Flashcards in Interstitial Lung Disease - Goya Deck (17):
What is Interstitial Lung Disease (ILD)?
comprised of a diverse group of lung infiltrates that cause disruption of the alveolar structures and have common clinical, radiographic and physiological consequences
scarring of lung and SOB and restrictive pattern on PFTs
incidence of ILD varies with diseases
-idiopathic pulmonary fibrosis 30-40%
What is interstitium?
the space between the basement membranes of the alveolar lining epithelium and the capillary endothelium
What drugs can cause ILD?
What are the 2 idiopathic interstitial pneumonias that we have to know? What are their prognoses?
Usual Interstitial Pneumonia (UIP)
-poor prognosis --> more fibrosis and scarring
Nonspecific interstitial pneumonia (NSIP)
What are the 5 most common interstitial lung diseases?
Usual interstitial pneumonia
Nonspecific interstitial pneumonia
Connective tissue Disease
What is the common presentation of ILD?
Typical patients are middle aged presenting with progressive dyspnea & nonproductive cough
other symptoms depend on the underlying process
-connective tissues affect women > men (except RA)
-pneumoconiosises affect men more
long latency from exposure --> disease
What are some PE findings associated with ILD?
-clubbing of fingers (except in sarcoidosis)
-pulmonary HTN and cor pulmonale in advanced diseases
What x-ray findings will be seen in ILD?
reticular or reticulonodular pattern is the most common
honey-combing is a late finding (seen better on CT)
*CXR goof for suggesting presence of ILD but not the stage
What is a great test for suspected early ILD?
high resolution CT scan
start as sub pleural patch leading to diffuse fibrosis "honeycomb lung"
What will PFTs for ILD show?
-decrease in TLC --> restrictive
-decrease in FVC
-increase in FEV1/FVC ratio
How will the bronchoalveolar lavage differ in the causes of ILD? When is this done?
Lymphocytes-hypersensitivity pneumonitis & sarcoidosis
Neutrophils increased in IPF & asbestosis
*only done in suspected infectious causes of ILD
When would a lung biopsy be used to diagnose ILD?
to exclude neoplastic and infectious processes
useful in diagnosing UIP, nonspecific interstitial pneumonia
What may be the initial procedure of choice in ILD? What causes are good yield?
What is the major goal of management of ILD?
identify and aggressively treat the inflammatory process (many causes are not responsive to treatment)
remove the offending agent
What are some treatment options for ILD?
Immunosuppressants (Azathioprine, Cytoxan, Cyclosporin)
Corticosteroids* (suppress the alveolitis)
When should a lung transplant be considered?
Failure to medical therapy
Worsening oxygen desaturation with minimal exercise
Worsening pulmonary function testing
normally only do a single lung transplant