Interstitial lung disease Flashcards
Interstitial Lung Disease
Lung fibrosis which increases the diffusion pathway and decreases compliance
Causes
Environmental: asbestosis
Drugs
Hypersensitivity: Extrinsic Allergic Alveolitis
Infection: TB, viral or fungi (aspergillosis)
Systemic disease:
- Sarcoidosis
- RA
- SLE, Sjogren’s,
- UC
- ankylosing spondylitis
Drugs that can cause ILD
Drugs: (BANS ME)
- Bleomycin
- Amiodarone
- Nitrofurantoin
- Sulfasalazine
- MEthotrexate
Extrinsic Allergic Alveolitis
Acute allergen exposure in sensitised pts → Type 3 hypersensitivity
Chronic exposure → granuloma formation- Type 4 hypersensitivity
Causes of EAA
Birds
Farmer’s/mushroom worker’s
Beer/Bread workers - Malt worker’s lung (aspergillos)
Clinical features of EAA
4-6h post-exposure:
- Fever, rigors, malaise
- Dry cough, dyspnoea
- Crackles (no wheeze)
Chronic
- Increasing dyspnoea
- Wt. loss
- T1 respiratory failure
- Cor pulmonale
Ix of EAA
Respiratory exam Basic Obs Bloods - Acute: neutrophilia, ↑ESR CXR Spirometry Bronchoalveolar lavarge - lymphocytosis
EAA CXR
Opacification or
fibrosis → honeycomb lung
Bilateral hilar enlargement (rare)
EAA Spirometry
Restrictive defect
FEV1/FVC > 0.7
Narrow flow volume loop
Mx of EAA
Avoid exposure
Steroids: acute / long-term
Complications of ILD
↑ risk Ca lung
Type 2 respiratory failure and cor pulmonale
Mx of ILD
Stop smoking Pulmonary rehabilitation O2 therapy Palliation Tx symptoms of heart failure Lung transplant offers only cure
Obstructive or restrictive
Restrictive
Idiopathic pulmonary fibrosis presentation
Dry cough Exertion also dyspnoea Weight loss Fine end inspiratory crackles Clubbing
Spirometry
FEV1/FVC > 0.7
Narrowing of flow volume loop
