Interstitial lung disease - Revision history

Rossdonaldson1: /* Background */

2023-12-13T22:11:19Z

Background

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	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	* General group of diseases that involve the scarring of lung parenchyma		* General group of diseases that involve the scarring of lung parenchyma
	* Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings		* Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings
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	**Acute interstitial pneumonitis		**Acute interstitial pneumonitis
	**[[Sarcoidosis]]		**[[Sarcoidosis]]
	**[[Idiopathic pulmonary fibrosis]]		**[[Idiopathic pulmonary fibrosis]]

	==Clinical Features==		==Clinical Features==

ClaireLewis at 23:52, 25 January 2019

2019-01-25T23:52:00Z

← Revisión anterior		Revisión del 23:52 25 ene 2019
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	==Background==		==Background==
	* General group of diseases that involve the lung parenchyma		* General group of diseases that involve the scarring of lung parenchyma
	* Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings		* Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings
	* Specific diseases separated into ones with known causes and idiopathic		* Specific diseases separated into ones with known causes and idiopathic
	* Treatment and prognosis differs between specific diseases		* Treatment and prognosis differs between specific diseases
	* Examples of specific diseases: ~~interstitial~~ pneumonia~~, hypersensitivity~~ pneumonitis~~, cryptogenic~~ organizing pneumonia~~, acute~~ interstitial pneumonitis~~, sarcoidosis, idiopathic~~ pulmonary fibrosis		* Examples of specific diseases:
			**Interstitial pneumonia
			**Hypersensitivity pneumonitis
			**Cryptogenic organizing pneumonia
			**Acute interstitial pneumonitis
			**[[Sarcoidosis]]
			**[[Idiopathic pulmonary fibrosis]]

	==Clinical Features==		==Clinical Features==
	* Symptoms~~: progressive~~ exertional dyspnea, ~~persistent~~ nonproductive cough, hemoptysis, pleuritic chest pain		* Symptoms
	* ~~History~~ of occupational ~~exposure:~~ asbestosis, silicosis		**Progressive exertional [[dyspnea]]
	* Abnormal chest imaging or pulmonary function tests		**Persistent, nonproductive [[cough]]
	* Take detailed history making sure to focus on past medical history (connective tissue disease, ~~inflammatory bowel disease~~, ~~malignancy~~), ~~smoking history~~, ~~family history, medications~~, ~~occupational and environmental exposures~~		*+/- [[hemoptysis]], pleuritic [[chest pain]]
	* Physical exam ~~is generally~~ nonspecific		* May have history of smoking, occupational exposures (asbestosis, silicosis, grain dust, bird droppings), medications that can cause pulmonary damage, connective tissue disease, IBD
			*Physical exam
			**Usually nonspecific
			**Increased work of breathing, [[hypoxia]]
			**+/- Abnormal lung sounds (classically fine, "velcro-like" crackles)

	==Differential Diagnosis==		==Differential Diagnosis==
	* Pneumonia
	* Asbestosis		{{Pulmonary fibrosis differential}}
	* Berylliosis
	* Pulmonary ~~edema~~
	* Coal worker's pneumoconiosis
	* Cryptogenic organizing pneumonia
	* Drug induced pulmonary toxicity
	* Farmer's lung
	* Hypersensitivity pneumonitis
	* Interstitial pulmonary fibrosis
	* Collagen-vascular disease
	* Lung malignancy
	* Restrictive lung disease
	* Sarcoidosis
	* Silicosis

	{{SOB DDX}}		{{SOB DDX}}

	==Evaluation==		==Evaluation==
	~~''Work up and test results differ between types~~ of ~~interstitial lung diseases~~. ~~Below are common studies obtained to determine disease~~. ~~See page for specific disease for specific labs/imaging and findings~~. ''		*Definitive diagnosis of ILD rarely made in the ED
	* ~~CBC~~/~~CMP~~		*ED workup should focus on assessing for reversible pathologies that may be causing or exacerbating symptoms (e.g. infection, [[PE]], [[pulmonary hypertension]], [[pulmonary edema]], concomitant [[COPD]] exacerbation, etc.)
	* ~~Serologic studies: ANA~~, ~~Rheumatoid factor~~		**VBG/ABG
	* ~~Imaging: Chest x-ray, chest CT~~		**CBC, BMP
	* ~~Pulmonary function tests~~		**[[CXR]]
	* ~~Cardiac ECHO~~		**Consider CT chest (to rule out PE or better characterize lung parenchyma)
	* ~~Bronchoalveolar lavage~~		**+/- Infectious workup, echo as appropriate
	* ~~Lung~~ biopsy		*Inpatient/outpatient workup may include serologic studies (ANA, rheumatoid factor), PFTs, BAL, lung biopsy

	==Management==		==Management==
	* ~~Management differs between specific types of interstitial~~ lung ~~diseases. This is why it is important~~ to ~~determine specific cause of disease.~~ See ~~specific disease page for~~ management.		*Treat underlying/exacerbating factors (e.g. antimicrobials for infection, optimize volume/hemodynamics for pulmonary hypertension patients, bronchodilators for concomitant obstructive lung disease)
			*Support [[oxygen therapy\|oxygenation]] and [[ventilation]]
			*Specific disease treatments vary, but many respond to [[steroids]], sometimes at high doses
			**See management section of [[idiopathic pulmonary fibrosis]]

	==Disposition==		==Disposition==
	* ~~Depending on how stable the patient is, patient can be admitted for work up or discharged for outpatient work up.~~		* Low threshold to admit
	* Important to ~~determine acute vs chronic symptoms.~~

