Transcript Interstitial Lung Disease

Interstitial Lung Disease
Baz Lazar
SLIME 14th October 2013
Overview
Definition and causes
 Finals Clinical Case – work through
 History and examination
 Management
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Information sheet
5 things about ILD
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Chronic disease, often idiopathic
Fine bi-basal end expiratory Creps
Restrictive deficit, reduced DLCO
HRCT can be diagnostic
Treatment - ? Steroids, ? avoidance
Definition and Pathology
Interstitial Lung Disease
 Diffuse parenchymal lung disease
 Affects gas exchange surfaces
Pathological findings
 Chronic inflammation ± progressive
interstitial fibrosis
 Hyperplasia of type II alveolar epithelial
cells
Causes
Systemic
• Sarcoidosis
• CTD
Known
Idiopathic
• Inorganic
• Organic
• Drugs
• IPF
• LIP
ILD
Finals Case
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This is Mr Clarke, a 64 year old gentleman
with SOB. He has a long cardiac history
but please focus on the SOB.
Pointers to ILD
Dry persistent cough
 Reduced exercise tolerance
 Drug history
 Occupational history
 Pets and hobbies
 Signs/symptoms of connective tissue
disease
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Mr Clarke – 64m
Increasing SOB over the last 6 months.
 Exercise tolerance 100 yards
 Dry cough
 Non-smoker, works as an office manager.
 Pigeon owner
 PMHx: HTN, MI, AF; Whooping cough as
child
 DHx: Amiodarone, Ramipril, Atenolol,
Simvastatin
 Allergic to latex
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Mr Clarke – 64m
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Increasing SOB over the last 6 months.
Exercise tolerance 100 yards.
Dry cough.
Non-smoker, works as an office manager.
Pigeon owner.
PMHx: HTN, MI, heart failure, pacemaker,
CABG. AF; Whooping cough as child
DHx: Amiodarone, Ramipril, Atenolol,
Simvastatin
Allergic to latex
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What are the most likely causes for this
patient’s presentation and why?
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What would you like to examine and
why?
ILD Signs
General:
increased
resp effort,
?wasted
Fine, Bibasal
creps
Clubbing
ILD
Signs
Mr Clarke:
Slightly short of breath with
O2 sats 93% on air
He has clubbing.
Auscultation reveals bilateral
basal fine end inspiratory
crepitations and no wheeze.
?
Reduced
expansion
Cyanosis
Cor
pulmonale
Signs
15 minutes
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2.
3.
Divide page into 3
Summary and Differentials ± problem list
(biopsychosocial)
Investigations - BBIO
Management – Conservative, medical,
Surgical; Acute and chronic etc
Differentials
Resp: ILD: HP, IPF, drug induced;
Bronchiectasis
 Cardiac: CCF, Angina/ACS
 ? Anaemia of chronic disease
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Investigations
Bedside:
Bloods:
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ABG
Sats, PEFR
ECG
Sputum MC+S
FBC, UE, LFT, CRP/ESR
Ca2+, ACE,
RF, anti-CCP, ANA, T-Spot;
? precipitins
Investigations
Imaging:
Other
• CXR,
• HRCT,
• Echo
• Pulmonary function tests –
Restrictive deficit + Reduced DLCO
• Biopsy, BAL,
Management
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Supportive and symptomatic
Acute:
◦ ABC (carefully titrate O2), steroids, ? ABx if infective
exacerbation
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Conservative:
◦ Lifestyle – exercise, quit smoking, weight loss,
pulmonary rehab
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Medical
◦ ? steroids, MDT, palliative, LTOT
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Surgical: Lung transplant
Extra
◦ Compensation – industrial diseases act
5 things about ILD
Chronic disease, often idiopathic
 Fine bibasal end expiratory Creps
 Restrictive deficit, reduced DLCO
 HRCT can be diagnostic
 Treatment - ? Steroids, ? avoidance
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Useful sources of info
Dr Woodhead presentation with images
http://www.mededcoventry.com/Specialtie
s/Respiratory/Presentations.aspx
 Dr Clarke learning
centre:http://www.askdoctorclarke.com/le
arningcentre.php
 Oxford Cases in Medicine and Surgery
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