1) Practical questions and answers from experts
(underline: our answers）
・Do you use BAL for Dx ? ⇒Yes, unless a high chance of triggering the need for MV.
・Do you use empirical ABTs Tx ? ⇒Yes, broad-spectrum antibiotic therapy.
・Do you treat with antivirals ? ⇒No, unless severely lymphopenic.
⇒Usually No. but. Yes, at flu season.
・Do you treat for pneumocystis ? ⇒Yes, co-trimoxazole.
・Do you use anticoagulation ? ⇒No, because warfarin do harm fot IPF (PANTHER trial)
⇒Yes, LMWH or rh-Thrombomodulin (0.06 mg/kg/day x 6days), unless known bleeding disorders.
・Do you use corticosteroid ? ⇒Yes, pulse Tx: mPSL 1g/d, for 3d.
・Do you use immunosuppressant ? ⇒No, due to lack of evidence.
⇒Yes, unless overt infection.
※To prevent 2nd AEX during tapering CS is crucial.
(Antoniou KM and Wells AU. Respiration 2013; 88: 285-274.)
2) Summary of management of AE-IPF
・Early diagnosis and intervention are important.
・Exclude pulmonary embolism and heart failure.
・Evaluate infectious etiology.
・Pulse CS therapy, broad ABTs, PPI, co-trimoxazole are recommended therapies for AE.
・NPPV should be introduced early.