Low Dose Oral Imatinib During The Treatment Of Systemic Sclerosis Interstitial Lung Disease

CASE STUDY PROGRESS: The client has now received 3 cycles of combination chemotherapy for her breast cancer. Her last treatment with doxorubicin, cyclophosphamide, and 5-fluorouracil was approximately 12 days ago. She came to the emergency room with a 2-day history of fever, chills, and shortness of breath. On arrival, she is disoriented and agitated. Vital signs are 86/43, 119, 28, 39.8° C, SaO2 85% on room air. Laboratory data include WBC 1.2 thou/cmm, Hct 24.9%, Hgb 8.7 g/dl, platelets 125 thou/cmm. Differential WBC count shows 37% granulocytes, 60% lymphocytes, 3% monocytes. Chem 14 is within normal limits, with the exception of BUN 28 mg/dl, creatinine 1.6 mg/dl, and lactic acid 2.4 mg/dl. Chest x-ray demonstrates diffuse infiltrates in the left lower lung.

A recent doctor 's visit reveals that Mr. Amos has stage 3 lung cancer, characterized by his symptoms of nagging chest pain, fatigue, coughing up blood, substantial weight loss, and increased carbon dioxide levels in his blood. The doctor informed Mr. Amos that had he quit his smoking habit several years ago, he would have reduced his risk for developing lung cancer later in life. Mr. Amos immediately begins treatment for the lung cancer that has metastasized to his lymph nodes.

The treatments for lung cancer depends on the stage and type of lung cancer and involves Surgery, Radiation therapy, Chemotherapy, Targeted therapy, and Lung cancer is usually treated with a combination of therapies in general. In surgery the tumor and the nearby lymph nodes in the chest are typically removed to offer the best chance for a cure. For non-small cell lung cancer, a lobectomy which involves the removal of the entire lobe where the tumor is located has shown to be very effective. Unfortunately, Surgery may not be possible in some patient due to the stage and type of lung cancer they have. Chemotherapy involves drugs used to kill cancer cells. A combination of medications is often used and may be prescribed before or after surgery, or radiation therapy. It can improve survival and lessen lung cancer symptoms in all patients, even those with widespread lung cancer. Radiation therapy contains the use of high-energy x-rays or other particles to destroy cancer cells. Side effects include fatigue, malaise, loss of appetite, and skin irritation at the treatment site. Radiation pneumonitis is the irritation and inflammation of the lung, which occurs in 15% of patients. It is important that the radiation treatments avoid the healthy parts of the lung.

A chest X-ray and CT scan result demonstrated a cavitation of the right lower pulmonary lobe. This result alone along with Bob’s history of smoking is a big red flag related to lung cancer. Bob’s history reveals that he has been smoking a ½ pack or more per day for 37 years. According to a study done on the diagnosis, staging, and treatment of lung cancer, habitual smokers have the highest risk of developing cancer of the lung than any other cancer (Herth, Eberhardt, Ernst, 2006). The study also concludes that a related association with lung cancer is swelling of the tissue, lung tumors and/cavitation, lymph in the bronchioles, and paratracheal areas. The swelling can lead to an obstructed airway, which matches Bob’s symptoms as well. Chest pain, stridor, and chest pain are all indications of complications in the respiratory system.

History of Present Illness: Mr. Magnuson is a very pleasant 77-year-old gentleman who was previously seen in this office by Elvira Aguila, MD for COPD and hypoxic respiratory failure. He is here today for routine followed up. He was last evaluated in January 2015. Since that time, he states that his dyspnea is worse. He feels that it is related to the weather. He does state that he works around the house, although he does have significant functional limitations because of shortness of breath. His wife also confirms that he is able to do less and less. He has a stable, minimal cough. He is using 4L of oxygen at night as well as, as needed throughout the day. He continues to smoke three to four cigarettes on

Management is diverse, the objective is to relief from symptoms, delay progression, increase exercise tolerance and reduce mortality; this can be accomplished by preventing and treating complications (Nettina, 2013). Since smoking is so rampant in this patient, it is critical that the nurse translates the importance of smoking cessation to slow disease advancement and increase survival (Nettina, 2013). Another standard treatment of COPD is the use of inhaled bronchodilators that reduce dyspnea and bronchospasm (Nettina, 2013). Some of these medications are long acting, such as the anticholinergic Tiotropium or the beta adrenergic agonists Salmeterol, others are short acting, used before activity or when symptoms worsen; examples of such are Ipratropium, an anticholinergic, and the beta adrenergic agonists Albuterol (Nettina, 2013).The patient that has repeated exacerbations and is symptomatic with a FEV1 less than fifty percent is often prescribed inhaled corticosteroids (Nettina. 2013). Those experiencing an acute exacerbation are prescribed oral corticosteroids due to their anti-inflammatory attributes (Nettina, 2013). All of these inhaled medications require the nurse to provide extensive teaching on proper use of the types of inhalers, as well as, the importance of the taking as prescribed; this is also the case of the oral corticosteroid

