Cough & breathlessness

Chief complaint A 53-year-old male presents with recurrent cough & breathlessness*15 days and hoarseness*5 days. History He had such episodes in the past also which resolves on its own. He has h/o diabetes which is well controlled with medication. He worked in a factory and deals with metal parts. He is a chronic smoker for the past 20 years. No family history of pulmonary disease. Investigations Bilateral diffused interstitial markings were noted on chest x ray. Management Please discuss the tmt of the case.

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Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream. Interstitial lung disease can be caused by long-term exposure to hazardous materials, such as asbestos. Some types of autoimmune diseases, such as rheumatoid arthritis, also can cause interstitial lung disease. In some cases, however, the causes remain unknown. Once lung scarring occurs, it's generally irreversible. Medications may slow the damage of interstitial lung disease, but many people never regain full use of their lungs. Lung transplant is an option for some people who have interstitial lung disease. Symptoms The primary signs and symptoms of interstitial lung disease are: Shortness of breath at rest or aggravated by exertion Dry cough.By the time symptoms appear, irreversible lung damage has often already occurred. Nevertheless, it's important to see your doctor at the first sign of breathing problems. Many conditions other than interstitial lung disease can affect your lungs, and getting an early and accurate diagnosis is important for proper treatment. Causes Bronchioles and alveoli in the lungs Bronchioles and alveoli in the lungsOpen pop-up dialog box Interstitial lung disease seems to occur when an injury to your lungs triggers an abnormal healing response. Ordinarily, your body generates just the right amount of tissue to repair damage. But in interstitial lung disease, the repair process goes awry and the tissue around the air sacs (alveoli) becomes scarred and thickened. This makes it more difficult for oxygen to pass into your bloodstream. Interstitial lung disease can be triggered by many different things — including airborne toxins in the workplace, drugs and some types of medical treatments. In most cases, the causes are unknown. Occupational and environmental factors Long-term exposure to a number of toxins and pollutants can damage your lungs. These may include: Smoking Silica dust Asbestos fibers Grain dust Bird and animal droppings Radiation treatments Indoor hot tubs Some people who receive radiation therapy for lung or breast cancer show signs of lung damage months or sometimes years after the initial treatment. Medications Many drugs can damage your lungs, especially: Chemotherapy drugs. Drugs designed to kill cancer cells, such as methotrexate (Otrexup, Trexall, others) and cyclophosphamide, can also damage lung tissue. Heart medications. Some drugs used to treat irregular heartbeats, such as amiodarone (Nexterone, Pacerone) or propranolol (Inderal, Innopran), may harm lung tissue. Some antibiotics. Nitrofurantoin (Macrobid, Macrodantin, others) and ethambutol (Myambutol) can cause lung damage. Anti-inflammatory drugs. Certain anti-inflammatory drugs, such as rituximab (Rituxan) or sulfasalazine (Azulfidine), can cause lung damage. Interstitial Lung Disease (ILD) Interstitial lung disease (ILD) is a group of many lung conditions. All interstitial lung diseases affect the interstitium, a part of your lungs. The interstitium is a lace-like network of tissue that goes throughout both lungs. It supports your lungs' tiny air sacs, called alveoli. Normally, the interstitium is so thin that it doesn’t show up on X-rays or CT scans. Types of Interstitial Lung Disease All forms of interstitial lung disease cause the interstitium to thicken. This can happen from inflammation, scarring, or a buildup of fluid. Some forms of ILD last a short time (acute); others are long-term (chronic) and don’t go away. Some types of interstitial lung disease include: Interstitial pneumonia. Bacteria, viruses, or fungi can infect the interstitium. A bacteria called Mycoplasma pneumoniae is the most common cause. Idiopathic pulmonary fibrosis. This makes scar tissue grow in the interstitium. Experts don’t know what causes it. Nonspecific interstitial pneumonitis. This is an interstitial lung disease that often affects people with autoimmune conditions such as rheumatoid arthritis or scleroderma. Hypersensitivity pneumonitis. This happens when dust, mold, or other things that you breathe irritate your lungs over a long time. Cryptogenic organizing pneumonia (COP). COP is a pneumonia-like interstitial lung disease without an infection. You might bronchiolitis obliterans with organizing pneumonia (BOOP). Acute interstitial pneumonitis. This is a sudden, severe interstitial lung disease. People who have it often need to be connected to a machine called a ventilator that breathes for them. Desquamative interstitial pneumonitis. This is an interstitial lung disease that partly results from smoking. Sarcoidosis. This causes interstitial lung disease along with swollen lymph nodes. It can also affect your heart, skin, nerves, and eyes. Asbestosis. This is an interstitial lung disease caused by breathing asbestos, a fiber used in building materials. Interstitial Lung Disease Symptoms The most common symptom of all forms of interstitial lung disease is shortness of breath. Almost everyone with ILD will have breathlessness, which can get worse over time. Other symptoms of interstitial lung disease include: Cough, which is usually dry and doesn’t bring up mucus. Weight loss, most often in people with COP or BOOP. With most forms of ILD, shortness of breath develops slowly (over months). If you have interstitial pneumonia or acute interstitial pneumonitis, your symptoms will come on quickly (in hours or days). Interstitial Lung Disease Causes and Risks The cause of most interstitial lung disease is unknown. Bacteria, viruses, and fungi can cause interstitial pneumonia. You can also get ILD if you regularly breathe in things that can bother your lungs. These include: Asbestos Bird proteins (such as from exotic birds, chickens, or pigeons) Coal dust or various other metal dusts from working in mining Grain dust from farming Silica dust Talc It’s rare, but certain drugs can cause ILD: Some antibiotics, like nitrofurantoin Some anti-inflammatory drugs, like rituximab Chemotherapy drugs like bleomycin Heart medications such as amiodarone Anyone can get interstitial lung disease, but some things can put you at higher risk: Age. Adults are much more likely to get ILD, but children can, too. Autoimmune disease like lupus, rheumatoid arthritis, and scleroderma Gastroesophageal reflux disease (GERD) Genetics. Some conditions are passed down among family members. Smoking Radiation treatments for cancer Interstitial Lung Disease Diagnosis People with interstitial lung disease usually go to the you because of shortness of breath or a cough. You will probably use imaging tests of your lungs to find out the problem. Chest X-ray. A simple chest X-ray is the first test for most people with a breathing problem. Chest X-rays in people with interstitial lung disease may show fine lines in the lungs. CT scan. A CT scan takes multiple X-rays of the chest, and a computer creates detailed images of the lungs and surrounding structures. These tests can usually find interstitial lung disease. High-resolution CT scan. If your doctor thinks you have an interstitial lung disease, certain CT scan settings can get better-quality images of your interstitium. This can help diagnose you. Lung function test. You sit in a sealed plastic booth and breathe through a tube to measure your total lung capacity, which might be reduced if you have ILD. You may also be less able to transfer oxygen from your lungs into your blood. Lung biopsy. Looking at lung tissue under a microscope is often the only way for a you to know which type of interstitial lung disease you have. Lung tissue is collected in a procedure called a lung biopsy, which can be done several ways: Bronchoscopy. You will run a tube called an endoscope through your mouth or nose and into your airways. Tiny tools on the endoscope can take a sample of lung tissue. Video-assisted thoracoscopic surgery (VATS). You will make small cuts to insert tools that take samples from multiple areas of lung tissue. Open lung biopsy (thoracotomy). In some cases, you might need traditional surgery with a large incision in the chest to get a lung biopsy. Treatments for Interstitial Lung Disease The treatment you get depends on the type of ILD you have and its cause. Antibiotics. These treat most interstitial pneumonias. Pneumonias caused by a virus usually get better on their own. Pneumonias caused by a fungus are rare but are treated with antifungal drugs. Corticosteroids. In some forms of interstitial lung disease, inflammation in your lungs causes damage and scarring. Corticosteroids cause your immune system’s activity to slow. This lessens the amount of inflammation in your lungs and the rest of your body. Inhaled oxygen. If you have low oxygen levels because of interstitial lung disease, inhaled oxygen may help your symptoms. Regular use of oxygen might also protect your heart from damage caused by low oxygen levels. Lung transplant. In advanced interstitial lung disease that has severely impaired you, you may need a lung transplant. Most people who have a lung transplant for interstitial lung disease make large gains in their quality of life and their ability to exercise. Azathioprine (Imuran). This drug also slows down the immune system. It’s not shown to improve interstitial lung disease, but some studies suggest it might help. N-acetylcysteine (Mucomyst). This potent antioxidant may slow the decline of lung function in some forms of interstitial lung disease. You’ll take it in combination with other treatments. Other drugs are considered controversial for interstitial lung disease treatment, including: Cyclophosphamide (Cytoxan) Cyclosporine Methotrexate Nintedanib (Ofev) Pirfenidone (Esbriet) These medicines affect the way your immune system works.

