Management of drug-induced interstitial lung disease Amitava Ganguli BSc, MRCP and Munir Pirmohamed PhD, FRCP
|
|
- Florence Ellis
- 5 years ago
- Views:
Transcription
1 Management of drug-induced interstitial lung disease Amitava Ganguli BSc, MRCP and Munir Pirmohamed PhD, FRCP VM Our series on serious ADRs focusses on rare but potentially fatal drug reactions and how to recognise and avoid them. This article describes the drugs most commonly associated with interstitial lung disease and discusses subsequent management. Figure 1. CT scan showing pulmonary fibrosis (green areas) Interstitial lung disease () occurs as a result of an insult to the lung parenchyma, and many classes of drugs have the potential to induce. Injury to alveoli, the alveolar epithelium and the surrounding vasculature results in an inflammatory response. 1 If the disease becomes chronic, inflammation spreads to adjacent portions of the interstitium and vasculature, resulting in interstitial fibrosis. Consequently, the alveolar epithelium thickens and loses its natural elasticity, thereby reducing its capacity to stretch. The net effect is a decrease in gas exchange across the epithelium and a restrictive pulmonary defect impairing gas exchange. Table 1 provides a stepwise approach to the diagnosis of. Incidence of drug-induced Drug-induced lung diseases often have no pathognomonic signs or symptoms and are underdiagnosed. Worldwide incidence of is not clearly known but per cent of cases are drug induced. 2 Table 2 provides a list of drugs causing ; some examples are discussed in greater detail below. Pathophysiology of druginduced The mechanism of drug-induced lung injury is not fully understood. However, cytotoxic damage from a drug or a hypersensitivity reaction to the drug and/or its metabolites is thought to be the main pathophysiological event. Direct toxicity usually occurs over time before manifesting clinically. Alveolar and bronchial epithelial cells may be injured by inhalation of a drug or through the vascular system. 3,4 In response to injury to the lung parenchyma, there is an immediate requirement to initiate tissue repair and restore barrier function. Acute injury may progress to chronic inflammation and eventually lead to fibrotic change that ultimately interferes with gas exchange. Hypersensitivity reactions do not show a simple dose-response relationship and require prior sensitisation to the drug (although this may be covert rather than overt). 5 The immune damage to the lung may be due to drug-specific antibodies or, more likely, drug-specific T cells. However, the Prescriber 5 May
2 Noninvasive evaluation history clinical examination blood tests lung function tests chest X-ray HRCT* Invasive evaluation bronchoalveolar lavage lung biopsy *HRCT: high-resolution computer tomography Table 1. Diagnostic features of interstitial lung disease this initiates an immune response, and what the individual predis- posing factors are. mechanism is poorly understood in terms of what constitutes the antigen, the mechanism by which occupation, pets, drugs; progressive dyspnoea fine end inspiratory crackles in lung; finger clubbing often normal; autoimmune screen, rheumatoid factor and ESR should be performed restrictive pattern and decreased transfer factor reticulonodular shadowing more accurate than conventional X-ray may reveal increased cell numbers for indeterminate cases and disease staging Clinical features of druginduced Drug-induced can be difficult to diagnose. It is important to rule out other causes before making this diagnosis and hence a careful history, examination and relevant investigations are essential. Patients should be asked about occupational history (farmers), environments they have been exposed to (asbestos) and pets (pigeons, parrots and budgerigars). With drug-induced the temporal relationship between commencing drug therapy and respiratory symptoms is important in differentiating acute from chronic disease. Acute pneumonitis secondary to drug therapy can present with acute breathlessness occurring over several hours. Fever, rash, wheeze and 42 Prescriber 5 May
3 peripheral eosinophilia are features of these reactions. The chronic form of the disease manifests as decreased exercise tolerance mainly as a result of progressive dyspnoea. Dry cough, weight loss and clubbing may also be present. It is also important to be aware that drug-induced lung injury may be enhanced by other factors such as age, impaired renal function, smoking and radiation therapy. Drugs causing Cytotoxic agents Bleomycin is the drug most commonly studied as a cause of. Some studies have shown that up to 25 per cent of patients develop some degree of lung injury, 6 although in the larger studies rates of 8-10 per cent have been observed. 6 Lung injury is due to cytotoxic damage and rarely due to a hypersensitivity reaction. Symptoms first appear 4-10 weeks following chemotherapy and the damage is predominantly at the lung base. Mitomycin, a similar drug, has been reported to induce pulmonary fibrosis in 2-12 per cent of patients. 