Interstitial Lung Disease Flashcards
How to confirm diagnosis of interstitial lung disease?
Clinical features and high resolution CT
What does high resolution CT show?
Ground glass appearance
Management of interstitial lung disease?
Gone oxygen if hypoxia
Remove or treat underlying cause
Stop smoking
Physiotherapy/ pulmonary rehab
Pneumococcal flu vaccine
Palliative care
Lung transplant
What is idiopathic pulmonary fibrosis?
Unknown cause, over 50, sob and dry cough for more than 3 months
What can you find on examination of idiopathic pulmonary fibrosis?
Clubbing and i basal fine inspiration crackles
Prognosis of idiopathic pulmonary fibrosis?
2-5 years
2 medications that slow progression of idiopathic pulmonary fibrosis?
- Pirfenidone- antifibrotic and anti-inflammatory
- Nintedanib- tyrosine kinase
Drug induced pulmonary fibrosis is caused by?
MANC
Methotrexate
Amiodarone
Nitrofunatoin
Cyclophosphamide
Secondary pulmonary fibrosis is due to?
RASS
Rheumatoid arthritis
Alpha 1 antitrypsin deficiency
SLE
Systemic sclerosis
What is hypersensitivity pneumonitis?
Type 3 reaction- parenchyma inflammation
What would you find with bronchoalveolar lavage in hypersensitivity pneumonitis?
Mast cells and lymphocytes
Examples of hypersensitivity pneumonitis?
Bird fancier lung: avian proteins from droppings
Farmer lung: saccharopolyspora rectivirgula
Mushroom workers: aspergillus clavatus
Malt workers lung: thermophilic actinomycetes
How to manage hypersensitivity pneumonitis?
Oxygen, remove allergen, steroids
Which condition is similar to pneumonia on CXR and had similar symptoms of cough, fever, sob lethargy?
Cryptogenic organising pneumonia- lung biopsy definitive investigation.
Treatment systemic corticosteroids
What can asbestosis cause?
Lung fibrosis
Pleural thickening and plaques
Adenocarcinoma
Mesothelioma
What would spirometry show in IPF?
Restrictive picture: FEV1 normal or reduced and FVC reduced hence FEV1/FVC increased
What can IPF cause?
Impaired gas exchange, hence reduced transfer factor
Investigation of choice in IPF?
CT- honeycombing , CXR- bilateral shadowing reticular opacities
What does asbestosis normally cause?
Lower lung fibrosis
Features of asbestosis?
Dyspnoea/ reduced exercise tolerance
Clubbing
Bilateral end inspiratory crackles
Restrictive pattern on lung function test and reduced gas transfer
Possible features of mesothelioma?
Progressive sob
Chest pain
Pleural effusion
Mean survival for mesothelioma?
8-14 months
Which occupations put yo at risk of developing silicosis?
Mining, slate works, foundries, potteries
What are the features of silicosis?
Upper zone fibrosing lung disease, egg shell calcification of hilar lymph nodes
What is a risk factor for developing tuberculosis?
Inhalation of silica ( toxic to macrophages)
How does coal dust cause coal workers pneumoconiosis?
Dust in engulfed by alveolar and interstitial macrophages in the bronchioles. They are then moved by the macrophages via the mucocilary elevator and removed from body as mucus. However prolonged exposure causes macrophages to accumulate in alveoli starting an immune response causing damage to lung tissue
What are the 2 types of pneumoconiosis?
Simple and progressive massive fibrosis
What is simple pneumoconiosis?.
Most commonest type, patients are asymptomatic. Increases the risk of lung disease COPD. 30% of those with stage 3 will lead to progressive massive fibrosis
Staging of simple pneumoconiosis?
- Some opacities but normal lung markings visible
- Large number of opacities but normal lung markings visible
- Large number of opacities with normal lung not visible
What happens in progressive massive fibrosis?
Round fibrotic masses commonly in upper lobes. Patients will be sob and cough, possibly black sputum.
What will a lung function test show for progressive massive fibrosis?
Obstructive/ restrictive picture
What will CXR show for progressive massive fibrosis?
Upper zone fibrosis
Spirometry for progressive massive fibrosis?
Normal or slightly reduced FEV1 but reduced FVC- restrictive
Management of pneumoconiosis?
Avoid exposure to coal dust and other respiratory irritants (smoking)
Manage symptoms of chronic bronchitis
Patients may be eligible for compensation via the industrial injuries act
Presentation of extrinsic allergic alveolitis?
Sob, cough fever, in chronic stages productive cough, lethargy , anorexia and weight loss
Management of extrinsic allergic alveolitis?
Oral glucocorticoids
