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Interstitial lung disease

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Related Terms
  • Alveoli, antifibrotics, anti-rejection medication, blood gases test, bronchoalveolar lavage, bronchoscope, bronchoscopy, chest x-ray, collapsed lung, cor pulmonale, corticosteroids, cytotoxic drugs, dyspnea, fibrosis, exercise tests, gastroesophageal reflux disease, lung biopsy, hypertension, hypoxemia, idiopathic pulmonary fibrosis, immunosuppressive agents, IPF, interstitium, lung disease, lung scarring, lung tissue, lung transplant, PFT, pneumonitis, pneumothorax, pulmonary disease, pulmonary fibrosis, pulmonary function tests, pulmonary hypertension, respiratory failure, respiratory infection, right-sided heart failure, thoracoscopic surgery, transbronchial biopsy.

Background
  • Interstitial pulmonary lung disease (ILD), also known as interstitial pulmonary fibrosis, is a general term that describes more than 100 chronic lung disorders that damage the interstitium. The tissue located between the airs sacs of the lungs is called the interstitium.
  • The disease affects the lungs in three ways. First, the lung tissue is damaged. Second, the interstitium becomes inflamed. Finally, fibrosis (scarring) begins in the alveoli (air sacs) and interstitium, and the lung becomes stiff, making it difficult to breathe.
  • Lung scarring is irreversible. Corticosteroid drugs, the most common treatment, can sometimes slow the damage of interstitial lung disease. However, many patients never regain full use of their lungs.
  • While most cases of interstitial lung disease develop gradually with few warning signs, it may develop suddenly in some patients. Although doctors can pinpoint why some cases of interstitial lung disease occur, most are idiopathic (have no known cause). The most common type of idiopathic ILD is called interstitial pneumonitis, which causes patches of inflammation in the lung without infection.
  • More than 200,000 people have been diagnosed with ILD in the United States, and nearly five million people have been diagnosed worldwide. It is estimated that more than 40,000 patients die each year from ILD worldwide. The outlook for patients with ILD varies depending on the underlying cause of the disease.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Lung Association. Interstitial Lung Disease and Pulmonary Fibrosis. . Accessed May 15, 2009.
  2. National Jewish Medical and Research Center. About Interstitial Lung Disease. . Accessed May 15, 2009.
  3. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 15, 2009.
  4. Pulmonary Fibrosis Foundation. . Accessed May 15, 2009.
  5. Chapman, Jeffrey. Idiopathic Interstitial Lung Disease. The Cleveland Clinic. . Accessed May 15, 2009.

Causes
  • Drugs: Nearly 50 drugs can damage the interstitium of the lungs, especially chemotherapeutic agents, anti-arrhythmic agents, certain psychiatric medications and some antibiotics (like ciprofloxacin).
  • Infections: Pulmonary infections can lead to ILD. These include viral infections (like cytomegalovirus, which occurs most often in HIV patients), bacterial infections (like pneumonia), fungal infections (like histoplasmosis, which is present in the southern United State and caused by Histoplasma capsulatum) and parasitic infections (like lung fluke worms).
  • Occupation and environmental factors: Long-term exposure to a number of toxins or pollutants can potentially cause lung damage. For instance, workers who continually inhale silica dust (silicosis), asbestos fibers (asbestosis) or hard metal dust are especially at risk of developing ILD. Exposure to certain chemical fumes (like sulfuric acid) and ammonia or chlorine gases may also cause ILD. In addition, chronic exposure to a wide range of substances, including grain dust, sugar cane and animal droppings, may also cause serious lung damage. Other substances, such as moldy hay, can damage the lungs if they cause a hypersensitivity reaction in the lungs (hypersensitivity pneumonitis). Even bacterial or fungal overgrowth in poorly maintained humidifiers and hot tubs can potentially cause lung damage.
