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Methotrexate can also lead to pulmonary toxicity (lung damage), although this is fairly uncommon and more commonly it can confound the leukopenia caused by sarcoidosis. [19] Due to these safety concerns it is often recommended that methotrexate is combined with folic acid in order to prevent toxicity. [19]
Lung transplantation is the only therapeutic option available in severe cases. A lung transplant can improve the patient's quality of life. [30] Immunosuppressive drugs can also be considered. These are sometimes prescribed to slow the processes that lead to fibrosis. Some types of lung fibrosis respond to corticosteroids, such as prednisone. [29]
Methotrexate was originally developed and continues to be used for chemotherapy, either alone or in combination with other agents.It is effective for the treatment of several cancers, including solid tumours of breast, head and neck, lung, bladder, as well as acute lymphocytic leukemias, non-Hodgkin's lymphoma, osteosarcoma, and choriocarcinoma and other trophoblastic neoplasms.
The cause is unknown, hence the term idiopathic. [2] Risk factors include cigarette smoking, acid reflux disease (GERD), certain viral infections, and genetic predisposition. [1] The underlying mechanism involves scarring of the lungs. [1] Diagnosis requires ruling out other potential causes. [3]
The differential diagnosis includes other types of lung disease that cause similar symptoms and show similar abnormalities on chest radiographs. Some of these diseases cause fibrosis, scarring or honeycomb change. The most common considerations include: chronic hypersensitivity pneumonitis; non-specific interstitial pneumonia; sarcoidosis
A technique called pleurodesis can be used to intentionally create scar tissue within the pleural space, usually as a treatment for repeated episodes of a punctured lung, known as a pneumothorax, or for pleural effusions caused by cancer. While this procedure usually generates only limited scar tissue, in rare cases a fibrothorax can develop. [6]
This can lead to parts of the lung having a honeycomb-like appearance. The extrinsic causes result in lung restriction, impaired ventilatory function, and even respiratory failure due to the diseases that effect the lungs ability to create a change in lung volumes during respiration due to the diseases of the systems stated above. [3]
The primary treatment involves mechanical ventilation together with treatments directed at the underlying cause. [1] Ventilation strategies include using low volumes and low pressures. [1] If oxygenation remains insufficient, lung recruitment maneuvers and neuromuscular blockers may be used. [1]