Interstitial Lung Disease Flashcards
What is interstitial lung disease?
Umbrella term describing a number of conditions that cause inflammation + fibrosis the lung parenchyma:
- usual interstitial pneumonia (including. Idiopathic pulmonary fibrosis)
- non-specific interstitial pneumonia
- hypersensitivity pneumonitis
- sarcoidosis
- asbestosis
Presentation of interstitial lung disease
dyspnoea on exertion
dry cough
fatigue
Diagnosis of interstitial lung disease
- clinical features
- high-resolution CT scan of thorax: ground glass appearance
- spirometry >70%
- lung biopsy
- bronchoalveolar lavage
What blood tests should be done after a diagnosis of interstitial lung disease for diseases associated with ILD?
- ANA: SLE
- Rheumatoid factor + anti-CCP: RA
- ANCA: vasculitis
- Anti-GBM: pulmonary renal disease
- ACE: sarcoidosis
- HIV test
What is the most common type of pulmonary fibrosis?
Usual interstitial pneumonia (incl. idiopathic pulmonary fibrosis)
Typical findings of idiopathic pulmonary fibrosis
- basal fine end-inspiratory crackles
- finger clubbing
- reduced chest expansion
- pulmonary fibrosis
What is hypersensitivity pneumonitis?
inflammation of lungs due to immune response to inhaled organic antigens or chemicals e.g. mould, dust, animal proteins
Clinical presentation of hypersensitivity pneumonitis
- **acute*: 4-8 hours after exposure, often reversible + spontaneous settles after 1-3 days
- chronic: chronic exposure + less reversible
Common drug causes of pulmonary fibrosis
- amiodarone
- methotrexate
- nitrofurantoin
- penicillamine
- bleomycin
What is sarcoidosis?
Multisystem inflammatory disease characterised by formation of non caseating granulomas (no necrosis)
Where is sarcoidosis often found?
lungs
lymph nodes
Typical demographic of sarcoidosis
- 20-40 or ~60 years old
- woman
- black ethnic origin
Presentation of sarcoidosis
- 20-40 year old black woman
- shortness of breath
- dry cough
- skin nodules on shins
- weight loss
- fatigue
- uveitis, conjunctivitis
- polyarthralgia
Blood test findings of sarcoidosis
raised ACE + calcium
Skin findings of sarcoidosis
- erythema nodosum: raised, red, painful, tender nodules across both skins
- lupus pernio: raised purple skin lesions often on cheeks + nose
