Interstitial Lung Disease Flashcards
What is interstitial lung disease?
Any diesase affecting the lung interstitium - the latter parts of the bronchial tree such as terminal bronchi and alveoli
Interstitial lung disease will _______ gas transfer in the lungs
Impair
Interstitial lung disease is a form of _________ lung disease
Restrictive
What is another name for interstitial lung disease?
Diffuse parenchymal lung disease (DPLD)
What are the three types of interstitial lung disease?
- Acute
- Episodic
- Chronic
What may be the causes for chronic interstitial lung disease?
- Systemic disease
- Log term allergen/inflammatory agent exposure
- Idiopathic
What is sarcoidosis?
A condition caused by a hypersensitivity type IV reaction
It is a granuomatous disease involving non-caseating granuloma
Which interstitial lung condition is less common in smokers?
Sarcoidosis
What are the two types of sarcoidosis?
- Acute
- Chronic
Acute sarcoidosis may have signs and symptoms including what?
- Erythema nodosum - inflammation of fat cells under the skin giving a red blotchy appearance
- Bilateral hilar lymphadenopathy - enlargement of lymph nodes arround the hila
- Arthritis
- Fever
Chronic sarcoidosis may have signs and symptoms inlcuding?
- Lung infiltrates - alveolitis
- Skin infiltrates - oedema
- Peripheral lymphadenopathy
- Hypercalcaemia - high calcium level in blood serum
How can sarcoidosis be diagnosed?
- CXR
- CT scans - can show peripheral nodular infiltrate
- Tissue biopsies confirm presence pf non-caseating granulomatous tissue
- Pulmonary function testing will show a restrictive pattern since there are lung infiltrates
- Blood tests can show raised calcium and inflammatory cell levels
Differential diagnosis for sarcoidosis may include what?
- Tb
- Lymphoma
- Carcinoma
- Fungal infection
How is sarcoidosis treated?
Usually acute sarcoidosis does not need treated by if it affects a major organ steroids can be used
Oral steroids and immunosuppression can be used to treat chronic chronic sarcoidosis
Which types of immunosuppression drugs will be used to treat chronic sarcoidosis?
- Azathioprine
- Methotrexate
- Anti-TNF therapy
What is extrinsic allergic alveolitis also known as?
Hypersensitivity pneumonitis
What is extrinsic allergic alveolitis caused by?
Type III hypersensitivity reaction
This causes deposition of immune complexes around the body
Which conditions can cause extrinsic allergic alveolitis?
- Farmer’s lung
- Malt worker’s lung
- Bird fancier’s lung
Conditions that involve inhalation of a foreign pathogen
What are the three types of extrinsic allergic alveolitis?
- Acute
- Chronic
- Episodic
What symptoms will acute extrinsic allergic alveolitis involve?
- Cough
- Breathlessness
- Fever
- Myalgia
Can come on hours after exposure
What signs are there for acute extrinsic allergic alveolitis?
- Pyrexia
- Crackles
- Hypoxia
- Widespread pulmonary infiltrates on CXR
Describe chronic extrinsic allergic alveolitis
There is a low dose of allergen exposed over time leading to worseing breathlessness and cough
Lung crackles is the main sign and pulmonary fibrosis is common in the upper zones
What is the treatent of chronic extrinsic allergic alveolitis?
- Removal of antigen
- Oral steroids
How is chronic extrinsic allergic alveolitis diagnosed?
- History
- Precipitins (IgG antibodies to putative antigen)
- Lung biopsy
What can be heard upon auscultation at the lungs for idiopathic pulmonary fibrosis?
Fine inspiratory crackles
What does a CXR show for pulmonary fibrosis?
Bilateral infiltrates
A CT scan for pulmonary fibrosis shows what?
- Reticulonodular fibrotic shawdowing worse at lung bases and periphery
- Bronchiectasis
How can idiopathic fibrosis be diagnosed?
A good history focussing on common allergen sources
Damage of lung architecture in idiopathic fibrosis can lead to what?
Honeycombining
Which two drugs have been shown to have an anti-fibrotic effect?
- Pirfenidone
- Nintedanib
(can only slow condition - not curative)
Which treatment may be considered for young patients with idiopathic fibrosis?
Lung transplant
What is pneumoconiosis?
Damage done to the lungs via inhalation of dust such as that in coal mines or asbestosis for example
Simple pneumoconionis has what types of symptoms and how is it diagnosed?
There are no symptoms
Can be picked up on CXR
What is complicated pneumoconiosis?
Disease following progression of fibrosis leading to restrictive pattern of lung disease and breathlessness
Chronic bronchitis can become present when coal dust is combined with what?
Smoking
What is silicosis?
A condition that occurs after long-term exposure to quarts in mining, glass or boiler works
A simple pneumoconiosis will develop and over time chronic silicosis can produce symptoms and pulmonary fibrosis
How can asbestos be removed from the lungs?
It can’t be
What types of pleural disease is associated with asbestos?
- Benign pleural plaques - asymptomatic
- Acute asbestos pleuritis - fever, pain, bloody pleural effusion
- Pleural effusion and diffuse pleural thickening - restrictive impairment
- Malignant mesothelioma - incurable pleural cancer, presents with chest pain and pleural effusion
Why can asbestos not be cleared?
Macrophages attempt this but fail and enter the pleura to die
Pulmonary fibrosis or asbestosis is caused due to the long term exposure and has a restrictive defect
Which condition will increase the likelihood of asbestosis manifestation?
Bronchial carcinoma
(via smoking)
