Pulmonary fibrosis and occupational lung disease Flashcards
Difference between interstitial lung disease and pulmonary fibrosis and obstructive lung disease
Obstructive affects the main airways
Interstitial affects the area between the alveoli and capillaries
Interstitial lung disease can be inflammatory and fibrotic
Causes of interstitial lung disease
Idiopathic
Sarcoidosis
Related to occupations: asbestosis, silicosis or pneumoconiosis
Related to other exposures: Bird fancier’s lung
Related to other disease: often connective tissue disease and rheumatoid arthritis
Related to treatments: drugs or radiotherapy
POst infectious: e.g. TB or covid19
Cause of acute causes of diffuse lung disease
Infections (bacterial/viral/fungal), ARDS (acute respiratory distress syndrome),
Causes of acute or chronic causes of diffuse lung disease
Drugs (e.g. methotrexate, amiodarone, nitrofurantoin)
Toxins: radiotherapy
Vasculitis
Pulmonary oedema
Miscellaneous e.g sarcoidosis, inflammatory pneumonias
Chronic causes of diffuse lung disease
Idiopathic Inhalation e.g. asbestosis Connective tissue disorders e.g. rheumatoid arthritis Malignancy Miscellaneous e.g. bronchiectasis
History of interstitial lung disease
Breathlessness Cough Fatigue Weight loss Wheeze Associated symptoms
Examination findings of interstitial lung disease
Clubbing Hypoxia Crackles May have right heart failure symptoms Signs of other disease
IF history and exam suggest ILD, what do you do
Chest Xray CT scan of the lungs Blood tests (rheumatoid factors) Lung function tests (ILD causes restrictive pathology) Lung biopsy?
Management of interstitial lung disease
Mainstay is supportive e.g. stop smoking and avoid exposures
Antifibrotics, steroids, steroid-sparing agents
Acute exacerbation of interstitial lung disease management
Supportive, oxygen, high flow nasal oxygen,
What is hypersensitivity pneumonitis
Acute?
Chronic?
Exposure to inhaled organic antigen to which the person has been previously sensitise
Acute- short period of intense exposure, usually reversible
Chronic HP- Long-term lower level exposure, less reversible and may progress
Causes of hypersensitivity pneumonitis
Bird fancier’s lung
Farmer’s lung
Hot tub lung
Bagpipes
How to diagnose hypersensitivity pneumonitis
Thorough history Bloods (precipitins are helpful in diagnosis not required) Imaging Lung function testing Biopsy MDT
hypersensitivity pneumonitis management
Allergen avoidance
PPE from employer
Steroids
Steroid sparing agents
What lung diseases can asbestos cause
Pleural plaques (benign) Pleural thickening Asbestosis Mesothelioma (malignant tumour of serosal surface) Lung cancer
