Pulmonary fibrosis

Question 1

Causes of upper lobe fibrosis

Answer 1

Hypersensitivity pneumonitis
Coal worker's pneumoconiosis
Silicosis
Sarcoidosis
Ankylosing spondylitis
Tuberculosis

Question 2

Causes of lower lobe fibrosis

Answer 2

Idiopathic pulmonary fibrosis
Connective tissue disorders e.g. SLE
Drug induced- amiodarone, methotrexate
Asbestosis

Question 3

Idiopathic pulmonary fibrosis

Symptoms and signs

Answer 3

Seem in men 50-70 yrs. Progressive exertional dyspnoea. Bibasal fine end expiratory crackles. Dry cough. Clubbing.
Spirometry shows restrictive disease with FVC decreased so FEV1/FVC normal/high.

CXR- bilateral interstitial shadowing.

Question 4

Idiopathic pulmonary fibrosis

Management

Answer 4

Pulmonary rehabilitation
Pirfenidone- antifibrotic. 
Supplementary oxygen.
Transplant.
Poor outcomes- life expectancy 3-4 years.