Interstitial lung disease

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

Acute dyspnea

Emergent

Non-Emergent

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

References