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Clinical Advances in the Diagnosis and Therapy of the Interstitial Lung Diseases

Department of Medicine, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California–San Francisco, San Francisco, California

Correspondence and requests for reprints should be addressed to Talmadge E. King, Jr., M.D., San Francisco General Hospital, Room 5H22, 1001 Potrero Avenue, San Francisco, CA 94110. E-mail: tking{at}medsfgh.ucsf.edu

ABSTRACT

The last century experienced remarkable advances in the classification, diagnosis, and understanding of the pathogenesis of the interstitial lung diseases. Technological advances, particularly physiologic testing, lung imaging studies, bronchoalveolar lavage, surgical lung biopsy, and histopathologic assessment, improved our understanding of these entities. In particular, the advent of high-resolution computed tomography, the narrowed pathologic definition of usual interstitial pneumonia, and recognition of the prognostic importance of separating usual interstitial pneumonia from other idiopathic interstitial pneumonia patterns have profoundly changed the approach to these processes. Most recently, genetic medicine, the use of new technologies (e.g., microarrays, mass spectroscopic analysis of proteins, and laser capture microdissection), and the development of animal models have had a major impact on understanding the pathogenesis and potential molecular targets for interfering with fibrogenesis. This article highlights some of the advances and changes in clinical practice that took place in the management of patients with interstitial lung diseases over the last century.

Key Words: high-resolution computed tomography • idiopathic pulmonary fibrosis • interstitial lung diseases • usual interstitial pneumonia • nonspecific interstitial pneumonia • physiology • sarcoidosis

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