R2 Talk

Interstitial Lung Disease

Dr. Paul Mester

Mentor: Dr. Douglas Hornick, Departement of Pulmonary and Critical Care Medicine

Interstitial Lung Disease

History: look for history of cigarette smoking, environmental exposures, history of autoimmune disease

Symptoms: cough, dyspnea on exertion; may also have associated autoimmune symptoms (joint pains/swelling, Raynaud’s muscle weakness rash, GERD etc)

Physical exam: crackles, “Velcro” rales, finger clubbing (also look for extrapulmonary disease manifestations e.g. synovitis, Bouchard’s nodes, skin thickening/tightening etc)

Work-up: high-resolution CT and PFTs are most important. Also consider chest x-ray and autoimmune/infectious labs (ESR/CRP, ANCAs, RF/CCP, ANA/dsDNA, Scl-70/centromere, myositis panel/CK/aldolase, HIV etc)

Treatment: referral to appropriate sub-specialists (e.g., pulmonary, rheumatology) for further evaluation. Depending upon etiology treatment may include glucocorticoids, pirfenidone, nintedanib and/or immunomodulatory drugs (methotrexate, MMF, rituximab etc).

Pneumococcal vaccination and flu vaccinations are indicated

Smoking cessation is recommended

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