Interstitial Lung Disease

Question 1

Presentation

Answer 1

?oxygen ?breathlessness
Clubbing
Reduced air entry
Dull percussion and reduced vocal fremitus at both bases
Fine end inspiratory crackles at both bases

Question 2

Extra things to comment on

Answer 2

Signs of pulmonary hypertension
Signs of systemic rheumatological disease
Oxygen therapy

Question 3

Causes

Answer 3

• Idiopathic pulmonary fibrosis
• Rheumatological disease - RA, SS, SLE, AS
• Occupational exposure - asbestosis, silicosis
• Drugs - amiodarone, nitrofurantoin, methotrexate
• Eosinophilic lung disease - aspergillosis
• Vasculitis
• Resp diseases - sarcoidosis, TB
• Radiation

Question 4

Causes of clubbing - Resp

Answer 4

ILD, lung CA, mesothelioma, bronchiectasis, CF, lung abscess

Question 5

Idiopathic pulmonary fibrosis

Answer 5

Chronic progressive lung disease of unknown aetiology - inflammation and fibrosis of the lung parenchyma - also known as cryptogenic fibrosing alveolitis
Dyspnoea, restrictive physiology and bilateral pulmonary infiltrate

Question 6

Investigations

Answer 6

Bloods - incl. autoimmune screen and ACE
CXR
HRCT
Lung function tests

Question 7

Apical fibrosis

Answer 7

Berylliosis
Radiation
Extrinsic allergic alveolitis - hypersensitivity
Allergic bronchopulmonary aspergillosis
Sarcoidosis
TB
Silicosis

Coal worker’s pneumoconiosis
Langerhan’s cell histiocytosis
Ankylosing spondylitis
Psoriasis

Question 8

Basal fibrosis

Answer 8

Idiopathic pulmonary fibrosis
Rheumatological disease (except AS and psoriasis)
Connective tissue disease
Drugs
Asbestosis

Question 9

Complications

Answer 9

Respiratory failure
Chest infection
Pulmonary hypertension
Cor pulmonale
Carcinoma of the lung

Question 10

Management

Answer 10

Smoking cessation
Pulmonary rehab
Consider LTOT
Trial of steroids
Antifibrotics - pirfenidone
Surgery - lung transplant