ILDs Flashcards
(25 cards)
Describe the epidemiology of asbestos-related lung disease
Increasing prevalence recently
Commoner among certain professions eg. builders, ship builders
Almost entirely male predominance
Describe the types of asbestos-related lung disease
Pleural plaques: non-malignant thickening of the pleura
Asbestosis: pulmonary fibrosis due to asbestos
Mesothelioma: malignant disease of the pleura
Describe the presentation of asbestos-related lung disease
Pleural plaques: may be incidental finding on CXR/HRCT
Asbestosis: presents with progressive SOB, chronic dry cough, wheeze
Mesothelioma: pleuritic CP, SOB, cough, fatigue, weight loss
Describe the signs of asbestos-related lung disease on examination
Asbestosis: signs consistent w fibrosis
- Clubbing
- Fine late inspiratory crackles in bases
Mesothelioma: usually presents w pleural effusion
-Unilat absent breath sounds and dullness to percussion
Describe the investigations for asbestos-related lung disease
- History and examination: focus on occupational exposure
- Bloods: FBC, CRP, U+Es, LFTs, BNP
- CXR (pleural thickening, linear interstitial fibrosis)
- HRCT diagnostic
- Spirometry
Describe the management of asbestos-related lung disease
No treatment
Asbestosis:
-Conservative: no smoking, exercise, vaccinations, pulmonary rehab
-Medical: O2 therapy
Mesothelioma:
- Medical: chemorad
- Surgical: pneumonectomy, pleurectomy
Describe the prognosis of asbestos-related lung disease
Pleural plaques- usually fine, do not progress
Asbestosis- prognosis related to the extent of fibrosis
Mesothelioma- highly lethal. 90-95% die within 5 years
Describe the epidemiology of idiopathic pulmonary fibrosis
Affects older adults
M > F
No geographic/racial predilection
Define IPF
IPF is a chronic progressive lung disease with scarring and fibrosis that occurs without a known cause
Describe the presentation of IPF
Main symptom: progressive SOB
- Chronic dry cough
- Fatigue
- Weight loss
Describe the signs of IPF on examination
General: dyspnoeic, thin
Hands: clubbing
Chest: fine late inspiratory crackles at the lung bases
Describe the differential diagnoses for IPF and how these are explored through history/exam/Ix
Respiratory:
- Other interstitial lung disease: history for occupational exposures and other symptoms suggesting connective tissue disease/etc, exam for other signs of systemic disease
- COPD: smoking history likely to be more, spirometry shows obstructive picture
Cardiac:
-HF: history for other symptoms/RFs, exam for signs of oedema/raised JVP, BNP and echo
Describe the investigations for IPF/pulmonary fibrosis
- History and examination
- Bloods: FBC, CRP, U+Es, LFTs, BNP, antibodies
- CXR
- HRCT: fine reticular (ground-glass) opacities with honey-combing
- Spirometry: restrictive picture (FEV1/FVC >0.7)
- Lung biopsy (not needed for all)
Describe the management of IPF
Conservative:
- Exercise and healthy lifestyle, no smoking
- Vaccinations
- Pulmonary rehab if needed
Medical:
- Specific drugs
- Treat cause eg. DMARDs/biologics for systemic disease
- Oxygen therapy
Surgical:
-Lung transplantation
Define pneumoconiosis
Pneumoconioses are a group of interstitial lung diseases caused by exposure to inorganic/mineral dust eg. silicon, coal dust
Describe the epidemiology of pneumoconioses
Usually associated with occupational exposure
M > F
Not very common
Describe the presentation of pneumoconioses
Most commonly progressive dyspnoea
+ chronic dry cough, wheeze
+fatigue, weight loss
Describe the investigations for pneumoconioses
Same as for other ILDs
- Bloods to rule out systemic disease, HF
- CXR first (upper lobe nodular opacities, egg-shell calcification of the hilum in silicosis)
- HRCT diagnostic (ground glass, honeycombing in upper lobes)
- Spirometry (commonly obstructive in coal + silicosis), used for prognosis + treatment planning
Describe the management of pneumoconioses
Similar to IPF:
Conservative: eg. pulmonary rehab, lifestyle, vax
Medical: bronchodilators, oxygen therapy
Surgical: transplant
Define extrinsic allergic alveolitis. What is the new term?
Now called hypersensitivity pneumonitis
A group of lung diseases caused by exposure to organic particles eg. mould, dust
What are some types of EAA/hypersensitivity pneumonitis?
Malt-workers lung: Aspergillus clavatus + fumigatus
Pigeon fanciers lung: pigeon faeces proteins
Farmer’s lung: Actinomycetes
Drug induced HP
Describe the pathophysiology of EAA/HP
Exposure to organic dust (non-human protein) causes an immune reaction -> inflammation of the airways
Describe the presentation of EAA/HP
3 syndromes:
Acute (hours after exposure):
-Fever and chills, myalgia
-Dry cough and SOB
Sub-acute (weeks-months):
- SOB and productive cough
- May not have a temporal relationship to exposure if constantly around eg. mould in the house
Chronic (months-years):
- SOB, cough
- Fatigue, weight loss
Describe the investigations for EAA/HP
Bloods: FBC, CRP, ESR, U+Es, serology CXR: patchy, nodular infiltrates HRCT if needed: reticulonodular opacities Spirometry : may be either R or O BAL/biopsy
