Patient will present as → a 55-year-old female who is a current smoker presents with a 9-month history of respiratory symptoms, including dyspnea on exertion, thoracic pain and dry cough, which were preceded by a pulmonary infection. On auscultation, you hear inspiratory crackles. Pulmonary function tests (PFTs) show only mild impairment of vital capacity with decreased lung volume and a normal to increased FEV1/FVC ratio
Chronic progressive lung disorder characterized by increasing scarring, which ultimately reduces the capacity of the lungs; etiology unknown
- Idiopathic pulmonary fibrosis is the most common of all interstitial lung diseases
- In order to be considered "idiopathic"you must be sure to rule out other common causes such as drugs, and environmental or occupational exposures.
Common "non-idiopathic" causes of pulmonary fibrosis which must be ruled out:
- Cigarette smoking
- Certain viral infections
- Exposure to environmental pollutants, including silica and hard metal dusts, bacteria and animal proteins, and gases and fumes
- The use of certain medicines (methotrexate, amiodarone, nitrofurantoin, rituximab, bleomycin, and cyclophosphamide)
- Radiation treatment
- Gastroesophageal reflux disease (GERD)
Treatment includes the judicial use of corticosteroids, O2, and eventually lung transplant
Early inspiratory crackles
Late, not early, inspiratory crackles are associated with interstitial lung disease.
Progressive dyspnea on exertion
Productive cough with copious sputum
A productive cough of copious amounts of sputum is most typical of a patient with chronic bronchitis.
Decreased breath sounds with hyperresonant percussion
Physical examination findings of decreased breath sounds with hyperresonant percussion is consistent with a diagnosis of chronic obstructive lung disease.
COPD appears as hyperinflation with flattening of the diaphragm on chest radiograph
Tuberculosis presents with pulmonary infiltrates on chest radiograph most often apical; cavitations may be seen with progressive primary tuberculosis.
Chest x-ray in bronchiectasis shows dilated and thickened bronchi that appear as ring-like markings.