7 Cyclophosphamide causes early-onset with a low incidence, estimated at less than 1 per cent. 8 Busulfan may cause months after initiation of treatment in 4 per cent of cases. 8 Immunosuppressants and antiinflammatory agents Methotrexate Methotrexate is a folate antagonist used to treat both malignancies and non-neoplastic disorders. It may cause both cytotoxic injury and hypersensitivity reactions. Methotrexate pulmonary toxicity occurs in 1-5 per cent of patients with rheumatoid arthritis and in as many as per cent of patients treated for primary biliary cirrhosis. 9 Gold and penicillamine Goldinduced interstitial pneumonitis is seen in less than 1 per cent of patients and occurs, on average, after three months of therapy and at a cumulative dose of approximately 700mg. 8 Penicillamine use in patients with rheumatoid arthritis is associated with chronic alveolitis/fibrosis, hypersensitivity pneumonitis, alveolar haemorrhage and bronchiolitis obliterans Prescriber 5 May
4 Anti-inflammatory gold penicillamine methotrexate Immunosuppressants bleomycin busulfan chlorambucil cyclophosphamide ciclosporin vinca alkaloids Cardiovascular amiodarone flecainide hydralazine procainamide Antimicrobial amphotericin ethambutol isoniazid minocycline nitrofurantoin tetracycline Antidepressants, antipsychotics fluoxetine phenothiazines trazodone tricyclics Miscellaneous appetite suppressants (dexfenfluramine, fenfluramine) bromocriptine methysergide propylthiouracil radiation Table 2. Drugs causing interstitial lung disease 2,8,15 Azathioprine Azathioprine is rarely associated with the development of chronic pneumonitis and fibrosis, and in fact the drug is used in the treatment of idiopathic pulmonary fibrosis. NSAIDs NSAIDs may cause acute pulmonary hypersensitivity reactions resulting in bilateral interstitial infiltration. 11 Onset of such a reaction can occur within the first week and up to thee years after first exposure. Antiarrhythmic agents Amiodarone Pulmonary toxicity has an incidence of approximately 5 per cent and, amongst these cases, fatality rates range from per cent. 12 The drug is concentrated in lung tissue and has a relatively long half-life. Clinically there are two patterns of pulmonary toxicity. The most common form is a subacute presentation characterised by cough, dyspnoea and weight loss. Chest X- rays demonstrate diffuse interstitial opacities. A less common form is that of an acute presentation that simulates an infectious process. Chest X-rays show patchy alveolar opacities that tend to be peripheral in distribution. CT scans may show pleural-based areas of focal consolidation or atelectasis. These opacities have increased CT density that is due to the fact that amiodarone accumulates in the lung and has a high iodine content. Procainamide (Pronestyl) Between 50 and 90 per cent of patients taking procainamide for longer than two months develop serum antinuclear antibodies (ANAs); per cent of these ANA-positive patients develop symptomatic drug-induced SLE, per cent of these have pulmonary manifestations that, in up to 40 per cent, are accompanied by bibasilar pulmonary infiltrates. 10 Antibiotics Nitrofurantoin may cause severe acute toxicity in 1 out of 5000 new administrations. 13 Mixed interstitial and alveolar infiltrates on chest X-ray are seen in 16 per cent of these patients and are associated with a mortality of 0.5 per cent. Chronic pulmonary toxicity occurs in 1 of 750 patients on long-term therapy for asymptomatic bacteriuria. Approximately 70 per cent of patients fail to improve or show significant residual pulmonary abnormalities, and mortality has been reported at 8-10 per cent. 10 Anticonvulsants Carbamazepine is a commonly used antiepileptic that can cause an acute hypersensitivity syndrome, but the incidence of this is not well known. Antidepressants Tricyclics (amitriptyline, imipramine and dosulepin) It is well documented that pulmonary injury occurs with acute overdose of tricyclic antidepressants. There is also some evidence of an association between cryptogenic fibrosing alveolitis and tricyclic use, particularly imipramine and dothiepin. 14 Antipsychotics and miscellaneous drugs Phenothiazines and atypical neuroleptics There are reports of eosinophilic pneumonitis and non- 44 Prescriber 5 May
