („usual interstitial pneumonia“) vorliegt. Im Fall der UIP müssen deshalb im Einzelfall die Risiken einer Langzeitimmunsuppression und der zu erwartende therapeutische Nutzen kritisch gegeneinander abgewogen und der Behandlungserfolg engmaschig überprüft werden. Eine besonders ungünstige Prognose trotz immun-suppressiver Therapie mit einer Mortalität von 62% innerhalb von 2 Monaten weist die AIP („acute interstitial pneumonia“) auf, die damit am ehesten das histologische Korrelat des historischen Hamman-Rich-Syndrom repräsentiert. Für keine Form der idiopathischen interstitiellen Pneumonien stehen gegenwärtig kurative Therapieansätze zur Verfügung. Diese Sachlage erfordert intensive Überlegungen zur Ätiopathogenese, damit die Heilungschancen mittels Beseitigung exogen-ätiologischer oder endogen-pathogenetischer Kausalfaktoren voll genutzt werden können. Hieraus ergeben sich möglicherweise auch Wege für eine begründete Prophylaxe.Schließlich sollte versucht werden, sekundäre und komplikative Krankheitserscheinungen günstig zu beeinflussen. Für einen Teil der Patienten stellt heute die Lungentransplantation eine realistische Behandlungs-möqlichkeit dar.

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Authors
  1. C. Vogelmeier
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  2. J. Behr
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© 2003 Springer-Verlag Berlin Heidelberg

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Vogelmeier, C., Behr, J. (2003). Lungengerüsterkrankungen. In: Therapie innerer Krankheiten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-10475-0_24

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  • DOI: https://doi.org/10.1007/978-3-662-10475-0_24

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-10476-7

  • Online ISBN: 978-3-662-10475-0

  • eBook Packages: Springer Book Archive

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