Diagnosis and management of interstitial lung disease

Translational Respiratory Medicine

Table 2 Clues from the initial evaluation that suggest specific types of ILD

History elicited	Frequently associated ILD or complications of ILD
Rapid onset and worsening	AIP
	Infection
	Acute HP, acute EP
	Drug reaction
	COP
	CTD (e.g. acute lupus pneumonitis)
	DAH (e.g. GPS)
Smoking	RB-ILD, DIP, PLCH
Occupation: Pipefitter, foundry worker, coal miner,	Pneumoconiosis
Pneumotoxic drug exposure	Drug-induced ILD
Hemoptysis	DAH, pulmonary capillaritis, pulmonary venoocclusive disease, LAM
Hemoptysis	Superimposed complications (e.g. pulmonary emboli, lung neoplasm)
Pleurisy	CTD (SLE, RA)
Wheezing	HP, EP
Eye symptoms	CTD, sarcoidosis, PAG
Impaired vision combined with albinism & Puerto Rican heritage	HPS
Rash	Sarcoidosis, CTD
Exposure to organic antigens at home or at work (e.g. birds, grain dust, humidifiers, visible molds, hot tubs,etc.)	HP
	Occupational ILD
Abnormal GER, GERD, dysphagia	CTD (especially scleroderma), IPF
Sicca symptoms	Sjögren’s disease
Raynaud’s phenomenon	CTD
Arthralgias, arthritis	CTD, sarcoidosis
Myalgias, muscle weakness	DM-PM
Morning stiffness	RA, CTD
Age >70 years	IPF > other ILD if HRCT suspicious for IIP

AIP = acute interstitial pneumonia; COP = cryptogenic organizing pneumonia; CTD = connective tissue disease; DAH = diffuse alveolar hemorrhage; DM-PM = dermatopolymyositis; EP = eosinophilic pneumonia; GER = gastroesophageal reflux; GERD = gastroesophageal reflux disease; GPS = Goodpasture’s syndrome; HP = hypersensitivity pneumonitis; HPS = Hermansky-Pudlak syndrome; IIP = idiopathic interstitial pneumonia; IPF = idiopathic pulmonary fibrosis; LAM = lymphangioleiomyomatosis; PAG = polyangiitis with granulomatosis; PLCH = pulmonary Langerhans cell histiocytosis; SLE = systemic lupus erythematosus; RA = rheumatoid arthritis.
Reprinted with permission from Interstitial Lung Disease: A Practical Approach. Meyer KC, Raghu G: Patient evaluation. Second Edition, New York: Springer; 2011:3–16.