Interstitial lung disease

Question 1

How is a diagnosis of interstitial lung disease made?

Answer 1

Combination of:

• Clinical features
• High resolution CT showing a “ground glass” appearance

Question 2

Which vaccinations are patients with interstitial lung disease offered?

Answer 2

• Flu jab

- Pneumococcal jab

Question 3

What is meant by idiopathic pulmonary fibrosis?

Answer 3

Progressive pulmonary fibrosis (scarring) with no clear cause

Question 4

Which signs would you typically find on examination in a patient with idiopathic pulmonary fibrosis?

Answer 4

• Finger clubbing

- Bibasal fine inspiratory crackles

Question 5

Which drugs are currently licensed to slow the progression of idiopathic pulmonary fibrosis?

Answer 5

• Pirfenidone

- Nintedanib

Question 6

Which drugs can cause pulmonary fibrosis?

Answer 6

• Methotrexate
• Amiodarone
• Nitrofurantoin

Question 7

Which conditions can cause pulmonary fibrosis? What is this type of pulmonary fibrosis called?

Answer 7

Secondary pulmonary fibrosis:

• Genetic conditions, e.g. alpha-1 antitrypsin deficiency
• Autoimmune conditions, e.g. rheumatoid arthritis, SLE

Question 8

What is hypersensitivity pneumonitis? This is also known as…

Answer 8

Type III hypersensitivity reaction in response to an environmental allergen, resulting in inflammation and destruction of the lung parenchyma

This is also known as extrinsic allergic alveolitis

Question 9

Give some examples of specific causes of hypersensitivity pneumonitis

Answer 9

• Farmer’s lung (reaction to mouldy spores in hay)
• Bird-fancier’s lung (reaction to bird droppings)
• Malt worker’s lung (reaction to mould on barley)

Question 10

What is asbestosis?

Answer 10

Lung fibrosis related to the inhalation of asbestos

Question 11

Describe the management of hypersensitivity pneumonitis

Answer 11

• Remove allergen

- Steroids