Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dyspnoea
- cough
- crackles
Other diagnostic factors
- weight loss, fatigue, and malaise
- clubbing
Risk factors
- advanced age
- male sex
- family history
- gene mutations and nucleotide polymorphisms
- cigarette smoking
- occupational and environmental exposures
- gastro-oesophageal reflux
- viral infection
- bacterial infection
- diabetes
Diagnostic investigations
1st investigations to order
- CXR
- high-resolution CT (HRCT) chest
- pulmonary function tests
Investigations to consider
- surgical lung biopsy
- bronchoalveolar lavage (BAL)
- trans-bronchial lung biopsy and cryobiopsy
- CRP
- erythrocyte sedimentation rate (ESR)
- anti-nuclear antibody immunofluorescence
- rheumatoid factor
- anti-cyclic citrullinated peptide
- myositis panel
Treatment algorithm
acute exacerbation
all patients not currently experiencing acute exacerbation
Contributors
Authors
Mary Elizabeth Kreider, MD, MS
Associate Professor of Clinical Medicine
Pulmonary, Allergy, and Critical Care Division
Perelman School of Medicine
University of Pennsylvania
Philadelphia
PA
Disclosures
MEK is serving as site principal investigator for Bellerophon and United Therapeutics for interstitial lung disease (ILD) studies. Her institution receives payments for those trials.
Jake G. Natalini, MD, MS
Assistant Professor of Medicine
Pulmonary, Critical Care, and Sleep Division
NYU Grossman School of Medicine
New York University
New York
NY
Disclosures
JGN is serving as site principal investigator for a CareDx clinical diagnostics study in lung transplantation. His institution receives payments for this trial. He has also previously provided consulting services to CareDx.
Acknowledgements
Dr Mary Elizabeth Kreider and Dr Jake G. Natalini would like to gratefully acknowledge Dr Judd David Flesch, Dr Gregory Tino, and Dr Jeffrey C. Munson, previous contributors to this topic.
Disclosures
GT has served as a consultant for InterMune. GT has served as a principal investigator for clinical trials in idiopathic pulmonary fibrosis. JCM and JDF declare that they have no competing interests.
Peer reviewers
Stephen Nathan, MD
Medical Director
Lung Transplant & Advanced Lung Disease Program
Inova Fairfax Hospital
Falls Church
VA
Disclosures
SN is an author of a reference cited in this monograph.
Athol Wells, MD, FRCP
Professor of Respiratory Medicine
Interstitial Lung Disease Unit
Royal Brompton Hospital
London
UK
Disclosures
AW declares that he has no competing interests.
Differentials
- Idiopathic non-specific interstitial pneumonia
- Cryptogenic organising pneumonia (formerly known as bronchiolitis obliterans organising pneumonia [BOOP])
- Acute interstitial pneumonia (AIP)
More DifferentialsGuidelines
- European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness
- ERS statement on transition of care in childhood interstitial lung diseases
More GuidelinesVideos
Late inspiratory crackles (rales)
Spirometry technique and interpretation
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