1/15/2009 1 Diffuse Parenchymal Lung Disease David J. Lederer, MD, MS Irving Assistant Professor of Clinical Medicine Irving Assistant Professor of Clinical Medicine Division of Pulmonary, Allergy, and Critical Care Medicine Columbia University College of Physicians and Surgeons Respiratory System Mechanics Gas Causes of Disease Structural Change Functional Change Exchange Ventilation Vascular Changes
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Diffuse Parenchymal Lung Disease - Columbia … 4 Terminology • Diffuse parenchymal lung disease (DPLD) A group of non-infectious, non-neoplastic lung diseases each characterized
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Diffuse Parenchymal Lung Disease
David J. Lederer, MD, MSIrving Assistant Professor of Clinical MedicineIrving Assistant Professor of Clinical Medicine
Division of Pulmonary, Allergy, and Critical Care MedicineColumbia University College of Physicians and Surgeons
Respiratory System
Mechanics
Gas
Causes of
Disease
Structural Change
FunctionalChange
Exchange
Ventilation
VascularChanges
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Compartments of the Lung
Courtesy Alain Borczuk, MD
Parenchymal Inflammation and Fibrosis
Normal Lung DPLD
Courtesy Alain Borczuk, MD
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Overview
• Terminology and classification scheme• Pathophysiology• Clinical manifestations• Pathogenesis• Management
A group of non-infectious, non-neoplastic lung diseases each characterized by varying degrees of inflammation and/or fibrosis of thecharacterized by varying degrees of inflammation and/or fibrosis of the parenchyma of both lungs.
• Interstitial lung disease (ILD)Old term for DPLD
• Idiopathic interstitial pneumonias (IIPs)A group of 7 DPLDs of unknown cause
• Idiopathic pulmonary fibrosis (IPF)• Idiopathic pulmonary fibrosis (IPF)The most common IIP (full definition to follow)
• Pulmonary fibrosisNon-specific term denoting bilateral parenchymal fibrosis
Spectrum of DPLD
Diffuse Parenchymal Lung Diseases
DPLD of known cause
Idiopathic interstitial
Granulomatous DPLDs Other forms of
DPLD
ATS/ERS Guidelines for IIP. AJRCCM 2002:165:277-304.
cause e s apneumonias (IIPs) (e.g., sarcoidosis)
DPLD
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Known Causes of DPLD• Drugs (chemotherapy, antibiotics)
Case• 54 year old man comes to see you because of two
years of dyspneayea s o dysp ea– First, while mowing his lawn – Then, more dyspneic than his wife in the gym– Now dyspneic with most activities at home.
• Dry cough (no sputum) and occasional joint pains. • No wheezing or hemoptysis.• No fever or chills• No fever or chills. • No chest pain, orthopnea, PND, or edema. • No rash, visual changes, Raynaud’s phenomenon,
dysphagia, or heartburn
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Case
• Past medical historyOsteoarthritis– Osteoarthritis