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82 developed an index defined as GAP (gender, age, physiology), in order to predict mortality in IPF. US and Italian patients included in this study were divided in three groups: 228 patients, 44.3% of which with biopsy proven IPF, were included in the derivation cohort and 555, 54.7% of which with biopsy, in two validation cohorts of 330 and 325 patients. Mean follow-up was 1.7 and 2.4 in the derivation and the validation cohorts, respectively. The primary endpoint of the study was time to death or lung transplantation. Overall mortality was 49% in the derivation cohort and 62% in the validation cohorts. A competing-risk regression model was used to screen potential predictors of mortality in the derivation cohort including age, sex, body mass index (BMI), smoking status, supplemental oxygen use, FVC, FEV1, TLC and DLCO. Age, sex, FVC% predicted and DLCO% predicted were identified as independent predictors and were used to develop the GAP individual risk calculator towards mortality and staging system. Three stages (stages I, II, and III) were identified based on the GAP index with 1-year mortality of 6%,16%, and 39%,

Mr. HS is a 78-year-old retired male, who presented to the emergency room at Northeast Methodist Hospital initially on February 11, 2011, with complaints of shortness of breath and coughing. He was diagnosed as having a COPD Exacerbation and was placed on antibiotic therapy and was released home. He was also advised at that time to complete the entire course of antibiotics and return to his primary treating physician if his condition did not improve.

Each year about 42,000 more people aged 65 and older are diagnosed with IPF. Idiopathic pulmonary fibrosis affects more men than women. Most people who have Idiopathic Pulmonary Fibrosis are over 50 years old typically, but not always. It is progressive, unpredictable, and irreversible. The damage it does to the lungs cannot be undone. There are treatment options that may help slow its progression, but ultimately there is no cure. IPF is a progressive disease, which means that over time the scarring becomes more widespread and lung function declines. Doctors can’t predict how quickly this will happen. IPF progresses rapidly for some people and slowly for others. People who have a lung transplant have a mortality rate of about 50% to 56% after five years. Staging systems for idiopathic pulmonary fibrosis may help health-care professionals and researchers to better define the medical condition of their patients. However, for idiopathic pulmonary fibrosis, staging systems are constantly being redefined. For example, the first staging systems traditionally considered the disease as mild, moderate, or severe while others considered stages as early or advanced. The stages are kind of impulsive and loosely based on pulmonary function tests. Unfortunately, there are no standardized definitions for mild, moderate, and severe idiopathic pulmonary fibrosis. In addition to testing

Radiological imaging plays an important role in the evaluation of Interstitial Pneumonia. The chest radiograph remains the first step for the detection of ILDs, while a high resolution computed tomography (HRCT) scan clearly has improved utility for detection and classification of ILD.The presence of typical clinical and HRCT features is sufficient to allow a confident diagnosis of ILD. As 85% of patients with normal HRCT still have a normal HRCT at a mean follow up of 5 yrs (52), a normal HRCT at baseline predicts a low likelihood for the development of SScILD.Pulmonary involvement in scleroderma was assessed using different

To date, Patient C has had approximately 91 IVIG treatments, 6 rounds of chemotherapy, 5 years worth of steroid shots, 9 spinal taps, numerous x-ray swallow studies, CT scans, and MIBG scans, and he just finished having his 3rd porta catheter placed (S. Berkley, personal communication, December 1,

A 65 year-old woman with known COPD on inhalers presented with a one-month history of a cough and increased shortness of breath. Lung function revealed FEV1 1.40 (54% predicted), TLCO (63% predicted) and patient performance status was 1. She proceeded to have staging CT scan/PET scan/EBUS and investigations all revealed final diagnosis stage IIIA T3N2M0 Non small cell lung cancer squamous (NSCLC).

|Specific Purpose: |To inform readers on the causes, effects and treatments of lung cancer. |

Desquamative interstitial pneumonia is one of the idiopathic interstitial pneumonias and smoking-related interstitial lung diseases. It causes respiratory symptoms including cough and dyspnea. There are non-specific findings in the blood test and chest radiograph. The diagnosis required high-resolution computed tomography and lung biopsy. We present a case of passive smoking related desquamative interstitial pneumonia diagnosed by lung biopsy. Successful improvement is achieved after methylprednisolone