Insterstitial Lung Disease Flashcards
What does interstitial lung disease affect?
The lung parenchyma
Name some types of ILD
Usual Interstitial Pneumonia (UIP)
non specific interstitial pneumonia (NSIP)
Extrinsic allergic alveolitis
Sarcoidsosis
What features of the history are particularly important regarding ILD?
Occupational and environmental history
How would ILD present on a peak flow test?
Restrictive
What investigations should be performed for new diagnoses of ILD?
ANA, ENA, RhF, ANCA, Anti-GBM, ACE, IgG to serum precipitins
What is the most common type of pulmonary fibrosis?
Usual interstitial pneumonia (UIP)
What is the usual cause of UIP?
Idiopathic
What are the classical findings in UIP?
Clubbing, reduced chest expansion
On ausculation, fine inspiratory reps like velcro usually heard in basal and auxiliary areas
May have features of pulmonary hypertension
Which responds better to steroids UIP or NSIP?
NSIP
What is another term for allergic alveoli’s?
Hypersensitivity pneumonitis
What happens in extrinsic allergic alveolitis?
Inhalation of organic antigen to which the individual has been sensitised
How may extrinsic allergic alveoli’s be triggered?
Exposure to birds
Drugs: amiodarone, nitrofurantoin
How can extrinsic allergic alveoli’s present?
Acute or chronic
Discuss ACUTE extrinsic allergic alveolitis
Occurs a short period from exposure normal 4-8hrs
Usually reversible
Spontaneously setles in 1-3 days
Can reoccur
Discuss CHRONIC extrinsic allergic alveolitis
Chronic exposure over months to years
Less reversible
What is sarcoidosis?
Multi system inflammatory condition of unknown cause
What is the relevant histology of sarcoidosis?
Non caseating granuloma
What is the prognosis for sarcoidosis?
50% get spontaneous remission, others get progressive disease
What investigations should be undertaken for a patient with sarcoidosis?
PFTs (obstructive until) fibrosis
CXR -4 stages
Bloods: renal function, ACE, calcium
Urinary calcium
Cardiac involvement: ECG, 24hr tape, ECHO, cardiac MRI
CT/MRI head may get headaches due to neurosarcoid
What is important in ILD treatment?
Detailed history to see if there is any triggers that could be removed
Discuss some principles in ILD treatment
Remove occupational exposures Avoid drugs associated Stop smoking N-acetylecysteine, immunosupressant, pirfenidone Transplant Treat infections Oxygen MDT, palliative care