  • Radiation: A small percentage of people who undergo radiation therapy for lung or breast cancer experience symptoms of lung damage months or even years after the initial treatment. The severity of the damage depends on how much of the lung was exposed to radiation, the total amount of radiation administered, whether chemotherapy was also used and whether the individual had an underlying lung disease.
  • Other medical conditions: Interstitial lung disease can occur with other disorders. In many cases those conditions do not directly attack the lungs. Instead, they involve systemic processes that affect tissue throughout the body. Among these are connective tissue disorders and hematological diseases, including systemic lupus erythematosus (autoimmune disorder that causes skin lesions), rheumatoid arthritis, dermatomyositis (rheumatic disease that causes inflammation of the muscles and skin), polymyositis (autoimmune disorder that causes inflammation and weakness in the muscles), Sjogren's syndrome (autoimmune disorder that causes immune cells attack and destroy the glands that produce tears and saliva) and sarcoidosis (fibrotic disease that causes inflammation of the lymph nodes and organs).
  • Idiopathic pulmonary fibrosis: Although doctors can determine why some people develop interstitial lung disease, in most cases the cause is unknown. Disorders with no known cause are considered idiopathic. There are several different types of idiopathic ILD.
  • Interstitial pneumonitis is the most common idiopathic interstitial lung disease, accounting for more than half of all cases. Interstitial pneumonitis develops in patches inside the lungs. Some parts of the lung are healthy while others are inflamed and others have scar tissue. The disease affects twice as many men as women, and usually develops between the ages of 40 and 70. Pneumonitis is not the same as pneumonia. Pneumonitis is lung inflammation without infection, while pneumonia is lung inflammation that is caused by an infection. Also, pneumonia usually affects one or two areas of the lungs, whereas pneumonitis involves all five lobes.
  • Other, less common types of idiopathic pulmonary fibrosis include nonspecific interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia (inflammation of the bronchioles and surrounding tissue in the lungs), respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonitis (chronic lung inflammation that primarily affects smokers), lymphocytic interstitial pneumonitis and acute interstitial pneumonitis.
  • Certain individuals are at an increased for developing idiopathic pulmonary fibrosis. For instance, people who smoke are more likely to develop the disease than people who do not. The risk appears to increase with the number of years and the amount of cigarettes smoked. Tobacco smoke temporarily paralyzes the cilia (small hairs) that line the bronchial tubes. The cilia are designed to filter irritants out of the airways. However, when the cilia are paralyzed, irritants remain in the bronchial tubes and infiltrate the alveoli, inflaming the tissue and breaking down the elastic fibers.
  • Researchers are have investigated whether gastroesophageal reflux disease (when stomach acid or bile back up into the esophagus) increases the chances of developing ILD.

Symptoms
  • Dyspnea (shortness of breath) is the most common symptom of ILD. Patients may also experience a dry cough (without sputum). When the disease is severe and prolonged, heart failure and swelling of the legs may occur.
  • Less common symptoms of ILD include wheezing, weight loss, cyanosis (bluish discoloration of the skin or mucous membranes caused by lack of oxygen in the blood) and clubbing of the fingers (enlarged fingertips with nails that curve over the tops of the fingertips).

Diagnosis
  • High-resolution computerized tomography (HRCT) scan: A high-resolution computerized tomography (HRCT) scan is the most common test used to diagnose ILD. The HRCT scan produces much more detailed cross-sectional images than a traditional chest x-ray or conventional CT-scan. A qualified healthcare provider can detect abnormalities in the lung tissue with images from an HRCT scan.
  • Pulmonary function tests (PFTs): Noninvasive pulmonary function tests (PFTs) are conducted to determine how well the lungs are functioning. During the test, the patient is asked to blow into a device called a spirometer. The device measures how much air the lungs can hold, as well as the airflow in and out of the lungs. As the scarring of the lungs worsens, the patient is able to take less air in and blow less out. Full PFTs are also available. These tests measure the amount of gases exchanged across the membrane between the alveolar wall and capillary membrane.
