Acute respiratory distress syndrome clinical features

Petty, T. L. and Ashbaugh, D. G. (1971) The adult respiratory distress syndrome. Clinical features and factors influencing prognosis and principles of management. Chest 60, 233-239. Gregory, T. J., Longmore, W. J., Moxley, M. A., Whitsett, J. A., Reed, C. R., Fowler, A. A., Ill, Hudson, L. D., Maunder, R. J., Crim, C., and Hyers, T. M. (1991) Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J. Clin. Invest. 88, 1976-1981. 

Acute exacerbations of IPF are characterized by rapid development of cough, dyspnea, hypoxemia, and worsening pulmonary infiltrates in patients with known IPF (29,148-151). Presentation is similar to acute respiratory distress syndrome (ARDS) (29,148,149,151,152). The cardinal histological feature is DAD superimposed on a background of UIP (149,151). Idiopathic acute interstitial pneumonia (AIP) (28,152) exhibits similar clinical and histological features as acute exacerbations of IPF, but lacks the requisite features of UIP. High-dose intravenous (IV) pulse methylprednisolone has been used to treat acute exacerbations of IPF, but data on treatment are limited to anecdotal cases and small series (29,148,149,151). This entity is reviewed in chapter 15 and will not be further discussed here. 

With the publication of two international consensus statements on the IIP, the American Thoracic Society and the European Respiratory Society formally recognized AIP as a distinct IIP with cardinal features of rapid symptom onset, unknown causation, and the presence of a DAD pattern on surgical lung biopsy (8,9). As these same clinical and pathologic features are present in patients with known causes of lower respiratory tract disease, in particular the acute respiratory distress syndrome (ARDS) and overwhelming lower respiratory tract infection, AIP is by necessity, a diagnosis of exclusion (Table 1). 

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