5 cardiogenic pulmonary oedema with these classes of drugs. 15 Miscellaneous drugs Bromocriptine, a dopamine agonist used in the treatment of pituitary tumours, has been reported to cause pulmonary fibrosis and pleural disease. 15 Leukotriene antagonists zafirlukast (Accolate) have been associated with hypereosinophilic-type. 15 Management of druginduced The diagnosis of this condition is usually made from the history. The next steps are to confirm the diagnosis. In an acute hypersensitivity response, blood tests may show a peripheral eosinophilia. Pulmonary function tests are a useful and simple investigation: they are likely to demonstrate a restrictive picture and decreased gas transfer coefficient (DLCO). A chest X-ray should be done and this may show a spectrum of changes from pulmonary infiltrates to lung fibrosis. Further investigations such as bronchoscopy and high-resolution computer tomography may need to be performed under the guidance of respiratory physicians. The primary goal of treatment is to suppress the inflammatory response and prevent the deposition of fibrotic tissue. Treatment consists mainly of discontinuing the offending drug immediately, and supportive management of the pulmonary symptoms, eg inhaler therapy and oxygen if required until the drug-induced lung disease improves. Challenge tests (reintroducing the suspected medication to see if symptoms recur) are rarely performed. Steroid therapy (such as prednisolone) is sometimes used to quickly reverse the lung inflammation caused by the offending drug. Prognosis of acute druginduced is usually excellent. Symptoms will resolve within hours, with full recovery generally being achieved. Chronic syndromes may take longer to resolve but often leave significant scarring that may need long-term supportive therapy. References 1. King TE. Interstitial lung disease. In: Braunwald E, Isselbacher KJ, Fauci AS, et al, eds. Harrison s principles of internal medicine. New York: McGraw-Hill, Ch 9: Coultas DB, Zumwalt RE, Black WC, et al. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med 1994;150: Tiddens H, Silverman M, Bush A. Prescriber 5 May
6 The role of inflammation in airway disease: remodeling. Am J Respir Crit Care Med 2000;162:S7-S Shimabukuro DW, Sawa T, Gropper MA. Injury and repair in lung and airways. Crit Care Med 2003;31:S Kline JN, Hunninghake GW. Hypersensitivity pneumonitis and pulmonary infiltrates with eosinophilia. In: Braunwald E, Isselbacher KJ, Fauci AS, et al, eds. Harrison s principles of internal medicine. New York: McGraw-Hill, Jules-Elysee K, White DA. Bleomycin induced pulmonary toxicity. Clin Chest Med 1990;11: Buzdar A, Legma S, Luna M, et al. Pulmonary toxicity of mitomycin. Cancer 1980;45: Cooper JAD, White DA, Matthay R. Drug-induced pulmonary disease. Part 1: cytotoxic drug. Part 2: non cytotoxic drugs. Am Rev Respir Dis 1986;133:321-40, Sharma A, Provenzale D, McKusick A, et al. Interstitial pneumonitis after low-dose methotrexate therapy in primary biliary cirrhosis. Gastroenterology 1994;107: Zitnik RJ, Matthay RA. Drug-induced lung disease. In: Schwarz MJ, King TE, eds. Interstitial lung disease. 3rd edn. Hamilton, BC Decker Inc, 1998; Zitnik RJ, Cooper JAD. Pulmonary disease due to antirheumatic agents. Clin Chest Med 1990;11: Martin WJ, Rosenow EC. Amiodarone pulmonary toxicity: recognition and pathogenesis. Chest 1988;93: , Jick S, Jick H, Walker A, et al. Hospitalisations for pulmonary reactions following nitrofurantoin use. Chest 1989;96: Hubbard R, Venn A, et al. Exposure to commonly prescribed drugs and the aetiology of cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med 1998;157: Ozkan M, et al. Drug induced lung disease. Cleveland Journal Medicine 2001;68: Dr Ganguli is a specialist registrar and honorary lecturer in clinical pharmacology and therapeutics, and Munir Pirmohamed is professor of clinical pharmacology and honorary consultant physician at Royal Liverpool University Hospital Pharmacy Stamp Age Title, Forename, Surname & Address D.o.B Please don t stamp over age box Number of daysʼ treatment N.B. Ensure dose is stated Endorsements S 46 Prescriber 5 May
INTERSTITIAL LUNG DISEASE Dr. Zulqarnain Ashraf
Indep Rev Jul-Dec 2018;20(7-12) Dr. Zulqarnain Ashraf IR-653 Abstract: ILD is a group of diseases affect interstitium of the lung. Repeated insult to the lung cause the interstitium to be damaged. Similarly
More informationCHAPTER II DRUG INDUCED PULMONARY DISEASES. BY J. jayasutha lecturer department of pharmacy practice Srm college of pharmacy SRM UNIVERSITY
CHAPTER II DRUG INDUCED PULMONARY DISEASES BY J. jayasutha lecturer department of pharmacy practice Srm college of pharmacy SRM UNIVERSITY Drug Induced Pulmonary Disorders Is almost always a diagnosis
More informationINTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018
INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial
More informationRadiological Imaging of Drug-Induced Pulmonary Lesions
Review Article imedpub Journals www.imedpub.com Journal of Clinical Radiology and Case Reports Radiological Imaging of Drug-Induced Pulmonary Lesions D souza M *, Rajiah P, Khan A and Irion K Department
More informationNitrofurantoin-Induced Lung Toxicity
Severe Nitrofurantoin-Induced Lung Toxicity Rami Jambeih, M.D. 1, John Flesher, M.D. 1,3, Joe J. Lin, M.D. 2,4 University of Kansas School of Medicine Wichita 1 Department of Internal Medicine 2 Department
More informationRestrictive lung diseases
Restrictive lung diseases Restrictive lung diseases are diseases that affect the interstitium of the lung. Interstitium of the lung is the very thin walls surrounding the alveoli, it s formed of epithelium
More informationDRUG INDUCED LUNG DISEASES