  • Exercise tests: ILD symptoms are worse when patients are physically active. A qualified healthcare provider may assess the patient's lung function during exercise (usually on a treadmill or stationary bike). The patient's blood pressure and oxygen levels may also be monitored during the physical activity.
  • Bronchoscopy (transbronchial biopsy): In many cases, a biopsy is necessary to diagnose interstitial lung disease. During a transbronchial biopsy, the physician passes a flexible, fiber-optic tube (bronchoscope) through the mouth and into the lungs. One or more small tissue samples are removed and examined in the laboratory. The procedure is performed on an outpatient basis using a local anesthetic. The most common side effects include sore throat and hoarseness, which may last a few days. Serious risks include bleeding and a collapsed lung (pneumothorax).
  • Bronchoalveolar lavage: During a bronchoalveolar lavage, a physician injects saline (saltwater) through a bronchoscope into part of the lung, and then immediately suctions it out. The fluid sample contains cells from the air sacs in the lungs. While this test samples a larger area of the lung than other procedures do, the results may not provide enough information to diagnose a specific ILD. This test is usually used to monitor the progress of a patient's lung disorder or to help determine the best treatment.
  • Chest X-ray: A chest X-ray is typically used to help exclude conditions that cause symptoms that are similar to interstitial lung disease, including emphysema and a collapsed lung.
  • Video-assisted thoracoscopic surgery: If other tests do not confirm a diagnosis, a thoracic surgeon may perform a surgical lung biopsy. During this procedure, an endoscope (flexible tube with a small camera) is inserted through a small incision between the ribs. The camera sends images to a video monitor. Surgical instruments are then inserted through another incision and small tissue samples are removed from two or three sites on the lungs. Risks of the procedure include infection, bleeding, air leakage in the lung wall and pneumonia.
  • Blood gases test: A blood gases test may be performed to determine the amount of oxygen present in the blood. Patients who have ILD have decreased levels of oxygen in their blood. A blood sample is taken from an artery. The sample may be taken from the radial artery in the wrist, the femoral artery in the groin or the brachial artery in the arm. In normal adults, the partial pressure of oxygen ranges from 75-100mmHg, the partial pressure of carbon dioxide ranges from 35-45mmHg and the oxygen saturation ranges from 94-100%.

Treatment
  • General: Treatment and prognosis vary depending on the particular lung disease. Patients who smoke tobacco are encouraged to quit. Patients should discuss treatment options with their qualified healthcare providers.
  • Antifibrotics: Antifibrotics have been used to help reduce the development of scar tissue. It has been suggested that the medication may help slow the progression of lung damage without suppressing the immune system. Colchicine and D-penicillamine have not shown positive results in clinical trials. However, pirfenidone was recently shown to have some potential benefit in a small phase II trial, and follow-up studies are ongoing. Further research is needed to determine whether antifibrotics can effectively reduce scar tissue in ILD patients.
  • Corticosteroids: Patients are initially treated with corticosteroids to reduce inflammation in the lungs. However, these medications only help about 20% of ILD patients. Individuals who have a non-idiopathic disorder are most likely to benefit from anti-inflammatory treatment. Steroids rarely alleviate ILD symptoms with idiopathic pulmonary fibrosis, and if they do, the benefits are usually temporary. In general, steroids have to be taken for several months until symptoms improve. The patient is tapered off treatment once the symptoms improve. If corticosteroids are taken for long periods of time or in large doses, side effects may include glaucoma, bone loss (which can may lead to osteoporosis), high blood sugar levels (which may lead to type 2 diabetes), poor wound healing and increased susceptibility to infection.
  • Cytotoxic drugs: Cytotoxic drugs like azathioprine and cyclophosphamide have been used to treat ILD. The drugs are prescribed when steroid treatment is unsuccessful, or they are used in combination with steroids as a first-line treatment. Serious side effects, including reduced production of red blood cells, skin cancer and lymphoma, have been reported with cytotoxic drugs.
