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Interstitial Lung Disease

Interstitial Lung Disease . Baz Lazar SLIME 14 th October 2013. Overview. Definition and causes Finals Clinical Case – work through History and examination Management Information sheet. 5 things about ILD. Chronic disease, often idiopathic Fine bi-basal end expiratory Creps

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Interstitial Lung Disease

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  1. Interstitial Lung Disease Baz Lazar SLIME 14th October 2013

  2. Overview • Definition and causes • Finals Clinical Case – work through • History and examination • Management • Information sheet

  3. 5 things about ILD • Chronic disease, often idiopathic • Fine bi-basal end expiratory Creps • Restrictive deficit, reduced DLCO • HRCT can be diagnostic • Treatment - ? Steroids, ? avoidance

  4. 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

  5. Causes

  6. Finals Case • This is Mr Clarke, a 64 year old gentleman with SOB. He has a long cardiac history but please focus on the SOB.

  7. Pointers to ILD • Dry persistent cough • Reduced exercise tolerance • Drug history • Occupational history • Pets and hobbies • Signs/symptoms of connective tissue disease

  8. 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

  9. 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, heart failure, pacemaker, CABG. AF; Whooping cough as child • DHx: Amiodarone, Ramipril, Atenolol, Simvastatin • Allergic to latex

  10. What are the most likely causes for this patient’s presentation and why? • What would you like to examine and why?

  11. 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.

  12. 15 minutes • Divide page into 3 • Summary and Differentials ± problem list (biopsychosocial) • Investigations - BBIO • Management – Conservative, medical, Surgical; Acute and chronic etc

  13. Differentials • Resp: ILD: HP, IPF, drug induced; Bronchiectasis • Cardiac: CCF, Angina/ACS • ? Anaemia of chronic disease

  14. Investigations

  15. Management • Supportive and symptomatic • Acute: • ABC (carefully titrate O2), steroids, ? ABx if infective exacerbation • Conservative: • Lifestyle – exercise, quit smoking, weight loss, pulmonary rehab • Medical • ? steroids, MDT, palliative, LTOT • Surgical: Lung transplant • Extra • Compensation – industrial diseases act

  16. 5 things about ILD • Chronic disease, often idiopathic • Fine bibasal end expiratory Creps • Restrictive deficit, reduced DLCO • HRCT can be diagnostic • Treatment - ? Steroids, ? avoidance

  17. Useful sources of info • Dr Woodhead presentation with images http://www.mededcoventry.com/Specialties/Respiratory/Presentations.aspx • Dr Clarke learning centre:http://www.askdoctorclarke.com/learningcentre.php • Oxford Cases in Medicine and Surgery

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