DRUG INDUCED LUNG DISEASES CHEMOTHERAPEUTIC AGENTS 1. CYTOTOXIC ANTIBIOTICS 2. ALKYLATING AGENTS 3. ANTIMETABOLITES 4. BIOLOGIC RESPONSE MODIFIERS CYTOTXIC ANTIBIOTICS BLEOMYCIN 1.CHRONIC PNEUMONITIS/
More informationInterstitial Lung Disease
Interstitial Lung Disease Interstitial lung disease (ILD) is a broad category of lung diseases that includes more than 130 disorders which are characterized by scarring (i.e. fibrosis ) and/or inflammation
More informationImaging Small Airways Diseases: Not Just Air trapping. Eric J. Stern MD University of Washington
Imaging Small Airways Diseases: Not Just Air trapping Eric J. Stern MD University of Washington What we are discussing SAD classification SAD imaging with MDCT emphasis What is a small airway? Airway with
More informationHYPERSENSITIVITY PNEUMONITIS
HYPERSENSITIVITY PNEUMONITIS A preventable fibrosis MOSAVIR ANSARIE MB., FCCP INTERSTITIAL LUNG DISEASES A heterogeneous group of non infectious, non malignant diffuse parenchymal disorders of the lower
More informationInterstitial Lung Disease
Interstitial Lung Disease Interstitial lung disease (ILD) is a broad category of lung diseases that includes more than 130 disorders which are characterized by scarring (i.e. fibrosis ) and/or inflammation
More informationDifferential diagnosis
Differential diagnosis Idiopathic pulmonary fibrosis (IPF) is part of a large family of idiopathic interstitial pneumonias (IIP), one of four subgroups of interstitial lung disease (ILD). Differential
More informationDOWNLOAD PDF DRUG-INDUCED LUNG DISEASES AND RADIATION PNEUMONITIS
Chapter 1 : Medicine-induced Lung Disease Keywords: Lung, adverse drug reaction, drug-induced lung disease, mechanism of pulmonary toxicity, diagnosis, treatment, review. INTRODUCTION The lungs are a target
More informationCLEARING THE AIR ON DIFFUSE PARENCHYMAL (INTERSTITIAL) LUNG DISEASE (ILD)
CLEARING THE AIR ON DIFFUSE PARENCHYMAL (INTERSTITIAL) LUNG DISEASE (ILD) David Northrop MBA, RRT Assistant Director of Respiratory Therapy Services The University of Kansas Health System Clinical Assistant
More informationDr.kassim.m.sultan F.R.C.P
Dr.kassim.m.sultan F.R.C.P inflammatory disorder of the lung, involving alveolar walls and terminal airways, that is induced, in a susceptible host, by repeated inhalation of a variety of organic agents.
More informationC h a p t e r 1 3 Interstitial Lung Disease
C h a p t e r 1 3 Interstitial Lung Disease Shirish P Shah 1, Somesh Chaudhary 2, P Shetty 2 1 Consultant Chest Physician, Nanavati Hospital, Mumbai, Former Head of Department of Chest Medicine, BYL Nair
More informationCommon things are common, but not always the answer
Kevin Conroy, Joe Mackenzie, Stephen Cowie kevin.conroy@nhs.net Respiratory Dept, Darlington Memorial Hospital, Darlington, UK. Common things are common, but not always the answer Case report Cite as:
More informationSCLERODERMA LUNG DISEASE: WHAT THE PATIENT SHOULD KNOW
SCLERODERMA LUNG DISEASE: WHAT THE PATIENT SHOULD KNOW Lung disease can be a serious complication of scleroderma. The two most common types of lung disease in patients with scleroderma are interstitial
More informationRadiation Pneumonitis Joseph Junewick, MD FACR
Radiation Pneumonitis Joseph Junewick, MD FACR 03/19/2010 History 16 year old with history of relapsed stage IV-A Hodgkin disease. Prior pulmonary involvement was irradiated. Diagnosis Radiation Pneumonitis
More informationEosinophils and effusion: a clinical conundrum
Ruth Sobala, Kevin Conroy, Hilary Tedd, Salem Elarbi kevin.peter.conroy@gmail.com Respiratory Dept, Queen Elizabeth Hospital, Gateshead, UK. Eosinophils and effusion: a clinical conundrum Case report A
More informationFinancial disclosure COMMON DIAGNOSES IN HRCT. High Res Chest HRCT. HRCT Pre test. I have no financial relationships to disclose. Anatomy Nomenclature
Financial disclosure I have no financial relationships to disclose. Douglas Johnson D.O. Cardiothoracic Imaging Gaston Radiology COMMON DIAGNOSES IN HRCT High Res Chest Anatomy Nomenclature HRCT Sampling
More information4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs
Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation
More informationISPUB.COM. How Drugs Affect The Lungs. S Kumar, S Mehra BACKGROUND AGE RACE LIMITED KNOWLEDGE SEX RISK FACTORS FREQUENCY
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 9 Number 2 S Kumar, S Mehra Citation S Kumar, S Mehra.. The Internet Journal of Pulmonary Medicine. 2007 Volume 9 Number 2. Abstract Drug-induced
More informationChronic Lung Disease in vertically HIV infected children. Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre
Chronic Lung Disease in vertically HIV infected children Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre Natural history of HIV in vertically infected children without and with
More informationInternational consensus statement on idiopathic pulmonary fibrosis
Eur Respir J 2001; 17: 163 167 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2001 European Respiratory Journal ISSN 0903-1936 PERSPECTIVE International consensus statement on idiopathic
