Interstitial lung disease Flashcards
What are the main types of interstitial lung disease?
Usual interstitial pneumonia
Non-specific interstitial pneumonia
Extrinsic Allergic alveolitis
Sarcoidosis
What investigations should you consider ordering for patients with interstitial lung disease?
ANA
ENA
RhF
ANCA
Anti-GBM
ACE
IgG to serum precipitins
HIV
What classical findings will you find on examination with a patient with interstitial lung disease?
Clubbing of the fingers
Reduced chest expansion
Fine inspiratory crepitations on auscultation - usually heard over the basal and axillary areas
Cardiovascular - may be features of cor pulmonale
What is extrinsic allergic alveolitis?
This is also known as hypersensitivity pneumonitis.
Acute - short period from exposure and is usually reversible.
Chronic - chronic exposure to an allergen for months to years and this is less reversible
What is sarcoidosis?
This is a multi-system inflammatory condition of unknown cause
Non caseating granulomas on histology
Immunological response
50% patients get spontaneous remission but others get progressive disease
What investigations would you order for sarcoidosis?
Pulmonary function testing
CXR
Bloods: Renal function, bone profile, ACE
Urinary calcium
ECG, echo, cardiac MRI
CT/MRI head
What are the treatment principles for interstitial lung disease?
Remove any offending factors such as drugs and occupational exposure
Smoking cessation
Consider LTOT in severe cases
Pulmonary rehabilitation
What is the pharmacological management for interstitial lung disease?
N-acetylcysteine
Pirfenidone
Immunosuppressants
can all be considered
How is interstitial lung disease diagnosed?
Using spirometry: FEV1:FVC ratio is preserved but both FEV1 and FVC are separately reduced.
CXR: May show signs including broken glass appearance due to increased radiopacity as a result of fibrotic scarring. This can progress to honeycombing appearance on a CXR.
