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Aktuelle Klassifikation interstitieller Lungenerkrankungen

Current classification of interstitial pulmonary diseases

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Zusammenfassung

Hintergrund

Die Konsensusklassifikation der idiopathischen interstitiellen Pneumonien (IIP, Lungenfibrose) aus dem Jahr 2002 hat 2013 eine in Teilen grundlegende Revision erfahren.

Fragestellung

Was sind die wesentlichen Kernpunkte des neuen Consensus Statements der American Thoracic Society (ATS)/European Respiratory Society (ERS) von 2013 für die Klassifikation der Lungenfibrosen?

Material und Methode

Auswertung der zur Verfügung stehenden Literatur zum Thema „Lungenfibrose“ in PubMed.

Ergebnisse

Der interdisziplinäre Ansatz (Pneumologie, Radiologie, Pathologie) zur Diagnosefindung wird gestärkt. Die unspezifische interstitielle Pneumonie (NSIP) ist jetzt eine eigenständige, spezifische Lungenfibroseform. Die raucherassoziierte respiratorische Bronchiolitis mit interstitieller Lungenerkrankung (RB-ILD) wird in der Klinik nun häufig ohne Lungenbiopsie auf der Grundlage der Klinik, Computertomographie sowie der bronchoalveolären Lavage diagnostiziert. Der heterogene Verlauf der idiopathischen Lungenfibrose (IPF) wird anerkannt. Der Begriff „akute Exazerbation“ wird nun im Wesentlichen bei akuten Schüben (< 30 Tage) auf dem Boden einer chronischen Fibrose (IPF und NSIP) verwendet. Es wird erkannt, dass es notwendig ist, einen klinischen Algorithmus zur Klassifizierung und für das Management von IIP-Fällen bereitzustellen. Die pleuroparenchymale Fibroelastose (PPFE) wird als seltene eigenständige spezifische Lungenfibroseform anerkannt. Ein sich schnell entwickelndes Gebiet der molekularen Marker ist vielversprechend für eine Verbesserung der diagnostischen Ansätze.

Schlussfolgerungen

Das ATS-/ERS-Update ist eine Ergänzung zum vorangegangenen Klassifizierung der Lungenfibrosen von 2002. Es umreißt Fortschritte in den letzten Jahren und zeigt potenzielle Bereiche für künftige Neuerungen auf.

Abstract

Background

The consensus classification of idiopathic interstitial pneumonia (IIP, also known as pulmonary fibrosis) in 2002 has undergone a significant revision in 2013.

Objectives

What are the key points of the new consensus statement of the American Thoracic Society (ATS)/European Respiratory Society (ERS) from 2013 for the classification of pulmonary fibrosis?

Material and methods

Evaluation of the available literature on the subject of pulmonary fibrosis in Pubmed.

Results

The interdisciplinary approach (i.e. pulmonology, radiology and pathology) for the diagnosis of lung fibrosis subtypes is highlighted. Nonspecific interstitial pneumonia (NSIP) is now a separate specific form of pulmonary fibrosis. Smoking-associated respiratory bronchiolitis with interstitial lung disease (RB-ILD) is now frequently diagnosed without a lung biopsy on the basis of clinical findings, computed tomography and bronchoalveolar lavage. The heterogeneous course of idiopathic pulmonary fibrosis (IPF) is now recognized. The term “acute exacerbation” will now be used for acute attacks (< 30 days) in patients with chronic lung fibrosis (IPF and NSIP). It has been recognized that it is necessary to provide a clinical classification algorithm for the management of IIP cases. Pleuroparenchymal fibroelastosis (PPFE) is recognized as a rare new entity of pulmonary fibrosis. The rapidly evolving field of molecular markers is promising for improving the diagnostic approach.

Conclusion

The 2013 ATS/ERS update is a supplement to the previous classification of lung fibrosis from 2002. It outlines progress in recent years and shows potential areas for future innovations.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Vogel-Claussen und A. Prasse geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Vogel-Claussen

  2. Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    A. Prasse

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  1. J. Vogel-Claussen
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Correspondence to J. Vogel-Claussen.

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Vogel-Claussen, J., Prasse, A. Aktuelle Klassifikation interstitieller Lungenerkrankungen. Radiologe 54, 1147–1152 (2014). https://doi.org/10.1007/s00117-014-2732-5

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  • DOI: https://doi.org/10.1007/s00117-014-2732-5

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