More informationAcute and Chronic Lung Disease
KATHOLIEKE UNIVERSITEIT LEUVEN Faculty of Medicine Acute and Chronic Lung Disease W De Wever, JA Verschakelen Department of Radiology, University Hospitals Leuven, Belgium Clinical utility of HRCT To detect
More informationOutline Definition of Terms: Lexicon. Traction Bronchiectasis
HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Idiopathic Pulmonary Fibrosis Page 1 of 10 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Idiopathic Pulmonary Fibrosis (Esbriet /pirfenidone, Ofev /nintedanib)
More informationRadiologic findings of drug-induced lung disease
Radiologic findings of drug-induced lung disease Poster No.: P-0115 Congress: ESTI 2015 Type: Educational Poster Authors: A. I. C. Santos, A. F. Roque, R. Mamede, L. Oliveira, T. Saldanha; Lisbon/PT Keywords:
More informationOverview of Idiopathic Pulmonary Fibrosis: Diagnosis and Therapy
Overview of Idiopathic Pulmonary Fibrosis: Diagnosis and Therapy Jeff Swigris, DO, MS Director, ILD Program National Jewish Health Disclosures Speaker - Boehringer Ingelheim and Genentech Objectives Describe
More informationThoracic lung involvement in rheumatoid arthritis: Findings on HRCT
Thoracic lung involvement in rheumatoid arthritis: Findings on HRCT Poster No.: C-2488 Congress: ECR 2015 Type: Educational Exhibit Authors: R. E. Correa Soto, M. J. Martín Sánchez, J. M. Fernandez 1 1
More informationCTD-related Lung Disease
13 th Cambridge Chest Meeting King s College, Cambridge April 2015 Imaging of CTD-related Lung Disease Dr Sujal R Desai King s College Hospital, London Disclosure Statement No Disclosures / Conflicts of
More informationCase Presentations in ILD. Harold R. Collard, MD Department of Medicine University of California San Francisco
Case Presentations in ILD Harold R. Collard, MD Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Definition/Classification High-resolution CT scan Multidisciplinary
More informationDiagnosing Idiopathic Pulmonary Fibrosis on Evidence-Based Guidelines
Diagnosing Idiopathic Pulmonary Fibrosis on Evidence-Based Guidelines Rebecca Keith, MD Assistant Professor, Division of Pulmonary and Critical Care Medicine National Jewish Health, Denver, CO Objectives
More informationHypersensitivity Pneumonitis (HP)
Hypersensitivity Pneumonitis (HP) Information for patients and families UHN Read this handout to learn about: What hypersensitivity pneumonitis (HP) is Signs and symptoms How your doctor will know if you
More informationCryptogenic Organising Pneumonia As The Initial Presenting Manifestation of SLE
BMH Medical Journal 2015;2(3):79-83 Case Report Cryptogenic Organising Pneumonia As The Initial Presenting Manifestation of SLE Neena Mampilly MD, G Manoj MD, Binoy J Paul MD, PhD, DNB, FRCP Baby Memorial
More informationNONE OVERVIEW FINANCIAL DISCLOSURES UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF (UIP) FOR PATHOLOGISTS. IPF = Idiopathic UIP Radiologic UIP Path UIP
UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF () FOR PATHOLOGISTS Thomas V. Colby, M.D. Professor of Pathology (Emeritus) Mayo Clinic Arizona FINANCIAL DISCLOSURES NONE OVERVIEW IPF Radiologic Dx Pathologic
More informationRespiratory diseases in Ostrołęka County
Respiratory diseases in Ostrołęka County 4400 persons underwent examination 950 persons were given referrals to more detailed investigation 600 persons were examined so far The results of more detailed
More informationSystemic lupus erythematosus (SLE): Pleuropulmonary Manifestations
08/30/10 09/26/10 Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations Camila Downey S. Universidad de Chile, School of Medicine, Year VII Harvard University, School of Medicine Sept 17,
More informationHypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas
Hypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas Rishi Raj MD Director, Interstitial Lung Diseases Program Clinical Professor of Pulmonary and Critical Care Medicine Stanford University
More informationReplacement of air with fluid, inflammatory. cells or cellular debris. Parenchymal, Interstitial (Restrictive) and Vascular Diseases.
Parenchymal, Interstitial (Restrictive) and Vascular Diseases Alain C. Borczuk, M.D. Dept of Pathology Replacement of air with fluid, inflammatory cells Pulmonary Edema Pneumonia Hemorrhage Diffuse alveolar
More informationNew respiratory symptoms and lung imaging findings in a woman with polymyositis
Maria Bolaki 1, Konstantinos Karagiannis 1, George Bertsias 2, Ioanna Mitrouska 1, Nikolaos Tzanakis 1, Katerina M. Antoniou 1 kantoniou@uoc.gr 1 Dept of Thoracic Medicine, Heraklion University Hospital,
More informationProfessor Rob Miller
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Professor Rob Miller University College London Medical School COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Prof Rob Miller
More informationUsual Interstitial pneumonia and Nonspecific Interstitial Pneumonia. Nitra and the Gangs.
