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Pulmonary function tests Diffusion study Steps to diagnose ILD Part 3 Dr. Sheetu singh

Pulmonary Function Tests Diffusion Study Steps to Diagnose ILD Part 3 Dr. Sheetu Singh Visit Our Website for more info - www.drsheetusingh.com

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Pulmonary function tests Diffusion study Steps to diagnose ILD Part 3 Dr. Sheetu singh

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  1. Pulmonary function tests Diffusion study • Moderate - severe reduction in DLCO but normal lung volumes in a patient with ILD suggest: • - COPD with ILD • - Pulmonary Vascular Disease • - LCH • - LAM • A reduction in DLCO is common but nonspecific. • The severity of the DLCO reduction does not correlate well with disease stage.

  2. 3. Six minute walk test • Simple and easy to perform • Ask patient to walk for 6 minutes in atleast a 30m long corridor • Measure SpO2 before and after the test • A fall in SpO2 >4% indicates → ILD, Pulmonary vascular disease

  3. Diagnostic algorithm for evaluation of ILD Cough and Exertionaldyspnoea Chest radiograph, PFT, 6MWT Either reticular/nodular/cystic shadow on CXR OR Restrictive spirometry & diffusion defect OR Desaturation on 6MWT dUIP →IPF CTD-ILD HRCT Chest Confident clinical diagnosis* Sarcoid, HP, PAP, Lymphangitis carcinomatosis Other idiopathic IIP Bronchoscopy BAL, Endobronchial biopsies, TBLB, EBUS-TBNA Open lung or VATS assisted lung biopsy or Transbronchial cryobiopsy If inconclusive

  4. Suspect ILD in OPD 1. Look at breathing pattern: rapid breath/repetitive short dry cough/very breathless while reaching to stool & comfortable soon 2. Listen base: Velcro strip sound & sometimes clubbing 3. Ask to walk 6 min: SpO2 dips 4. X Ray chest shows dirty lungs & spirometry is abnormal Investigate: HRCT

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