Interstitial Lung Disease Galle Clinical Society20th January 2015Kirthi Gunasekera MB MD FC! FCC!Consultant es"iratory !hysician# Central Chest Clinic$ational %os"ital# Colo&'oCase 1(5 year la)y *ith heu&atoi) +rthritis ,or o-er 15 years# "resente) *ith "rogressi-e shortness o, 'reath ,or . &onths/She ha) 'een treate) *ith $S+IDs an) Methotre0ate ,or o-er 1 years20a&ination!ale# Dys"noeic *ith 3ne en) ins"iratory cre"itations in 'ilateral lung 'ases C4Di5use in3ltrati-e o"acities "re)o&inantly in 'ilateral lo*er lo'es %C6 7 "atchy areas o, groun)7glass o"acities an) -arying )egrees o, reticular a'nor&alitiesDistri'ution 8 lo*er 9one "re)o&inance'ilateral an) sy&&etrical su'"leural "re)o&inance:s"aring$;$ S!2CIFC I$62S6I6I+L !$2 S&oking+ll o, the ,ollo*ing D!LD are associate) *ith s&oking aA I!F'A BILDcA DI!)A %istiocytosis 4In Goo)"astureJs syn)ro&e100K o, s&okers vs. 20K o, nons&okers e0"erience "ul&onary he&orrhageIn)i-i)uals e0"ose) to as'estos *ho s&oke are &ore likely to )e-elo" as'estosisSubacute Diseases (weeks to months)HSP,Sarcoid,Cellular NSIP,Drug, Chronic P,!ronchiolitis"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" Chronic Diseases (months to #ears)$IP,%ibrotic NSIP,Pneumoconioses, C&D'related, Chronic HSPSmoking ((!I)D and P)CH)*cute Diseases (Da#s to weeks)D*D (*IP), P, &asculitis+DPH, Drug, C&D""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""%istory> Duration o, Illness%istory> +ge an) Gen)erL+M6u'erous sclerosis!neu&oconiosis+ge Gen)er!hysical Fin)ingsesting 6achy"neaShallo* 'reathingDry cracklesDigital clu''ing!ul&onary %6$$on7"ul&onary 3n)ingsILD> 2-aluationa)iogra"hicC4 %C6!hysiologic testing!F620ercise testLung Sa&"lingB+LLung 'io"sy> @6BB0# SurgicalAC4> LlMI6+6I;$SC4 is nor&al> in 10 to 15 K o, sy&"to&atic "atients *ith "ro-en in3ltrati-e lung )isease .0K o, those *ith 'ronchiectasis L 10 K o, "atients *ith e&"hyse&aC4 has a sensiti-ity o, M0K an) a s"eci3city o, M2K "ercent ,or )etection o, D!LDC4 can "ro-i)e a con3)ent )iagnosis in L 2. K o, casesC4 CL o'literation o, nor&al structuresInterstitial In3ltrates$o)ularLinear or reticularMi0e)%oneyco&'Cysts an) traction 'ronchiectasisGG;C4 CLLung =olu&esestricti-e Disease.)C(&&C.)C(&&C.)C(&&CNor!(&I./N0 /ise(seItinclu)es>e)uce) lung -olu&es@-ital ca"acity# total lung ca"acityAre)uce) )i5using ca"acity @DLC;Astatic lung co&"liance is )ecrease)B+LF e0a&inationthe cell counts in B+LF o, ILDs is t*ice than that o, nor&al hu&anscell co&"le&ent o, ILDs is )i5erence ,ro& that o, nor&al hu&ans,or e0a&"le# the "ercents o, neuto"hils in B+LF o, I!F is higher than that o, nor&al hu&ansIn-estigation o, sus"ecte) ILD%istory an) Clinical 20a&inationChest 47ray an) S"iro&etryCon3r& Diagnosis+ssess Se-erity Full lung ,unction 1 &inute *alk ;-ernight o0i&etry20clu)e co&"lications 2chocar)iogra&Disease s"eci3c In-estigations e/g/ Galliu& scan# 2( hour urinary calciu& @sarcoi)A !ituitary MI @LangerhanJs %istiocytosisA 6u'erous sclerosis genoty"ing @L+MA Bloo) tests %C6 MD6 assess&entCon3)ent DiagnosisCNes $oSurgical lung 'io"syConsi)er B+L O 6BB0@i, non7)iagnosticAMD6 +ssess&entMaher 6M Clinics in +llergy an) I&&unology 2012BhatJs ne*CC%;$IC FIB;6IC II!SI)io"athic !ul&onary Fi'rosis+ chronic# "rogressi-e 3'rosing interstitial "neu&onia o, unkno*n cause;ccuring "ri&arily in ol)er a)ults# li&ite) to the lungsCharacteri9e) 'y "rogressi-e *orsening o,)ys"nea an) lung ,unction6he histo"athologic an):or ra)iologic "attern o,