INTERSTITIAL LUNG DISEASE Esam H. Alhamad, M.D Assistant Professor of Medicine Consultant Pulmonary & Critical Care Medicine

ATS/ERS. Am J Respir Crit Care Med 2002;165:277-3

SMOKING ASSOCIATED INTERSTITIAL LUNG DISEASE

Desquamative Interstitial Pneumonia (DIP) Liebow 1965 DIP desquamation of epithelial cells?, but the main histopathologic finding is accumulation of macrophages within alveolar space 90% smoked or had smoked cigarettes May occasionally be seen with CTD, and drug induced lung disease

DIP: SURVIVAL Nicholson et al DIP: SURVIVAL Nicholson et al. Am J Respir Crit Care Med 2000;162:2213-2217

Desquamative Interstitial Pneumonia DIP Clinical Features Young adult, average 40-50 yr Men > women Dyspnea 87% Cough 43% Inspiratory crackles 57% Digital clubbing 26% Pulmonary function: Restrictive 30%, Obstructive 15%, Dlco 35%, Normal 20% Ryu et al. Chest 2005;127:178-184

Desquamative Interstitial Pneumonia DIP HRCT Ground glass opacities 83% Bilateral reticular opacities 17% Patchy consolidation 6% Honeycombing rare

Desquamative Interstitial Pneumonia DIP

HRCT: Contrasting DIP with UIP

DIP: Treatment and Outcome Prognosis is generally good, average survival 12 yrs (Carrington et al. Nengl J Med 1978;298:801-809) Spontaneous improvement has been reported Corticosteroids and smoking cessation seems to be effective, immunosuppresive agents? Late relapse and recurrence in transplanted lung has been reported Progression to respiratory failure is uncommon

Extremely common histopathologic lesion in cigarette smoker Respiratory Bronchiolitis Associated Interstitial Lung Disease (RB-ILD) Extremely common histopathologic lesion in cigarette smoker Slight male predominance Dyspnea, cough Inspiratory crackles 42% Digital clubbing 25% Ryu et al. Chest 2005;127:178-184

RB-ILD SURVIVAL Nicholson et al RB-ILD SURVIVAL Nicholson et al. Am J Respir Crit Care Med 2000;162:2213-2217

RB-ILD: HRCT findings Ground glass opacities 100% Centrilobular nodules are common Associated emphysematous changes may occur Honeycombing is rare

What is the most common misdiagnosis given to patients with hypersensitivity pneumonitis? Bacterial or viral pneumonia

What are the symptoms seen in acute hypersensitivity pneumonitis which occour four to six hours after antigen exposure? Fever, chills, dyspnea, and malaise

What physical findings are seen in acute hypersensitivity pneumonitis? Fever, pulmonary crackles, possibly cyanosis

What is the most common physical abnormality in subacute disease? Diffuse crackles

Where are the infiltrates in hypersensitivity pneumonitis? Usually bilateral and equally distributed (involving the upper lobes)

What is the chest x-ray findings in the early stages of the disease? Within normal limit

What is the chest x-ray finding in chronic disease? Diffuse interstitial fibrosis

What is the classic PFT abnormality in hypersensitivity pneumonitis? Restrictive pattern

What is the main cause of respiratory disability in patients with hypersensitivity pneumonitis? Pulmonary fibrosis

Which patient is least likely to have IPF: A 30 year old man, a 50 year old woman, or a 70 year old man? 30 year old man, IPF most commonly diagnosed in individuals between the ages of 40-70 years

Approximately 60% of patients with IPF have what extremity findings? Clubbing

What is the most common cause of death in patients with IPF? Respiratory failure

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