Interstitial Lung Disease Flashcards
(23 cards)
What is interstitial lung disease?
Group of diseases which all cause inflammation and eventually fibrosis of pulmonary interstitium
What is the pulmonary interstiitum?
Thin tissue surrounding alveoli
Symptoms of interstital lung disease?
Chronic dry cough
SOB
Fatigue
Examples of interstitial lung disease?
Idiopathic pulmonary fibrosis
Secondary pulmonary fibrosis
Hypersensitivity pneumonitis
Cryptogenic organising pneumonia
Asbestosis
What are the most common forms of interstitial lung disease?
Idiopathic pulmonary fibrosis (most common)
Hypersensitivity pneumonitis (2nd common)
What conditions are associated with ILD?
Connective tissue disorders, e.g. systemic sclerosis
Rheumatoid arthritis
Alpha 1 antitrypsin deficiency
Sarcoidosis
Diagnosis for ILD?
What are the findings?
Spirometry - normal, OR restrictive pattern of FEV1/FVC ratio greater than 0.7
HRCT (GOLD STANDARD) - ground glass appearance, traction bronchiectasis
CXR - nodular and reticular shadowing
General management of all interstitial lung disease?
Treat the underlying cause
Home oxygen
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care
Lung transplant
What is idiopathic pulmonary fibrosis?
Who is it more common in?
Symptoms of IPF?
Prognosis?
Progressive fibrotic lung disease of unknown origin
Older patients (mean: 74) and smokers
Insidious onset of cough and SOB > 3 months
Bibasal end inspiratory FINE crackles
Clubbing
2-5 year survival rate from diagnosis
What drugs can cause secondary pulmonary fibrosis?
Amiodarone (also causes grey/blue skin)
Cyclophosphamide
Methotrexate
Nitrofurantoin
Characteristic finding on HRCT for idiopathic pulmonary fibrosis?
Peripheral basal honeycombing
Management of idiopathic pulmonary fibrosis?
Pirfenidone
Nintedanib
MoA of nintedanib in treating IPF?
tyrosine kinase inhibitor
If HRCT or spirometry don’t show a clear diagnosis for ILD what other investigations can you do?
Lung biopsy
Bronchoalveolar lavage
What is hypersensitivity pneumonitis?
What hypersensitivity reaction is it?
Type III and IV hypersensitivity reaction to an inhaled allergen, leading to inflammation and damage to lung tissue
Investigation for hypersensitivity pneumonitis?
Management?
Bronchoalveolar lavage - airways washed with saline and fluid analysed for presence of lymphocytes
Remove allergen, oxygen, steroids
Examples of hypersensitivity pneumonitis?
Bird-fancier’s lung - bird droppings
Farmer’s lung - mouldy spores in hay
Mushroom worker’s lung - specific mushroom antigens
Malt worker’s lung - mould on barley
What is Cryptogenic Organising Pneumonia?
Signs and symptoms of it?
Findings on CXR?
Definitive diagnosis?
Management?
Focal lung inflammation - idiopathic or infection/inflammation/medications/radiation/environmental triggers
Symptoms and CXR findings same as pneumonia
Lung biopsy- definitive diagnosis
Management - corticosteroids
What is asbestosis?
Lung fibrosis related to asbestos exposure. It is oncogenic (causes cancer)
Complications of asbestosis
Fibrosis
Pleural thickening and plaques
Adenocarcinoma
Mesothelioma
What must happen to all deceased patients with asbestosis?
Referred to the coroner
Patients are eligible for compensation.
Causes of upper zone lung fibrosis?
Coal workers pneumoconiosis
Hypersensitivity pneumonitis
Ankylosing spondyliytis
Radiation
Tuberculosis
Sarcoidosis/Silicosis
CHARTS mnenomic
What are the spirometry findings for ILD vs Asthma? (TLCO, FEV1/FVC)
ILD
FEV1/FVC ratio > 0.7
TLCO decreased
Asthma
FEV1/FVC ratio < 0.7
TLCO increased/normal