Usual Interstitial pneumonia and Nonspecific Interstitial Pneumonia Nitra and the Gangs. บทน ำและบทท ๓, ๑๐, ๑๒, ๑๓, ๑๔, ๑๕, ๑๗ Usual Interstitial Pneumonia (UIP) Most common & basic pathologic pattern
More information11/10/2014. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective Radiology Pathology Clinical 1 Role of HRCT Diagnosis Fibrosis vs. inflammation Next step in management Response to treatment
More informationCase 4 History. 58 yo man presented with prox IP joint swelling 2 months later pain and swelling in multiple joints Chest radiograph: bi-basilar
Case 4 History 58 yo man presented with prox IP joint swelling 2 months later pain and swelling in multiple joints Chest radiograph: bi-basilar basilar infiltrates suggestive of pulmonary fibrosis Open
More informationDiagnosing ILD. What is important in 2016? Chris Grainge
Diagnosing ILD What is important in 2016? Chris Grainge Senior Staff Specialist Respiratory Medicine John Hunter Hospital Conjoint A/Prof University of Newcastle Conflict of interest I have acted as a
More informationNitrofurantoin Pulmonary Toxicity: A Brief Review
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 6 Number 2 B Vahid, B Wildemore Citation B Vahid, B Wildemore.. The Internet Journal of Pulmonary Medicine. 2005 Volume 6 Number 2. Abstract
More informationCombined Pulmonary Fibrosis and Emphysema - A Case Series
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 1 Ver. III (January. 2017), PP 15-19 www.iosrjournals.org Combined Pulmonary Fibrosis and Emphysema
More informationPULMONARY MEDICINE BOARD REVIEW. Financial Conflicts of Interest. Question #1: Question #1 (Cont.): None. Christopher H. Fanta, M.D.
PULMONARY MEDICINE BOARD REVIEW Christopher H. Fanta, M.D. Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Financial Conflicts of Interest
More informationLines and crackles. Making sense of ILD
Lines and crackles Making sense of ILD Case JM 65 year old male Gradual shortness of breath, going on over a year Some dry cough Ex-smoker, quit 10 years ago Crackles in the bases CXR presented Sent to
More informationPulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment
Prague, June 2014 Pulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment Katerina M. Antoniou, MD, PhD As. Professor in Thoracic Medicine ERS ILD Group Secretary Medical School,
More informationDefinition, classification and epidemiology
Interstitial Lung Diseases Definition, classification and epidemiology Haluk Türktaş Professor of Pulmonary Medicine Gazi University Ankara Interstitial Lung Diseases Definition of ILD A diverse group
More informationAtopic Pulmonary Disease: Findings on Thoracic Imaging
July 2003 Atopic Pulmonary Disease: Findings on Thoracic Imaging Rebecca G. Breslow Harvard Medical School Year IV Churg-Strauss Syndrome Hypersensitivity Pneumonitis Asthma Atopic Pulmonary Disease Allergic
More informationManish Powari Regional Training Day 10/12/2014
Manish Powari Regional Training Day 10/12/2014 Large number of different types of Interstitial Lung Disease (ILD). Most are very rare Most patients present with one of a smaller number of commoner diseases
More informationSESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I. December 5, 2012
SESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I December 5, 2012 FACULTY COPY GOAL: Describe the basic morphologic and pathophysiologic changes in various conditions
More informationNintedanib and Pirfenidone: New Medications in the Management of Idiopathic Pulmonary Fibrosis
Nintedanib and Pirfenidone: New Medications in the Management of Idiopathic Pulmonary Fibrosis Brad Zimmermann, PharmD, MBA Pharmacy Grand Rounds May 02, 2017 Rochester, Minnesota 2017 MFMER slide-1 Objectives
More information5/9/2015. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. No, I am not a pulmonologist! Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective No, I am not a pulmonologist! Radiology Pathology Clinical 1 Everyone needs a CT Confidence in diagnosis Definitive HRCT +
More informationTests Your Pulmonologist Might Order. Center For Cardiac Fitness Pulmonary Rehab Program The Miriam Hospital
Tests Your Pulmonologist Might Order Center For Cardiac Fitness Pulmonary Rehab Program The Miriam Hospital BASIC ANATOMY OF THE LUNGS Lobes of Lung 3 lobes on the Right lung 2 lobes on the Left Blood
More informationד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה Presentation: S.A is 25 years old. Referred to a gastroentrologist because of abdominal pain and bloody diarrhea in the last few weeks.
More informationDisease spectrum. IPA Invasive pulmonary aspergillosis
Aspergillus & ABPA Disease spectrum IPA Invasive pulmonary aspergillosis ABPA ABPA pathophysiology conidia of Aspergillus trapped in mucous and narrowed airways of asthmatics/cf germinate to form hyphae
More informationInterstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun
Interstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun. 26.11.11 Introduction Interstitial Lung Diseases (ILD) are group of diseases that affect the interstitium of the lungs,
More informationUIP OR NOT UIP PATTERN: THAT IS NOT THE ONLY QUESTION!
