Interstitial Lung Disease

Question 1

What is the typical history associated with interstitial lung disease?

Answer 1

• Progressive dyspnea and non-productive cough
• History of exposure to occupational or environmental toxins (e.g., asbestos, silica)
• Possible history of connective tissue disease

Question 2

What are the key physical examination findings in interstitial lung disease?

Answer 2

• Bibasilar inspiratory crackles (velcro crackles)
• Digital clubbing in advanced cases
• Signs of pulmonary hypertension or right heart failure

Question 3

What investigations are necessary for diagnosing interstitial lung disease?

Answer 3

• High-resolution CT scan showing interstitial changes
• Pulmonary function tests showing restrictive pattern (reduced TLC, FVC, normal or increased FEV1/FVC ratio)
• Lung biopsy if diagnosis is unclear

Question 4

What are the non-pharmacological management strategies for interstitial lung disease?

Answer 4

• Avoidance of exposure to known lung irritants
• Pulmonary rehabilitation and regular exercise
• Oxygen therapy if hypoxemia is present

Question 5

What are the pharmacological management options for interstitial lung disease?

Answer 5

• Antifibrotic agents (e.g., pirfenidone, nintedanib) for idiopathic pulmonary fibrosis
• Immunosuppressive therapy for connective tissue disease-associated ILD
• Corticosteroids for acute exacerbations

Question 6

What are the red flags to look for in interstitial lung disease patients?

Answer 6

• Rapidly worsening dyspnea or new onset of symptoms
• Signs of acute exacerbation: increased cough, fever, hypoxemia
• Hemoptysis or significant weight loss

Question 7

When should a patient with interstitial lung disease be referred to a specialist?

Answer 7

• Refractory or severe ILD not responding to initial treatment
• Need for advanced therapies (e.g., lung transplant)
• Consideration for enrollment in clinical trials

Question 8

What is one key piece of pathophysiology related to interstitial lung disease?

Answer 8

• Chronic inflammation and fibrosis of the lung interstitium
• Leads to impaired gas exchange and reduced lung compliance
• Can result from various etiologies including occupational exposures and autoimmune diseases