COPD chronic bronchitis Allergic bronchitis

Adv PFT DLCO to rule out obstructive airways disease, ILD, pneumoconiosis etc.

COPD Emphysema Chronic bronchitis Prevention is better than cure For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. Bronchodilators are medicines that make breathing easier by relaxing and widening your airways. There are 2 types of short-acting bronchodilator inhaler: beta-2 agonist inhalers – such as salbutamol and terbutaline.

* Allergic bronchial ** COPD Pneumoconiosis Needs further investigation and evaluation to conclude and line of treatment. Till reports complied. Antihistamine orally. Steroid orally. Bronchodilator. Nebulization. BS antibiotics orally. Improve General health and smoking must be stopped.

Thanks Dr Kute Ankush

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Tnx Dr Ashok Leel sir

Smokers couch / Allergic bronchial asthma ? Pulmonary function test CBC ESR Sputum test for AFB HB A1 C Stop smoking Use Masks .. Good control of sugar Montalakast and Levocetrizine OD Butamide inhalation Job Shift if possible

ILD pneumoconiosis steroid bronchodiators

C O P D Ad spirometery TT Seroflo & Duoline rotacap inhalation through rotahaler sos Antibiotics orally at the time of attack Smoking should be reduced gradually He gets vocal cords affected due to smoking & some cold allergy leading pressure over recurrent laryngeal nerve that was cause for couldn’t speak So get his laryngoscopes done for any abnormally

COPD- Chronic bronchitis with acute exacerbation Treat with bronchodilators, steroids to reduce inflammation and short course of antibiotics to treat acute exacerbation. Oxygen if spo2 is low.

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