ILD

Question 1

What can you be exposed to that cause ILD?

Answer 1

Environmental
(Inorganic dusts, asbestos),
Drug induced,
Radiation,
Smoking,
Oxygen

Question 2

What are systemic diseases that cause ILD?

Answer 2

Connective tissue disease,

Inflammatory bowel disease,

Sarcoidosis

Question 3

What are idiopathic unknown causes of ILD?

Answer 3

Idiopathic pulmonary fibrosis,

Nonspecific interstitial pneumonitis,

Cryptogenic organizing pneumonia,

Hamman-Rich Syndrome,

Eosinophilic Granuloma

Question 4

What is the pathophysiology of ILD?

Answer 4

Lung is injured and repairs, its the repair is incorrect

Increased interstitial tissue (especially connective tissue) replaces normal alveoli, capillaries and healthy interstitium

Fibroblasts in interstitium produce collagen

Fibrotic cystic airspaces are produced

Question 5

What are the signs and symptoms of ILD?

Answer 5

Excertional dyspnea

nonproductive cough

May have Pulmonary Hypertension, leading to Cor Pulmonale

Question 6

How can you diagnose ILD?

Answer 6

Inspiratory Crackles, diminished BS
Occasionally wheezing - if airway involved (like sarcoidosis)

CXR: low lung volume with bilateral nodular opacities / ground glass

PFT: show restrictive disease: All volumes are reduced, FEV1/FVC = Normal

Question 7

What would an ABG look like in ILD?

Answer 7

Arterial PaO2 and PaCO2 are reduced, pH normal, greater Hypoxemia with exertion

Question 8

At the alveolar level, What happens to gas exchange in ILD?

Answer 8

Diffusion impairment contributes to hypoxemia on exercise.

Physiologic dead space and physiologic shunt and VQ mismatch are increased.

There is marked reduction in diffusing capacity due to thickening of blood gas barrier and VQ mismatch.

Question 9

Whats is asbestosis? what does it cause in the lung?

Answer 9

Asbestosis - environmental

Pleural plaques, fibrosis, effusions,

atelectasis and parenchymal scarring

Question 10

how long after exposure does it take for asbestosis to be seen? What can we do to improve it slow the progression?

Answer 10

Exposure usually many years before disease

No therapy to improve / decrease progression

Question 11

Tell me about silicosis, and what other disease it makes more active

Answer 11

Silicosis - Environmental
From chronic exposure to inhaling Silica particles (sand, quartz)
Mining, tunneling, sandblasting,

Increased risk of lung CA and TB (2 to 30 fold more active TB)

Question 12

Tell me about Coal Workers Pneumoconiosis, whats the treatment?

Answer 12

Coal Minors - very similar to Silicosis

Simple CWP can be asymptomatic with + CXR finding and not progress

No true therapy other than alleviating symptoms and exposure

Question 13

What is hypersensitivity Pneumonitis?

Answer 13

Hypersensitivity Pneumonitis- environmental

Immune reaction to inhaled antigens

Organic or inorganic

Question 14

What are organic hypesensitivity Pnumonitis?

Answer 14

Bacteria or Fungus:
Farmer’s Lung - Moldy Hay 
Humidifier Lung - Home  Humidifier systems
Bird breeder’s lung
Mushroom Worker’s lung

Question 15

What is an inorganic hypersensitivity Pneumonitis?

Answer 15

Vaporized paints and plastics

Question 16

What are the 2 phases of hypersensitivity Pneumonitis?

Answer 16

Acute:Present with Sudden SOB, Chest pain,

Chronic = months or years and can be difficult to distinguish from other ILD

Question 17

How can we assess hypersensitivity Pneumonitis in patients?

Answer 17

By History taking (hobbies, work, etc)

we can assess their exposure to antigens

Question 18

What can we use to treat hypersensitivity pneumonitis?

Answer 18

Steroids

Question 19

What are antibiotics that can cause ILD?

Answer 19

Nitrofuratoin and Sulfasalazine

Question 20

What are anti-inflammatory drugs that can cause ILD?

Answer 20

Asprin and methotrexate

Question 21

What are cardiovascular drugs that can cause ILD?

Answer 21

Amniodarone and Tocainide

Question 22

What are chemotheraputic drugs that can cause ILD?

Answer 22

Belomycin and Methotrexate

Question 23

What illicit drugs can cause ILD?

Answer 23

Methadone, Heroin, Propoxyphene

Question 24

What is the treatment for ILD caused by drugs?

Answer 24

Treatment supportive, corticosteroids and of course, stop the drug

Question 25

How do we spot of radiation treatment is causing ILD? What can we do to treat it?

Answer 25

Treatment for CA can result in ground glass at site and beyond

Treatment is supportive only

Question 26

What are some diseases that are linked with ILD?

Answer 26

Scleroderma, Rheumatoid arthritis, Sjogren’s syndrome, Polymyositis, Dermatomyositis,
Systemic Lupus Erythematosis

Question 27

What is Sarcoidosis?

Answer 27

non casiating granuloma

Multisystem granulomatous inflammatory disorder usually involving the lung

Inflammatory cells create granulomas in several organs, most commonly in the lung

MOST COMMON ILD in US AFFECT younger

Question 28

What are the symptoms of Sarcoidosis?

Answer 28

Symptoms can include chest pain and wheezing, Inflammation of iris, adenopathy

Question 29

What is Idiopathic Pulmonary Fibrosis?

Answer 29

Progressive fibrotic lung disease isolated to lung

Usually older than 60 with smoke, hairdressing chemical, farming or metal dust exposure

Question 30

How do you diagnose Idiopathic Pulmonary Fibrosis?

Answer 30

Lung Biopsy

Question 31

What is Cryptogenic organizing PNA?

Answer 31

Inflammation of the bronchioles and surrounding lung tissue

Often presents after failed PNA tx with antibiotics

Question 32

What happens to 02 sats in patient?

Answer 32

in MILD ILD There usually is desatting on exertion even after starting with normal stats at rest.

Giving oxygen can improve quality of life

Question 33

What vent setting should we give patients with ILD?

Answer 33

Compliance is very low, so expect high PIPs
Vt 4-8 ml/kg
Rate 20-35
I time .5 - .8

Question 34

What can the lung look like in end stage ILD?

Answer 34

Honeycomb cystic

Question 35

What are generalized treatments for ILD?

Answer 35

Give Oxygen

Mechanical vent