UIP OR NOT UIP PATTERN: THAT IS NOT THE ONLY QUESTION! STÉPHANE JOUNEAU 11 JULY 2014 Respiratory Medicine Department, Pontchaillou Hospital, Rennes, France CASE OVERVIEW This case highlights how a usual
More informationA Review of Interstitial Lung Diseases. Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco
A Review of Interstitial Lung Diseases Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Why it is important Definition/Classification
More informationNonspecific interstitial pneumonia and usual interstitial pneumonia: comparison of the clinicopathologic features and prognosis
Original Article Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparison of the clinicopathologic features and prognosis Xia Li 1, Chang Chen 2, Jinfu Xu 1, Jinming Liu 1, Xianghua
More informationLiebow and Carrington's original classification of IIP
Liebow and Carrington's original classification of IIP-- 1969 Eric J. Stern MD University of Washington UIP Usual interstitial pneumonia DIP Desquamative interstitial pneumonia BIP Bronchiolitis obliterans
More informationSHO Teaching. Dr. Amir Bhanji Consultant Nephrologist, Q.A hospital, Portsmouth
SHO Teaching Vasculitis Renal medicine Dr. Amir Bhanji Consultant Nephrologist, Q.A hospital, Portsmouth OUTLINE What is vasculitis Causes Classification Brief look into ANCA Associated Vasculitis (AAV)
More informationHospital-acquired Pneumonia
Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired
More informationNew lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma
July 2016 New lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma Contributed by: Laurel Rose, MD, Resident Physician, Indiana University School of Medicine,
More information11.3 RESPIRATORY SYSTEM DISORDERS
11.3 RESPIRATORY SYSTEM DISORDERS TONSILLITIS Infection of the tonsils Bacterial or viral Symptoms: red and swollen tonsils, sore throat, fever, swollen glands Treatment: surgically removed Tonsils: in
More informationLUNG DISEASES DUE TO ORGANIC&INORGANIC DUSTS. Dr.kassim.m.sultan F.R.C.P
LUNG DISEASES DUE TO ORGANIC&INORGANIC DUSTS Dr.kassim.m.sultan F.R.C.P efinition of hypersensitivity pneumonitis(extrinsic allergic alveolitis): Inflammatory disorder of the lung, involving alveolar walls
More informationCombined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases
CASE REPORT Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases Nobuhiko Nagata 1, Kentaro Watanabe 2, Michihiro Yoshimi 3, Hiroshi Okabayashi 4, Katsuo Sueishi 5, Kentaro
More informationPATHOPHYSIOLOGICAL PROCESS TEMPLATE
1 PATHOPHYSIOLOGICAL PROCESS TEMPLATE DISEASE: Chronic obstructive pulmonary disease (COPD) DEFINITION: COPD can be defined as a disease in which there is a significant damage to the lungs thus reducing
More informationHRCT in Diffuse Interstitial Lung Disease Steps in High Resolution CT Diagnosis. Where are the lymphatics? Anatomic distribution
Steps in High Resolution CT Diagnosis Pattern of abnormality Distribution of disease Associated findings Clinical history Tomás Franquet MD What is the diagnosis? Hospital de Sant Pau. Barcelona Secondary
More informationISPUB.COM. Drug induced pulmonary diseases. S Verma, V Mahajan INTRODUCTION ETIOPATHOGENESIS EPIDEMIOLOGY
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 9 Number 2 Drug induced pulmonary diseases S Verma, V Mahajan Citation S Verma, V Mahajan. Drug induced pulmonary diseases. The Internet Journal
More informationCryptogenic Organizing Pneumonia Diagnosis Approach Based on a Clinical-Radiologic-Pathologic Consensus
Cryptogenic Organizing Pneumonia Diagnosis Approach Based on a Clinical-Radiologic-Pathologic Consensus Poster No.: C-1622 Congress: ECR 2012 Type: Scientific Exhibit Authors: C. Cordero Lares, E. Zorita
More informationImaging Cancer Treatment Complications in the Chest
Imaging Cancer Treatment Complications in the Chest Michelle S. Ginsberg, MD Objectives Imaging Cancer Treatment Complications in the Chest To understand the mechanisms of action of different classes of
More informationRespiratory Diseases and Disorders
Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower
More informationA 72-year-old male with worsening interstitial infiltrates and respiratory failure
A 72-year-old male with worsening interstitial infiltrates and respiratory failure Case report On November 24, 2004, a 72-year-old male was admitted to the medical intensive care unit (ICU) with a history
More informationProgress in Idiopathic Pulmonary Fibrosis
Progress in Idiopathic Pulmonary Fibrosis David A. Lynch, MB Disclosures Progress in Idiopathic Pulmonary Fibrosis David A Lynch, MB Consultant: t Research support: Perceptive Imaging Boehringer Ingelheim
More informationChronic Cough. Dr Peter George Consultant Respiratory Physician Royal Brompton and Harefield Hospitals
Chronic Cough Dr Peter George Consultant Respiratory Physician Royal Brompton and Harefield Hospitals Overview Common causes of chronic cough Important diagnoses not to miss How to investigate a cough
More informationSurvival in Patients With Cryptogenic Fibrosing Alveolitis*
