Idiopathic interstitial pneumonias (IIPs) Flashcards
Are IIPs a subset of DPLDs or vice versa?
IIPs are a SUBset of diffuse parenchymal lung diseases, 1 of 4 DPLD types DPLDs are diseases of interstitial space and parenchyma that are NOT caused by malignancy and infection
What is the first question you should ask yourself when evaluating someone for suspected IIP?
Are you sure this is idiopathic? Take a DETAILED history and physical exam, especially of exposures over many years
What is an average latency for silicosis, a type of occupational lung disease?
20-30 years i.e. your history better be from womb to tomb
What should you include in your interview about exposure histories? (5)
jobs hobbies pets household mold/water damage medications + home remedies
Other than exposures, what should you be aware of when you are trying to determine if your patient really has an IDIOPATHIC form of DPLD?
connective tissue disease
What should rashes, joint pain, muscle aches, organ dysfunction, and stigmata (synovitis, etc) point you to when initially evaluating a suspected IIP?
Connective tissue disorder, i.e. this is NOT an IIP, but an ILD secondary to a known cause
Once you have taken a detailed history which is negative, what should you ask yourself when evaluating someone for a suspected IIP?
Is this sarcoidosis?
What is the most common radiographic finding in sarcoidosis?
bilateral hilar lymphadenopathy
Where does sarcoidosis tend to predominate in the lung?
upper lobe parenchyma
What is the classic radiographic pattern of lung damage in sarcoidosis?
reticular and reticulonodular pattern fibrosis at late stages
Other than a consistent history and the absence of other causes of granulomatous disease, what do you need to diagnose sarcoidosis?
a tissue biopsy with non caseating granulomas
How do you treat sarcoidosis? 1 standby + 2 options
immunosuppressive therapy prednisone +- steroid-sparing agents like methotrexate or azathioprine
What are examples of steroid sparing agents? Where are they used?
methotrexate or azathioprine combined with corticosteroids in sarcoidosis tx
If you have eliminated exposure history (except for smoking) and sarcoidosis, what should you ask yourself when evaluating a patient with suspected IIP?
are there a lot of eosinophils?
How do you investigate for eosinophilia in working up suspected IIP? What’s a positive finding?
bronchoalveolar lavage (BAL) > 25 % eosinophils is highly suggestive of eosinophilic pneumonia
What is a normal BAL eosinophil count?
near 0
How do you treat eosinophilic pneumonias?
corticosteroids
A patient presents with dramatic and acute hypoxemic respiratory failure. They are admitted to the ICU and a BAL finds a eosinophil count of 30%. What do they most likely have?
acute eosinophilic pneumonia