  • Lung transplant: A lung transplant may be necessary for patients who have severe ILD and do not respond to other treatment options. In order to be considered for a transplant, patients must not smoke or agree to quit smoking. They must be healthy enough to undergo surgery and post-transplant treatments. In addition, they must be willing to follow the medical program outlined by the rehabilitation and transplant team.
  • In most cases, single-lung transplants are more successful in people with ILD than double-lung transplants are.
  • The survival rate for a lung transplant is lower than it is for other types of transplants. Organ transplant recipients must take immunosuppressive (anti-rejection) drugs (like cyclosporine) for the rest of their lives. These agents make them more susceptible to infections and diseases.
  • Oxygen therapy: While oxygen therapy cannot prevent lung damage, it can make breathing and exercise easier for ILD patients. Oxygen therapy may also prevent or reduce complications associated with low oxygen levels and reduce blood pressure on the right side of the heart. Most patients receive oxygen during sleep or exercise. However, some patients may use it continually.
  • Pulmonary rehabilitation: Pulmonary rehabilitation is a program for patients with chronic lung disease. It includes both medical care and support. The goal is to help patients with ILD live full, satisfying lives. Programs focus on exercise, including breathing techniques, as well as education, emotional support and nutritional counseling. In most cases, rehabilitation programs include a team of healthcare professionals, including doctors, nurses, rehabilitation specialists, dietitians and social workers. Programs vary widely.

Integrative therapies
  • Good scientific evidence:
  • Bromelain: Some physicians use bromelain, an enzyme derived from pineapple, to help reduce inflammation. It is sometimes recommended to be taken with turmeric (Curcuma longa), which may enhance the effects of bromelain.
  • Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceaefamily. Use cautiously with a history of bleeding disorders, stomach ulcers, or heart, liver, or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Probiotics: Limited evidence with day care children suggests supplementation with Lactobacillus GG may reduce number of sick days, frequency of respiratory tract infections, and frequency of related antibiotic treatments. Fermented milk (with yogurt cultures and L. casei DN-114001) may reduce the duration of respiratory infections in elderly people. More research is needed to make a firm conclusion.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Yoga: Limited human study exists for yoga in the treatment of lung diseases, such as bronchitis, fluid around the lungs (pleural effusion), or airway obstruction. Better-designed research is necessary before any conclusions can be made.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Unclear or conflicting scientific evidence:
  • Arginine: Early study suggests that arginine supplements may decrease the risk of respiratory infections. Large, well-controlled studies are needed to clarify this relationship.
  • Avoid if allergic to arginine, with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control blood sugar levels.
  • Cat's claw: Cat's claw may have anti-inflammatory effects, which has led to research of this herb for conditions such as allergies. Large, high-quality human studies are needed comparing effects of cat's claw alone vs. placebo.
  • Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, lupus). Use cautiously with bleeding disorders or a history of stroke, or if taking drugs that may increase the risk of bleeding. Discontinue use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
  • Chiropractic: There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques for respiratory tract infections such as pneumonia. Additional study is needed in this area.
  • Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis (inflammation of the arteries), or unstable spondylolisthesis (a slippage of the vertebrae in the spine). Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution during cervical adjustments.
  • Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants, and is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussel sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Chlorophyll may help to regulate immunity in patients with active destructive pneumonia. Further studies are required to further elaborate on the immune-modifying effects of chlorophyll.
  • Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressants or antidiabetes agents. Avoid if pregnant or breastfeeding.
  • Cordyceps: Cordyceps is a fungus found mainly in China, Nepal, and Tibet. Most studies using cordyceps for bronchitis have been low quality comparative controlled studies conducted in China. Although results are promising, more studies should be performed before recommending cordyceps for respiratory disorders.
  • Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking anticoagulants, immunosuppressants, hormonal replacement therapy, or birth control pills. Avoid with myelogenous types of cancers. Avoid if pregnant or breastfeeding.
  • Dandelion: Research in laboratory animals suggests that dandelion root may possess anti-inflammatory properties. There is a lack of well-conducted human studies currently available in this area.
  • Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Potassium blood levels should be monitored. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Euphorbia: Euphorbia balsamifera has been studied in patients with acute dental pulpitis, and may be comparable to that of pulpal nerve caustics. Additional study is necessary to make a recommendation for inflammation.
  • Avoid if allergic or hypersensitive to pollen from Euphorbia fulgens. Use cautiously with history of Epstein Barr virus infection or stomach conditions. Avoid if pregnant or breastfeeding.
  • Eyebright: Several iridoid glycosides isolated from eyebright, particularly aucubin, may possess anti-inflammatory properties comparable to those of indomethacin (a nonsteroidal anti-inflammatory drug). However, there is currently insufficient evidence to recommend for or against eyebright as an anti-inflammatory agent.
  • Avoid with a known allergy or hypersensitivity to eyebright. Hypersensitivity to members of the Scrophulariaceae family may lead to a cross-sensitivity reaction. Use cautiously as an eye treatment, particularly homemade preparations, due to the risk of infection if not sterile. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.
  • Garlic: Garlic (Allium sativum) may improve the immune system's ability to fight off infection, such as a cold virus, and may reduce the severity of upper respiratory tract infections. However, this has not been demonstrated in well-designed human studies.
  • Caution is advised when taking garlic supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Garlic supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
  • Ginkgo: Based on early study, ginkgo may be effective in treating pulmonary interstitial fibrosis. Further research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceae family. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding due to insufficient scientific evidence of safety. The risk of bleeding associated with ginkgo may be dangerous during pregnancy.
  • Ginseng: Several studies have looked at the effects of ginseng in a variety of lung conditions. Ginseng (CVT-E002) may be effective for preventing respiratory infections caused by the respiratory syncytial virus. More study is needed in this area.
  • Avoid ginseng if known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Iodine: Based on limited available clinical study, regular oropharyngeal application of povidone-iodine may decrease the prevalence of ventilator-associated pneumonia in patients with severe head trauma. Evidence in this area is not conclusive.
  • Reactions to iodine can be severe, and deaths have occurred. Avoid iodine-based products if allergic or hypersensitive to iodine. Do not use for longer than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Avoid sodium iodide with gastrointestinal obstruction. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Iodine is considered safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Kiwi: Kiwi (Actinidia deliciosa, Actinidia chinensis) may be beneficial in lung conditions such as upper respiratory infections (including colds). However, scientific data is lacking. Limited available study suggests that kiwi, and other fruits high in vitamin C, may have a protective effect on lung conditions in children, especially wheezing. However, properly controlled studies are lacking at this time on the use of kiwi for prevention of respiratory problems.
  • Avoid if allergic or hypersensitive to kiwi, latex, birch pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds and related substances. Kiwi is generally considered safe when taken in amounts naturally found in foods. Use cautiously with anti-platelet drugs like aspirin, cilostazol or clopidogrel. Use cautiously with hormone therapies or serotonergic drugs. Avoid if pregnant or breastfeeding. The amount found in foods appears to be safe in most people.
  • L-carnitine: Currently there is insufficient evidence to support the use of carnitine for respiratory distress.
  • Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Licorice: Many medical conditions are marked by inflammation. Because licorice can affect the metabolism of steroids, licorice is sometimes used to help decrease inflammation. Additional study is needed to make a conclusion.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Lutein: Lutein is found in high levels in foods such as green vegetables, egg yolk, kiwi fruit, grapes, orange juice, zucchini, squash, and corn. For some commercially available supplements, lutein is extracted from marigold petals.There is early evidence of a role of carotenoids in lung function and severity of respiratory infections. More research is needed to make a conclusion.
  • Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for cardiovascular disease or cancer. Avoid if pregnant or breastfeeding.
  • Physical therapy: Lung hyperinflation is a technique used by physiotherapists to mobilize and remove excess lung secretions, reinflate areas of pulmonary collapse, and improve oxygenation. Early evidence suggests that chest physiotherapy techniques such as postural drainage, external help with breathing, percussion, and vibration are not better that receiving advice of deep breathing instructions in the treatment of serious pneumonia. Additional research is needed to better understand the effectiveness of physical therapy for pulmonary conditions.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist; however, complications are possible. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Probiotics: Although some clinical studies support the use of probiotics for pneumonia, there is insufficient evidence to draw any firm conclusions.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Reflexology: It is unclear whether reflexology can benefit patients with lung diseases. More research is needed in this area.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Rhodiola: Early study suggests that rhodiola may protect against acute lung injury. Further studies are needed before a conclusion can be made.
  • Avoid if allergic or sensitive to Rhodiola. Use cautiously in people with diabetes, cardiovascular disease, or neurological or psychiatric disorders. Rhodiola is not recommended for use during pregnancy or breastfeeding.
  • Sea buckthorn: Sea buckthorn (Hippophae rhamnoides) is found throughout Europe and Asia, particularly eastern Europe and central Asia. The plant's orange fruit and the oil from its pulp and seeds have been used traditionally for lung conditions, including coughing and phlegm reduction. Human study supports the use of sea buckthorn in pneumonia, although more clinical research is necessary.
  • Avoid if allergic or hypersensitive to sea buckthorn, its constituents, or members of the Elaeagnaceae family. Use cautiously in patients with cancer, high blood pressure, or bleeding disorders. Avoid doses higher than those found in foods if pregnant or breastfeeding.
  • Siberian ginseng: Preliminary study of a combination product containing Siberian ginseng suggests the potential for reduced symptoms associated with respiratory tract infections. Due to the presence of other ingredients in this product, the effect of Siberian ginseng cannot be determined, and further study is required.
  • Avoid in patients with a known allergy/hypersensitivity to Siberian ginseng, its constituents, related products, or members of the Araliaceae family. Use cautiously in patients with blood pressure disorders, bleeding disorders or in those using anticoagulant or antiplatelet agents, diabetes or in those using antidiabetic agents, autoimmune disorders, psychiatric disorders, or impaired gastrointestinal function. Use cautiously in patients taking digoxin, CNS depressants, or steroids. Avoid in children or pregnant and lactating women.
  • Thymus extract: Preliminary evidence suggests that both intramuscular and oral thymus extract may be useful for reducing symptoms of respiratory tract infections. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Laboratory and animal studies show activity against inflammation for turmeric and its constituent curcumin. Reliable human research is lacking.
  • Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with history of bleeding disorders, immune system deficiencies, liver disease or gallstones. Use cautiously with blood-thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.
  • Vitamin A: Limited available study did not find an effect of a moderate dose of vitamin A supplementation on the duration of uncomplicated pneumonia in underweight or normal-weight children aged younger than five years. However, a beneficial effect was seen in children with high basal serum retinol concentrations.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity may occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Vitamin C: Vitamin C (ascorbic acid) is a water-soluble vitamin that is necessary for the body form collagen in bones, cartilage, muscle, and blood vessels. It also aids in the absorption of iron. Vitamin C may play a role in pneumonia prevention. However, further research is needed.
  • Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, liver cirrhosis, gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). It is unclear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.
  • Vitamin E: Daily supplementation with oral vitamin E may be beneficial for respiratory infection prevention. Additional research is warranted.
  • Caution is advised when taking vitamin E supplements, as adverse effects and drug interactions are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Avoid if pregnant or breastfeeding, unless otherwise directed by a doctor. Use cautiously with bleeding disorders or if taking blood thinners.
