interstitial lung disease

Question 1

Give examples of drugs that can cause interstitial lung disease

Answer 1

Nitrofurantoin, methotrexate, amiodarone, ace-inhibitors, heroin

Question 2

Give examples of conditions that can cause ILD

Answer 2

Lupus, RA, asbestosis,

Question 3

If you have pulmonary fibrosis in the context of granulomatous inflammation what condition would this suggest

Answer 3

sarcoidosis

Question 4

How will the lungs look in spirometry

Answer 4

they are small and stuff so you will have reduced FVC and the flow/volume chart will appear much smaller

Question 5

what immunological screens would you do in a person who you suspected of ILD

Answer 5

Rheumatoid factor
ANA screen - for lupus
ANCA screen for ANCA-associated vasculitis
Avian precipitans and aspergillus precipitans - Hypersensitive pneumonitis
Serum ACE level - elevated in sarcoid
Serum immunoglobulins - elevated in active sarcoid.

Question 6

what is a characteristic feature of idiopathic pulmonary fibrosis on a CXR/HRCT

Answer 6

Honeycombing (usually sub-pleural)

Question 7

what is the drug used to treat idiopathic pulmonary fibrosis

Answer 7

pirfenidone. Has anti-fibrotic and auto-inflammatory effects. Likely to suppress fibroblast proliferation. Not a very good drug

Question 8

what can be given to patients for symptom control in IPF

Answer 8

oxygen therapy at home, diuretics (for fluid retention if they develop cor pulmonale), antibiotics to prevent infection. In some patients (if young enough) lung transplant may be considered.