ILD + asbestosis Flashcards
what is ILD
Rnage of lung diseases affecting the parenchyma - cellular infiltration of alveoli, interstitium and distal AWs -> fibrosis
Lungs are smal and stiff
Common ILDs
Isiopathic pulmonary fibrosis
Sarcoidosis
Hypersemsitivity pneumonitis
O/E with ILD
Loss of chest expansion
Crackles - fibrosis, fine crackles, dry cough, restrictive
Coarse = bronchiectasis, wet cough, obstructive
CXR in ILD
increased bilateral symmetrical interstitial markings with basal predominance
Lost of lines, reticular, small nodules
heart border shaggy and indistinct = hallmark of fibrosis
Lung function tsts in ILD
FEV1/FVC - normalor increased -
FEV1 normal or reduced, FVC reduced much = more
Reduced TLCO = restritive pattern
What investigation do afet evidence of fibrosis
CT thorax abdo
Dont lung biopsy - high morbidity and mortaltiy
CT scan of lung in ILD
Subplural reticulation and honeycombed change
Risks for ILD
Environmental/occupational exposures eg dust, asbestos, pets, birds
Drugs - methotrextae, nitrofurantoin, amiodarone
CTD - RA - autoantibodies anti CCP
Progression of ILD
Gets worse before symptoms show - vital picked up early, most preferably pre clinical
Supportive treatment ILD
Oxygen, rehab, morphine
Treat SOB and pain
Cure for ILD
Only lung transplant
Upper limit is 65 for single - often too old
Medication for ILD and side effects
Pirfenidone/nintedanib - antifibrotics improve survival
GI upset, photosensitive rash
Features of IPF
progressive exertional dyspnoea
bibasal fine end-inspiratory crepitations on auscultation
dry cough
clubbing
Forms of asbestos
Setpentine - long curly white (chrystolite)
Amphibole - blue (crocidolite) and brown (amosite)
Which from of asbestos is more fibrogenic
Ampiboe - blue and brown, stronger, shorter rigid needles cant be cleared
Asbestos exposure
- mining or dilling absestos
- Industrial uses
- construction, insulation, fireproofing, brake linings, ship building, pipe-fitting, boiler fitting, carpentry, pluming and electrical repair.
How long does asbestosis take to happen after expsoure
15-20 years, can be over 40
Where is most affected in asbestosis
Subpleural of lower lobe w relative central spacing
Diagnosis of asbestosis
Structural pathology + exposure history + exclusion of other causes
Management of asbestosis
Avoid exposure and smoking cessation
Flu and pneumonia vaccine
Pulm rehab
Screen for other diseases caused by asbestos
Long term O2 therapy
No evidence for antifibrtoics
What does asbestos esp increase the risk of
All forms of lung cancer esp mesotherlioma
Other conditions can be caused by asbestos
Asbestos related pleural disease
Pleural plaques
benign asbestos pleural effusion
Diffuse pleura thicening
Malignant mesothelioma
What is benign asbestos pleural effusion and when does it ovcur
unilateral pleural effusion within 0 years of exposure to asbestos
Investigations for BAPE
Fluid = exudate, blood stained
Positive PET scans (less than inflam/malign)
Management of BAPE
Often spontaneously resolves after few months
Repeat aspirationns or pleurodesis if need
Can -> fibrosis
What is diffuse pleural thickening
Fibrsosi of pleura often following BAPE
What see on CXR/CT in duffuse pleural thickening
XRAY - smooth conglomerate opacity along pleura
CT pleura >3mm thick
Features of DPT
Pain, SOB
Reduced FVC, low TLCO, KCO normal or elevated
What causes mesothelioma
Crocidolite - most carcinogenic asbestos
How confirm mesotheluoma
If effusion - thoroscopy
US or CT guided biopsies otherwise
Treatment for malignant mesothelioma
universally fatal
Can give cisplatin and pemetrexed if fit enough
No benefit from surgery
Emerging antiPD1 drugs zumabs
Conditions qualifying for industrial injuries displacement benefity
- Diffuse pleural thickening
- Asbestosis
- Mesothelioma
- Lung cancer ass w asbestos exposure
Criteria for industrial injuries displacement benefity
- Clear hisotry of asbestos exposure at work
- Not self employed
- If employer no longer in business - one off payment government via Pneumoniciosis act 1979
- Amount reflects severity of disability and age at diagnosis
- Next of kin can make claims within 12 months of patients death
How long can make claims against employers in cicl courts
Within 3 years of diagnosis
Clear and precise documentation essential
Referral for malignant mesothelioma
Urgent CXR if >40 and
-2 of ollowing unexplained
-1 of following unexplained and ever smoked
-1 of following unexplained and asbestos exposure
-SOB
-Cough
-chest pain
-weight loss
-appetite loss
-fatigue
Consider - clubbing, pleural chest signs OE
Gold standard investigation IPF
High Res CT
When can you give antifibrotics IPF
FVC 50-80%
Treatment stopped if disease progression - loss of 10% FVC in 12 months
Prognosis in IPF, mesothelioma
IPF - 3-4 years
Mesothelioma - 12 months
