ILD

• What is the purpose of the lung interstitium?


  Space between between the parenychma/alveoli and associated capillaries/blood vessels

  Medium for protein/cell transport (gas exchange occurs here)
• What is the pathophys of ILD?


  Mutation -> too much ECM secreted -> fibrosis -> thickened interstitium -> greater distance for O2 & CO2 to travel between alveoli & capillaries -> compromised gas exchange
• What are the different types of ILD?


  Primary ILD

  • idiopathic pulmonary fibrosis
  • acute interstitial pnuemonia
  • desquamative interstitial pnuemonia

  Secondary ILD

  • sarcoidosis
  • RA
  • SLE
  • hypersensitivity pnuemonitis
  • asbestosis
  • drugs (methotrexate, amiodarone, bleomycin)
• What are the RFs of ILD?


  FHx

  Smoking

  Environmental exposure (mould, chemicals, dust, pollutants)

  Medications (methotrexate)

  Pre-existing conditions
• What are the symptoms of ILD?


  Progressive exertional dyspnoea

  Dry cough

  General malaise/fatigue

  Other symptoms of CTD (connective tissue disease)
• What are the signs of ILD?

  Fine end-inspiratory crackles

  Dull percussion note (effusion)

  Clubbing

  Other CTD signs
• What are the Inx for ILD?


  Obs (esp sats)

  Full Hx & examination

  Urine dip

  Bloods (FBC, U&Es, LFTs, CRP, autoimmune screen)

  CXR

  CT

  Bronchoalveolar lavage

  Lung function tests
• What is shown in the image?

  Pulmonary fibrosis

  
• What causes upper zone fibrosis?


  CHARTS

  Coal-worker pneumoconiosis

  Histiocytosis

  Ankylosing spondylitis

  Radiation

  TB

  Sarcoidosis/silicosis
• What causes lower zone fibrosis?

  RASIO

  RA

  Asbestosis

  SLE/Sjogrens

  Idiopathic pulmonary fibrosis

  Other (drugs etc.)
• What is hypersensitivity pnuemonitis?


  Inflammation due to allergy (hypersensitivity)

  Can also be an occupational disease
• Give some examples of hypersensitivity pneumonitis.


  Farmer's lung = from mouldy spores in hay

  Bird fancier's lung = bird droppings

  Mushroom worker's lung = specific mushroom antigens

  Malt worker's lung = mould on barely
• What is pnuemoconiosis?


  ILD 2nd to exposure to coal dust
• What is silicosis?


  ILD 2nd to exposure to silica
• What is the treatment & management of ILD?


  Avoid underlying cause

  Smoking cessation

  Pulmonary rehab

  Annual flu vaccine

  One off pneumococcal vaccine

  Antifibrotics

  Corticosteroids

  Azathioprine/other immunomodulators

  LTOT

  Transplant
• What are the possible complications of ILD?


  Respiratory failure

  Pulmonary HTN

  Mental health conditions

  SEs of steroids -> HTN, Cushing's, osteoporosis

  SEs of antifibrotics -> diarrhoea, nausea, weight loss