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

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

3. SMOKING ASSOCIATED INTERSTITIAL LUNG DISEASE

4. 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

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

6. Desquamative Interstitial Pneumonia DIP Clinical Features
Young adult, average 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:

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

8. Desquamative Interstitial Pneumonia DIP

9. HRCT: Contrasting DIP with UIP

10. DIP: Treatment and Outcome
Prognosis is generally good, average survival 12 yrs (Carrington et al. Nengl J Med 1978;298: )
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

11. 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:

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

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

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

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

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

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

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

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

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

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

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

24. 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 years

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

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

27. THANK YOU