Survival in Patients With Cryptogenic Fibrosing Alveolitis* A Population-Based Cohort Study Richard Hubbard, DM; Ian johnston, MD; and john Britton, MD Study objectives: To determine the median survival
More informationParenchymal, Interstitial i (Restrictive) i and Vascular Diseases
Pulmonary Diseases: Structure-Function Correlation II Parenchymal, Interstitial i (Restrictive) i and Vascular Diseases Alain C. Borczuk, M.D. Dept of Pathology Pulmonary Diseases: Structure-Function Correlation
More informationDifferential diagnosis
Differential diagnosis The onset of COPD is insidious. Pathological changes may begin years before symptoms appear. The major differential diagnosis is asthma, and in some cases, a clear distinction between
More informationConnective Tissue Disorder- Associated Interstitial Lung Disease (CTD-ILD) and Updates
Connective Tissue Disorder- Associated Interstitial Lung Disease (CTD-ILD) and Updates Maria Elena Vega, M.D Assistant Professor of Medicine Lewis Katz School of Medicine at Temple University Nothing to
More informationA Review of Interstitial Lung Diseases
Outline A Review of Interstitial Lung Diseases Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco Overview of diagnosis in ILD Why it is important Definition/Classification
More informationChest imaging II. Interstitial lung diseases
Chest imaging II. Interstitial lung diseases Dávid L. Tárnoki MD, PhD Ádám D. TárnokiMD, PhD Department of Radiology Semmelweis University Topics 1. Interstitial lung diseases 2. Occupational lung diseases
More informationAcute organizing interstitial pneumonia and interstitial nephritis due to salazosulfapyridine in a patient with rheumatoid arthritis
Allergology International (2003) 52: 37 41 Case Report Acute organizing interstitial pneumonia and interstitial nephritis due to salazosulfapyridine in a patient with rheumatoid arthritis Haruhiko Ogawa,
More informationIs it Autoimmune or NOT! Presented to AONP! October 2015!
Is it Autoimmune or NOT! Presented to AONP! October 2015! Four main jobs of immune system Detects Contains and eliminates Self regulates Protects Innate Immune System! Epithelial cells, phagocytic cells
More informationDiffuse Interstitial Lung Diseases: Is There Really Anything New?
: Is There Really Anything New? Sujal R. Desai, MBBS, MD ESTI SPEAKER SUNDAY Society of Thoracic Radiology San Antonio, Texas March 2014 Diffuse Interstitial Lung Disease The State of Play DILDs Is There
More informationEpidemiology and classification of smoking related interstitial lung diseases
Epidemiology and classification of smoking related interstitial lung diseases Šterclová M. Department of Respiratory Diseases, Thomayer Hospital, Prague, Czech Republic Supported by an IGA Grant No G 1207
More informationCase Study #2. Case Study #1 cont 9/28/2011. CAPA 2011 Christy Wilson PA C. LH is 78 yowf with PMHx of metz breast CA presents
Case Study #1 CAPA 2011 Christy Wilson PA C 46 yo female presents with community acquired PNA (CAP). Her condition worsened and she was transferred to the ICU and placed on mechanical ventilation. Describe
More informationUpdate on management of respiratory symptoms. Dr Farid Bazari Consultant Respiratory Physician Kingston Hospital NHS FT
Update on management of respiratory symptoms Dr Farid Bazari Consultant Respiratory Physician Kingston Hospital NHS FT Topics The common respiratory symptoms Cough: causes, diagnosis and therapy Update
More informationJune 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference. Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2
June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2 Departments of Pulmonary Medicine 1 and Laboratory Medicine and Pathology 2 Mayo Clinic
More informationNon-neoplastic Lung Disease II
Pathobasic Non-neoplastic Lung Disease II Spasenija Savic Prince Pathology Program Systematic approach to surgical lung biopsies with ILD Examples (chronic ILD): Idiopathic interstitial pneumonias: UIP,
More informationPathologic Assessment of Interstitial Lung Disease
Pathologic Assessment of Interstitial Lung Disease Dry and itchy? It could be eczema or fungal infection. We don t need to worry, the drugs aren t that dangerous. Kirk D. Jones, MD UCSF Dept. of Pathology
More informationFever in Lupus. 21 st April 2014
Fever in Lupus 21 st April 2014 Fever in lupus Cause of fever N= 487 % SLE fever 206 42 Infection in SLE 265 54.5 Active SLE and infection 8 1.6 Tumor fever 4 0.8 Miscellaneous 4 0.8 Crucial Question Infection
More information9/15/11. Dr. Vivien Hsu Director, UMDNJ Scleroderma Program New Brunswick, NJ September Scleroderma. Hard skin
Dr. Vivien Hsu Director, UMDNJ Scleroderma Program New Brunswick, NJ September 2011 Scleroderma Hard skin 1 No diagnostic test for scleroderma Pathogenesis is unknown prominent features of disease reflect
More informationPrescribing Framework for Methotrexate for Immunosuppression in ADULTS
Hull & East Riding Prescribing Committee Prescribing Framework for Methotrexate for Immunosuppression in ADULTS Patient s Name:.. NHS Number: Patient s Address:... (Use addressograph sticker) GP s Name:...
More information