  • Wild indigo: Preliminary evidence has shown immunostimulative properties in wild indigo extracts. However, available clinical studies have been conducted using the combination called Esberitox N (Echinaceae purpureae et pallidae radix, Baptisiae tinctoriae radix and Thujae occidentalis herba). Additional study is needed using wild indigo alone to better determine effectiveness for respiratory tract infections.
  • Avoid if allergic or hypersensitive to wild indigo, its constituents, or members of the Fabaceae family. Use cautiously if taking immunosuppressive agents. Avoid if pregnant or breastfeeding.
  • Yerba santa: Chumash Native Americans and other California tribes have used yerba santa (Eriodictyon californicum) and other related species (Eriodictyon crassifolium, Eriodictyon trichocalyx) for many centuries in the treatment of pulmonary conditions, saliva production, and to stop bleeding of minor cuts and scrapes. There is also clinical history of the use of Eriodictyon extracts in influenza, bacterial pneumonia, asthma, bronchitis, and tuberculosis. However, additional study is needed.
  • Avoid if allergic or hypersensitive to Eriodictyon species. Use cautiously in children. Avoid if pregnant or breastfeeding.
  • Zinc: Results from large clinical trials suggest that supplementation with zinc may reduce the incidence of lower respiratory infections. However, a recent study does not support the use of zinc supplementation in the management of acute lower respiratory infections requiring hospitalization in indigenous children living in remote areas. Due to conflicting results, further research is needed before a conclusion can be drawn. Future studies could examine whether these adult populations have a similar response.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Zinc: Limited available study found that zinc supplementation does not seem to lessen the duration of tachypnea, hypoxia, chest indrawing, inability to feed, lethargy, severe illness, or hospitalization for pneumonia in children.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

Prevention
  • Avoid routine exposure to occupational or environmental factors that may cause ILD.
  • Avoid tobacco cigarettes because smoking is strongly associated with idiopathic ILD.
  • Immunizations with the influenza (flu) vaccine (yearly) and pneumococcal pneumonia vaccine (every five to seven years) are recommended for individuals who are at risk for developing ILD because they may help prevent infection.
  • It is best to treat underlying medical conditions, such as respiratory infections, as quickly and efficiently as possible to avoid developing ILD or secondary complications.

Complications
  • Hypoxemia (low blood oxygen levels): ILD reduces the amount of oxygen the body can take in, which causes a low level of oxygen in the bloodstream. Low oxygen levels can interfere with the body's basic functioning, and severely low levels can be potentially life threatening.
  • Pulmonary hypertension (high blood pressure in the lungs): Pulmonary hypertension only affects the arteries in the lungs. This condition occurs when the smallest arteries and capillaries are compressed and ultimately destroyed by scar tissue. This causes increasing resistance of blood flow in the lungs, which raises pressure in the pulmonary arteries. Pulmonary blood pressure is measured by inserting a small catheter in the right side of the heart or by a noninvasive echocardiogram. Pulmonary hypertension can become progressively worse and may cause death.
  • Cor pulmonale (Right-sided heart failure): The right side of the heart pumps blood to the lungs, and it is less muscular than the left side. Cor pulmonale occurs when the heart's right ventricle has to pump harder than usual to move blood through blocked pulmonary arteries. At first, the walls of the right chamber thicken and dilate to compensate for the increased work. However, this is a temporary fix. Eventually, the right ventricle fails from the extra strain.
  • Respiratory failure: Respiratory failure is usually the final stage of chronic lung disease. This condition occurs when the oxygen levels in the blood become dangerously low or carbon dioxide levels become dangerously high. Extremely low blood oxygen levels can result in arrhythmias (irregular heartbeats) and unconsciousness. Extremely high levels of carbon dioxide can cause symptoms such as sleepiness and confusion. Respiratory failure is a serious condition that may be fatal.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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