Idiopathic interstitial pneumonia diagnosis

Idiopathic Interstitial Pneumonia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]; Chetan Lokhande, M.B.B.S [3]

Overview

Repeated measurements of different clinical and physiological parameters are believed to be useful in assessing the clinical course of IPF. Assessment of dyspnea, using an established clinical scale for rating the impact of dyspnea on activities. Lung volumes, DLCO, resting arterial blood gases, cardiopulmonary exercise testing with measurement of gas exchange, HRCT lung scans are our current tools for diagnosing idiopathic interstitial pneumonia. Physiologic testings have been used to determine the current functional lung capacity. Studies have shown that conventional lung function tests by spirometry have more precision in prognosis of patients with IPF, while extensive tests like gas exchange measurements at rest and exercise do not add additional information to make the prognostic or treatment evaluation more precise. .

Diagnosis

The diagnostic criteria for

AMERICAN THORACIC SOCIETY / EUROPEAN RESPIRATORY SOCIETY CRITERIAfor diagnosing of IDIOPATHIC PULMONARY FIBROSIS in absence of surgical lung biopsy

" Major criteria:(must have all)" Exclusion of other known causes of ILD, such as certain drug toxicities, environmental exposures, and connective tissue diseases Abnormal pulmonary function studies that include evidence of restriction (reduced VC, often with an increased FEV1/FVC ratio) and impaired gas exchange (increased P[A-a]O2, decreased PaO2 with rest or exercise or decreased DLCO) Bibasilar reticular abnormalities with minimal ground-glass opacities on HRCT scans Transbronchial lung biopsy/BAL showing no features to support an alternative diagnosis

" Minor criteria:" Age > 50 yr Insidious onset of unexplained dyspnea on exertion Duration illness > 3 mo Bibasilar, inspiratory crackles "