Chronic respiratory disease
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Of the idiopathic interstitial pneumonias, idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) have provoked the most debate and discussion. Although the two diseases are distinct entities, diagnosis is not always straightforward and requires a multidisciplinary approach, integrating clinical, radiological and histologic information. Although there is currently no effective treatment for either disease, the importance of differentiating NSIP from IPF lies in the management of the individual patient, with particular focus on outcome and pace of change, and enrollment into novel treatment trials of IPF.
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There is a growing understanding that chronic respiratory diseases in adults have their origins in early life. Adverse environmental exposures occurring in vulnerable periods during lung growth and development in the fetal period and in early childhood that alter lung structure and limit the growth in lung function may have lifelong consequences. ⋯ These exposures generally interact with a genetic predisposition, and gene-environment interactions and epigenetic phenomena are attracting considerable study. An understanding of how ambient exposures impact on normal lung growth and development will aid in understanding of how chronic respiratory diseases of adults develop and may lead to new preventative strategies.