CT 13 Interstitial Lung Disease Flashcards
what is the definition of ILD
includes many conditions that cause inflammation and fibrosis of the lung parenchyma
fibrosis is the replacement of elastic and functional tissue with non functional scar tissue
what are the key features of ILD
SOB on exertion
dry cough
fatigue
IPF findings on examination
- bibasal fine end-inspiratory crackles
- finger clubbing
Investigations for interstitial lung diseases
clinical features
high resolution CT
spirometry
if doubt:
lung biopsy
bronchoalveolar lavage
what will happen to spirometry in ILDs
- normal
or restrictive pattern
general management of ILDs
Remove or treat the underlying cause
Home oxygen where there is hypoxia
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care where appropriate
Lung transplant is an option, but the risks and benefits need careful consideration
what two drugs can slow disease progression of IPF
pirfenidone
nintedanib (inhibits tyrosine kinase)
what drugs can cause secondary pulmonary fibrosis
- amiodarone
- cyclophosphamide
- methotrexate
- nitrofurantoin
what conditions can cause secondary PF
- alpha 1 antitrypsin deficiency
- RA
- SLE
- Systemic sclerosis
- sarcoidosis
what is hypersensitivity pneumonitis
type III and type IV hypersensitivity reaction to an environmental allergen. Inhalation of allergens in patients sensitised to that allergen causes an immune response, leading to inflammation and damage to the lung tissue.
raised lymphocytes on bronchoalveolar lavage suggest hypersensitivity pneumonitis
what is a bronchoalveolar lavage
performed during a bronchoscopy procedure. The airways are washed with sterile saline to gather cells, after which the fluid is collected and analysed.
what is cryptogenic organising pneumonia
focal area of inflammation and damage. maybe idiopathic or triggered by infection, inflammatory disorders, medications or radiation, environmental toxins or allergens
presents identical to pneumonia so there is delay.
lung biopsy is definitive investigation
treatment = systemic steroids
asbestos exposure is linked to which conditions
lung fibrosis
pleural thickening and pleural plaques
adenocarcinoma
mesothelioma
pneumoconiosis
umbrella term: occupational lung disease caused by inhalation of dust (e.g. coal dust,
asbestos, silica
examples:
coal workers pneumoconiosis
silicosis = (nodular lesions in the upper lobes of the lung, as
well as ‘egg shell’ calcification of the hilar lymph nodes.)
asbestosis = (fibrotic cysts in lower lobes)
siderosis
ILD’s that affect the lower zones of the lungs
- IPF
- connective tissue disorders except ankylosing spondylitis
- drug induced ILD
- asbestosis
ILDs affecting the upper zones of the lungs : CHARTs
- Coal workers pneumoconiosis
- Hypersensitivity pneumonitis +histiocytosis
- Ankylosing spondylitis
- Radiation pneumonitis
- Tuberculosis
- Silicosis + Sarcoidosis
