Saha Avinandan, Vaidya Preyas J, Chavhan Vinod B, Achlerkar Amolkumar, Leuppi Jörg D, Chhajed Prashant N
Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.
Institute of Pulmonology Medical Research and Development, Mumbai, India.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(1):85-90. doi: 10.36141/svdld.v35i1.6393. Epub 2018 Apr 28.
There are no specific data on the management of pulmonary fibrosis post-H1N1 ARDS. We present the cases of three patients who responded positively to treatment with pirfenidone, azithromycin and prednisolone. Three males, aged 40, 45 and 59 years, had H1N1 ARDS requiring mechanical ventilation for two weeks or longer. After weaning off ventilation, they had persistent symptoms and hypoxemia at rest despite receiving prednisolone and home oxygen for at least three weeks following discharge. Computed tomography (CT) of the chest showed fibrosis and traction bronchiectasis. At presentation, they could not perform spirometry. Investigations ruled out infection. Pirfenidone (600 mg daily escalated to maximum tolerable dose of 2.4 gm daily) and azithromycin (500 mg thrice weekly) were added off-label to prednisolone. In one patient pirfenidone was discontinued after three months due to an adverse reaction and azithromycin was continued for nine months. At one year follow-up, all patients had symptomatic improvement, better effort tolerance, regression of opacities and no progression of fibrosis on CT, and improvement in spirometry and six minute walk tests. Pirfenidone and azithromycin added to prednisolone may have led to clinical and radiological improvement. The current experience suggests that this treatment approach to pulmonary fibrosis post-H1N1 ARDS be studied further. .
关于甲型H1N1流感所致急性呼吸窘迫综合征（ARDS）后肺纤维化的管理，目前尚无具体数据。我们报告了3例患者，他们接受吡非尼酮、阿奇霉素和泼尼松龙治疗后反应良好。3名男性患者，年龄分别为40岁、45岁和59岁，因甲型H1N1流感ARDS需要机械通气两周或更长时间。脱机后，尽管出院后接受了至少三周的泼尼松龙和家庭氧疗，但他们仍有持续症状和静息性低氧血症。胸部计算机断层扫描（CT）显示有纤维化和牵拉性支气管扩张。就诊时，他们无法进行肺功能测定。检查排除了感染。在泼尼松龙基础上加用了吡非尼酮（每日600毫克，逐步增至最大耐受剂量每日2.4克）和阿奇霉素（每周三次，每次500毫克），用药未按说明书。1例患者因不良反应在3个月后停用吡非尼酮，阿奇霉素持续使用9个月。在1年的随访中，所有患者症状均有改善，运动耐量提高，CT上的混浊影消退且纤维化无进展，肺功能测定和6分钟步行试验也有改善。在泼尼松龙基础上加用吡非尼酮和阿奇霉素可能导致了临床和影像学改善。目前的经验表明，这种针对甲型H1N1流感ARDS后肺纤维化的治疗方法有待进一步研究。