	==See Also==		==See Also==
	* [[Sarcoidosis ]]		* [[Sarcoidosis ]]
	* Idiopathic pulmonary fibrosis		* [[Idiopathic pulmonary fibrosis]]
			* [[Pneumoconiosis]]
			* [[Hypoxia]]
			* [[Dyspnea]]

	==References==		==References==

Rossdonaldson1: /* Differential Diagnosis */

2017-10-31T12:59:52Z

Differential Diagnosis

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	* Restrictive lung disease		* Restrictive lung disease
	* Sarcoidosis		* Sarcoidosis
	* Silicosis		* Silicosis

			{{SOB DDX}}

	==Evaluation==		==Evaluation==

Mholtz: Category added. References changed - need to be cited in the body text

2017-09-28T23:45:47Z

Category added. References changed - need to be cited in the body text

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	==References==		==References==
	* <Bradley B, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008; 63 Suppl 5:v1./>		<references/>
	* <Pipavath S, Godwin JD. Imaging of interstitial lung disease. Clin Chest Med 2004; 25:~~455./>~~
	* <Martinez FJ, Flaherty K. Pulmonary ~~function testing in idiopathic interstitial pneumonias. Proc Am Thorac Soc 2006; 3:315./>~~		[[Category:Pulmonary]]
	* <Schwartz M, King Jr TE. Interstitial Lung disease, 5th ed, People's Medical Clearing House, Shelton, CT 2011./>
	* <Raghu G, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788./>
	* <Garcia CK, Raghu G. Inherited interstitial lung disease. Clin Chest Med 2004; 25:421./>

Rossdonaldson1: /* Evaluation */

2017-09-28T21:12:05Z

Evaluation

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	==Evaluation==		==Evaluation==
	* Work up and test results differ between types of interstitial lung diseases. Below are common studies obtained to determine disease. See page for specific disease for specific labs/imaging and findings.		''Work up and test results differ between types of interstitial lung diseases. Below are common studies obtained to determine disease. See page for specific disease for specific labs/imaging and findings. ''
	* CBC/CMP		* CBC/CMP
	* Serologic studies: ANA, Rheumatoid factor		* Serologic studies: ANA, Rheumatoid factor
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	* Cardiac ECHO		* Cardiac ECHO
	* Bronchoalveolar lavage		* Bronchoalveolar lavage
	* Lung biopsy		* Lung biopsy

	==Management==		==Management==

Rossdonaldson1: /* See Also */

2017-09-28T21:11:51Z

Nlongland: Created page with "==Background== * General group of diseases that involve the lung parenchyma * Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings..."

2017-09-25T21:04:40Z

Created page with "==Background== * General group of diseases that involve the lung parenchyma * Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings..."

Página nueva

==Background==
* General group of diseases that involve the lung parenchyma
* Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings
* Specific diseases separated into ones with known causes and idiopathic
* Treatment and prognosis differs between specific diseases
* Examples of specific diseases: interstitial pneumonia, hypersensitivity pneumonitis, cryptogenic organizing pneumonia, acute interstitial pneumonitis, sarcoidosis, idiopathic pulmonary fibrosis

==Clinical Features==
* Symptoms: progressive exertional dyspnea, persistent nonproductive cough, hemoptysis, pleuritic chest pain
* History of occupational exposure: asbestosis, silicosis
* Abnormal chest imaging or pulmonary function tests
* Take detailed history making sure to focus on past medical history (connective tissue disease, inflammatory bowel disease, malignancy), smoking history, family history, medications, occupational and environmental exposures
* Physical exam is generally nonspecific

==Differential Diagnosis==
* Pneumonia
* Asbestosis
* Berylliosis
* Pulmonary edema
* Coal worker's pneumoconiosis
* Cryptogenic organizing pneumonia
* Drug induced pulmonary toxicity
* Farmer's lung
* Hypersensitivity pneumonitis
* Interstitial pulmonary fibrosis
* Collagen-vascular disease
* Lung malignancy
* Restrictive lung disease
* Sarcoidosis
* Silicosis

==Evaluation==
* Work up and test results differ between types of interstitial lung diseases. Below are common studies obtained to determine disease. See page for specific disease for specific labs/imaging and findings.
* CBC/CMP
* Serologic studies: ANA, Rheumatoid factor
* Imaging: Chest x-ray, chest CT
* Pulmonary function tests
* Cardiac ECHO
* Bronchoalveolar lavage
* Lung biopsy

==Management==
* Management differs between specific types of interstitial lung diseases. This is why it is important to determine specific cause of disease. See specific disease page for management.

==Disposition==
* Depending on how stable the patient is, patient can be admitted for work up or discharged for outpatient work up.
* Important to determine acute vs chronic symptoms.

==See Also==
* Sarcoidosis
* Idiopathic pulmonary fibrosis

==References==
* <Bradley B, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008; 63 Suppl 5:v1./>
* <Pipavath S, Godwin JD. Imaging of interstitial lung disease. Clin Chest Med 2004; 25:455./>
* <Martinez FJ, Flaherty K. Pulmonary function testing in idiopathic interstitial pneumonias. Proc Am Thorac Soc 2006; 3:315./>
* <Schwartz M, King Jr TE. Interstitial Lung disease, 5th ed, People's Medical Clearing House, Shelton, CT 2011./>
* <Raghu G, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788./>
* <Garcia CK, Raghu G. Inherited interstitial lung disease. Clin Chest Med 2004; 25:421./>

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	==See Also==		==See Also==
	* Sarcoidosis		* [[Sarcoidosis ]]
	* Idiopathic pulmonary fibrosis		* Idiopathic pulmonary fibrosis

	==References==		==References==