ILD

Question 0

What are the most common identifiable causes of ILD?

Answer 0

Exposure to occupational and environmental agents 
- dusts: silica, asbestos, coal
- metals: tin, aluminium, titanium, iron 
Drug induced 
- methotrexate 
- amiodarone
- radiation
- chemotherapy 

Connective tissue diseases
- SLE - RA - SCLERODERMA

Question 1

What is ILD?

Answer 1

A collective number of diseases that injure the lung parenchyma.

Based on injury to tissue and the lungs poor attempt to repair it.

Question 2

How is ILD classified?

Answer 2

Those with identifiable causes and those that are idiopathic.

Question 3

What are the idiopathic causes of ILD?

Answer 3

Sarcoidosis
Cryptogenic pneumonia/Bronchiolitis obliterans organising pneumonia not Bronchiolitis obliterans (different BOOP and BO)
Idiopathic Interstitial pneumonias which is made up of
- idiopathic pulmonary fibrosis
- acute interstitial pneumonia
- desquamative interstitial pneumonia

Question 4

What is the management of ILD?

Answer 4

Identify and treat the cause 
Prednisolone
Stop smoking
Home oxygen 
Pulmonary rehab 

Azathioprine for connective tissue disease? DMARD
Cyclophosphamide decreases immune systems response?
PREDNISOLONE

Question 5

Clinical presentation of ILD?

Answer 5

Progressive SOB on exertion 
Persisting non-productive cough 
History of exposure 
Abnormal CXR 
Restrictive PFTs
Respiratory symptoms in background of connective tissue disease

Question 6

What is farmers lung?

Answer 6

Hypersensitivity pneumonitis from inhalation of hay dust and mold spores and other agricultural products.

Question 7

What is sarcoidosis?

Answer 7

Involves abnormal collections of inflammatory cells (granulomas) that form nodules in organs.

Question 8

What is the cause of sarcoidosis?

Answer 8

Unknown, theory is in genetically susceptible individuals you get an altered immune response after exposure to an enviro, occupational or infectious agent.

Diagnosis of exclusion. Rule out TB with acid-fast bacilli.

Question 9

What is BOOP?

Answer 9

Bronchiolitis obliterans organising pneumonia is a non-infectious pneumonia.

An inflammation of the bronchioles.

Question 10

What investigations of ILD?

Answer 10

LAB:
CBE EUC LFTs

PFTs - restrictive picture
Antibodies for connective tissue disorders - RA (RF, anti-CCP), SLE (ANA +- anti-dsDNA), scleroderma (anti-topoisonerase),

CXR?

HRCT - ground glass appearance in early ILD, honeycomb in late (pulm. Fibrosis)

RHF - ECG, ECHO

BRONCHOALVEOLAR LAVAGE via bronchoscope, if not biopsy