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Interstitial lung disease: raising the index of suspicion in primary care.

Zibrak JD, Price D - NPJ Prim Care Respir Med (2014)

Bottom Line: ILD is rare and mainly a disease of the middle-aged and elderly.ILD is infrequently seen in primary care and a precise diagnosis of these disorders can be challenging for physicians who rarely encounter them.Primary care physicians (PCPs) play a key role in facilitating the diagnosis of ILD by referring patients with concerning symptoms to a pulmonologist and, in some cases, by ordering HRCTs.

View Article: PubMed Central - PubMed

Affiliation: Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.

ABSTRACT
Interstitial lung disease (ILD) describes a group of diseases that cause progressive scarring of the lung tissue through inflammation and fibrosis. The most common form of ILD is idiopathic pulmonary fibrosis, which has a poor prognosis. ILD is rare and mainly a disease of the middle-aged and elderly. The symptoms of ILD-chronic dyspnoea and cough-are easily confused with the symptoms of more common diseases, particularly chronic obstructive pulmonary disease and heart failure. ILD is infrequently seen in primary care and a precise diagnosis of these disorders can be challenging for physicians who rarely encounter them. Confirming a diagnosis of ILD requires specialist expertise and review of a high-resolution computed tomography scan (HRCT). Primary care physicians (PCPs) play a key role in facilitating the diagnosis of ILD by referring patients with concerning symptoms to a pulmonologist and, in some cases, by ordering HRCTs. In our article, we highlight the importance of prompt diagnosis of ILD and describe the circumstances in which a PCP's suspicion for ILD should be raised in a patient presenting with chronic dyspnoea on exertion, once more common causes of dyspnoea have been investigated and excluded.

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Related in: MedlinePlus

Classification of ILDs.4
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fig1: Classification of ILDs.4

Mentions: The American Thoracic Society and European Respiratory Society define ILD as a heterogeneous group of non-neoplastic disorders resulting from damage to the lung parenchyma by inflammation and fibrosis that diminish the lung’s capacity for alveolar gas diffusion.1 The latest classification of ILDs is shown in Figure 1.1,4 Most ILDs are ‘restrictive’ pulmonary disorders, i.e., the lungs have a reduced ability to expand on inhalation. This is in contrast to ‘obstructive’ pulmonary disorders such as asthma, COPD and emphysema, in which the airways of the lungs become narrowed or blocked so the patient cannot exhale completely. Some forms of ILD are associated with environmental or occupational exposures (e.g., asbestosis or silicosis), the use of certain drugs5 or with connective tissue disorders.2,6,7 Others, including the idiopathic interstitial pneumonias, have no known cause.1 Some cases of ILD do not meet the specific definitions for any form of ILD and are considered ‘unclassifiable’. This may be the case when there are non-specific or conflicting clinical, radiological or histopathological findings, or when patients are unable or unwilling to undergo diagnostic procedures.8


Interstitial lung disease: raising the index of suspicion in primary care.

Zibrak JD, Price D - NPJ Prim Care Respir Med (2014)

Classification of ILDs.4
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373409&req=5

fig1: Classification of ILDs.4
Mentions: The American Thoracic Society and European Respiratory Society define ILD as a heterogeneous group of non-neoplastic disorders resulting from damage to the lung parenchyma by inflammation and fibrosis that diminish the lung’s capacity for alveolar gas diffusion.1 The latest classification of ILDs is shown in Figure 1.1,4 Most ILDs are ‘restrictive’ pulmonary disorders, i.e., the lungs have a reduced ability to expand on inhalation. This is in contrast to ‘obstructive’ pulmonary disorders such as asthma, COPD and emphysema, in which the airways of the lungs become narrowed or blocked so the patient cannot exhale completely. Some forms of ILD are associated with environmental or occupational exposures (e.g., asbestosis or silicosis), the use of certain drugs5 or with connective tissue disorders.2,6,7 Others, including the idiopathic interstitial pneumonias, have no known cause.1 Some cases of ILD do not meet the specific definitions for any form of ILD and are considered ‘unclassifiable’. This may be the case when there are non-specific or conflicting clinical, radiological or histopathological findings, or when patients are unable or unwilling to undergo diagnostic procedures.8

Bottom Line: ILD is rare and mainly a disease of the middle-aged and elderly.ILD is infrequently seen in primary care and a precise diagnosis of these disorders can be challenging for physicians who rarely encounter them.Primary care physicians (PCPs) play a key role in facilitating the diagnosis of ILD by referring patients with concerning symptoms to a pulmonologist and, in some cases, by ordering HRCTs.

View Article: PubMed Central - PubMed

Affiliation: Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.

ABSTRACT
Interstitial lung disease (ILD) describes a group of diseases that cause progressive scarring of the lung tissue through inflammation and fibrosis. The most common form of ILD is idiopathic pulmonary fibrosis, which has a poor prognosis. ILD is rare and mainly a disease of the middle-aged and elderly. The symptoms of ILD-chronic dyspnoea and cough-are easily confused with the symptoms of more common diseases, particularly chronic obstructive pulmonary disease and heart failure. ILD is infrequently seen in primary care and a precise diagnosis of these disorders can be challenging for physicians who rarely encounter them. Confirming a diagnosis of ILD requires specialist expertise and review of a high-resolution computed tomography scan (HRCT). Primary care physicians (PCPs) play a key role in facilitating the diagnosis of ILD by referring patients with concerning symptoms to a pulmonologist and, in some cases, by ordering HRCTs. In our article, we highlight the importance of prompt diagnosis of ILD and describe the circumstances in which a PCP's suspicion for ILD should be raised in a patient presenting with chronic dyspnoea on exertion, once more common causes of dyspnoea have been investigated and excluded.

Show MeSH
Related in: MedlinePlus