Intersticiopatias

Diagnosis and Detection of Sarcoidosis
An Official American Thoracic Society Clinical Practice Guideline

Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.
Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel.Recommendations for or against various diagnostic tests were formulated

Para acessar a integra do artigo, click aqui 

Diagnosis of Hypersensitivity Pneumonitis in Adults
An Official ATS/JRS/ALAT Clinical Practice Guideline

Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociaci´on Latinoamericana del T´orax. 
Methods: Systematic reviews were performed for six questions. Theevidencewas discussed, andthenrecommendations were formulated by amultidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
Results: The guideline committee defined HP, and clinical, radiographic, andpathological features were described.HPwas classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposureswas agreed on. Serum IgG testing against potential antigens associated with  HP was suggested to identify potential exposures. For patients with  nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsywere  also made. For patients with fibrotic HP, suggestionsweremade in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithmwas created by expert consensus. Knowledge gaps were identified as future research directions.
Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.
Keywords: hypersensitivity pneumonitis; fibrotic hypersensitivity pneumonitis; nonfibrotic hypersensitivity pneumonitis; interstitial lung disease; pulmonary fibrosis

Para acessar a integra do artigo, click aqui 

ERS clinical practice guidelines on treatment of sarcoidosis

Please cite this article as: Baughman RP, Valeyre D, Korsten P, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J 2021; in press (https://doi.org/10.1183/13993003.04079-2020).
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online.

Para acessar a integra do artigo, click aqui 

Diretrizes brasileiras para o tratamento farmacológico da fibrose pulmonar idiopática.
Documento oficial da Sociedade Brasileira de Pneumologia e Tisiologia baseado na metodologia GRADE

RESUMO
A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI. Descritores: Fibrose pulmonar idiopática; Abordagem GRADE; Fibrose pulmonar/terapia medicamentosa; Guia de prática clínica.

Para acessar a integra do artigo, click aqui 

Diagnosis of Hypersensitivity Pneumonitis
Review and Summary of American College of Chest Physicians Statement 

Abstract: Assessment of lung biopsies for the diagnosis of hypersensitivity pneumonitis (HP) is one of the most difficult diagnostic problems for surgical pathologists. It is a form of interstitial lung disease resulting from an immune reaction provoked by an inhaled antigen in susceptible individuals. Although this definition sounds simple, in practice, the diagnosis of HP can be challenging. To address these issues, the American College of Chest Physicians (CHEST) has recently published a guideline for the diagnosis of  HP. In this review, we will explore the multidisciplinary diagnostic evaluation of HP with a focus on the pathologic features as outlined in the CHEST guidelines. The histologic criteria are divided into 4 diagnostic categories: (1) Typical nonfibrotic HP or fibrotic HP; (2) Compatible with nonfibrotic HP or fibrotic HP; (3) Indeterminate for nonfibrotic or fibrotic HP; and (4) Alternative Diagnosis. It is important to emphasize that patterns 1 to 3 do not represent discrete histologic entities or pathologic diagnoses. Rather, these categories are meant to serve as a practical guide for organizing a complex set of overlapping histologic patterns into an integrated diagnostic framework for facilitating multidisciplinary discussion. Highresolution computed tomography features are also summarized, emphasizing how the correlation of lung biopsies with computed tomography findings can help to favor the diagnosis, particularly in cases where biopsies are not typical for HP. This review highlights details of the histologic spectrum of HP as well as the utility of different types of biopsies and bronchoalveolar lavage. We also emphasize the importance of multidisciplinary discussion and the complex differential diagnosis. Key Words: hypersensitivity pneumonitis, usual interstitial pneumonia, nonspecific interstitial pneumonia, lung, computed tomography
(Am J Surg Pathol 2021;00:000–000)

Para acessar a integra do artigo, click aqui 

Interstitial pneumonia with autoimmune features: challenges and controversies

Guidelines for the Diagnosis and Management of Idiopathic Pulmonary Fibrosis: Update 2019
An American Thoracic Society Pocket Publication

his pocket guide is a condensed version of the 2011, 2015 and 2018 American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Latin American Thoracic Association (ALAT) Evidence-Based Guidelines for Diagnosis and Management of Idiopathic Pulmonary Fibrosis (IPF). This pocket guide was complied by Ganesh Raghu, MD and Bridget Collins, MD, University of Washington, Seattle from excerpts taken from the published official documents of the ATS. Readers are encouraged to consult the full versions as well as the online supplements, which are available at http://ajrccm.atsjournals.org/content/183/6/788.long.

All information in this pocket guide is derived from the 2011, 2015 and 2018 IPF guidelines unless otherwise noted. Some tables and figures are reprinted with the permission from the journals referenced. Produced in Collaboration with Boehringer Ingelheim Pharmaceuticals, Inc.

Para acessar a integra do artigo, click aqui 
 

Connective Tissue-Related Interstitial Lung Disease Primer

Introduction
• Interstitial lung disease (ILD) is a common manifestation of connective tissue diseases (CTDs).
• ILD can be seen in all CTDs but most commonly in rheumatoid arthritis (RA), systemic sclerosis (SSc), and idiopathic inflammatory myopathy (IIM).
• This primer will focus on the general features of CTD-ILDs along with distinct features noted in RA, SSc, and IIM-associated ILD.
Definition
• CTD-ILD is defined as evidence of ILD demonstrated by CT (i.e., some combination of reticulation, ground-glass opacities, traction bronchiectasis, honeycombing, and/or cysts) in the setting of an established CTD.
• Other causes of parenchymal lung disease in CTD need to be ruled out:

• Infection
• Drug-induced lung disease
• Malignancy
• Idiopathic and other interstitial lung diseases

Para acessar a integra do artigo, click aqui