Management of ILD

Question 1

non pharmacologic options for ILD management

Answer 1

• infection prevention (prevent pneumonia via vaccination
• pulmonary rehabilitation
• supplemental oxygen (resting/exertional)
• co-morbidities

Question 2

general pharmacoloic management of ILD

Answer 2

• immuno-modulatory
• anti-fibrotics
• lung transplantation
• education and support
• symptom management and palliative care

Question 3

first step of ILD management

Answer 3

• first must identify the potential agent
• occupational remediation
• stop the offending drug (drug cessation)
• antigen remediation in HP
• SMOKING CESSATION

Question 5

examples od immuno-modulatory therapies

Answer 5

• prednisone
• azathioprine
• mmf
• rituximab
• ivig

Question 6

examples of anti-fibrotic therapies

Answer 6

pirfenidone

-nintedanib

Question 7

Answer 7

ground glass opacity ; small bilateral effusion

Question 8

acute vs chronic nitrofurantoin pneumonitis

Answer 8

acute: hypersensitivity reaction
chronic: either cell-mediated or toxic response
- Typically a delay b/w exposure and symptoms

Question 9

Drug induced ILD management

Answer 9

stop the offending drug!! maybe prednosine. avoid future exposure

Question 10

Answer 10

upper lobe predominant abnormalities

• hila also pulled up

lung volume decreases

• upper lobe haziness= common in sarcoidosis, silicosis, chronic TB

Question 12

chronic silicosis/environmental toxin can cause ___ ___ ___

Answer 12

pulmonary/progressive mastofibrosis.

Question 13

management of silicosis

Answer 13

1. remove the ongoing exposure
   - 2. screen for everything– tb, autoimmune disease
2. stop smoking
3. supportive care
4. lung transplant

Question 14

Syndrome resulting from repeated inhalation of
finely dispersed antigens

 Caused by organic particles, small molecular
weight volatile and non-volatile chemicals

 Diffuse mononuclear cell inflammation of small
airways and lung parenchyma

 Non-fibrotic HP  Fibrotic HP

Answer 14

hypersensitivity pneumonitis

Question 15

diagnosing hypersensitivity pneumonitis (form of ILD):

Exposure History

 Exam: normal to end-stage fibrotic ILD 

PFTs– __ and low ___

 Serum specific IgG (___)

 HRCT Chest

 BAL fluid lymphocytosis

 +/-Lung Biopsy

 Review in Multi-Disciplinary Discussion
(MDD)

Answer 15

 Exam: normal to end-stage fibrotic ILD 

PFTs– restrictive and low DLCO

 Serum specific IgG (precipitins)

 HRCT Chest

 BAL fluid lymphocytosis

 +/-Lung Biopsy

 Review in Multi-Disciplinary Discussion
(MDD)

Question 16

what is idiopathic pulmonary fibrosis

Answer 16

chronic progressive parenchymal lung disease of complex etiology. The only cure is lung transplantation

Question 17

Natural history of idiopathic pulmonary fibrosis

Answer 17

Question 18

why is nintedanib more comon to be used than pirfenidone as an antifibrotic in IPF?

Answer 18

they’re both shown to slow progession and improve survival but nintenaib only needs to be taken once a day

Question 19