PARENCHYMAL DIFFUSE LUNG DISEASE

Overview and Facts

Parenchymal Diffuse Lung Disease encompasses a vast number of disorders that involve the respiratory system. The classic hallmark of the disease is the formation of scar tissue within the lung parenchyma (tissue), which will eventually lead to progressive difficulty of breathing once the scarring has occupied a large portion of the lungs and there has been no medications or therapy that has shown promise in reversing the scarring.

Parenchymal Diffuse Lung Disease is due to prolonged contact with harmful substances such as phenols and asbestos (most commonly seen in materials used in the insulation of houses). This disorder can also occur among patients suffering from autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis, to name a few.

Types and Symptoms

TYPES

The following are classified as Parenchymal Diffuse Lung Disease :

  • Pneumonia caused by bacteria, viruses and fungal infection. The most common causative agent is Mycoplasma pneumoniae. 
  • Pulmonary fibrosis with no identifiable cause- Growth of scar tissue within the lung parenchyma is seen
  • Pneumonia that occurs in persons who have weak immunity.
  • Pneumonitis secondary to hyperreactive airways- This subset is especially noted after exposure to moldy hay, residing on areas which are near the highway
  • Cryptogenic pneumonia- Mimics pneumonia symptoms but has no infectious component.
  • Interstitial lung disease developing less than six weeks of the initial symptom. This type is debilitating, and patients most often need assistive respiration.
  • Interstitial Pneumonia with desquamation- Generally caused by exposure to cigarette smoke
  • Sarcoidosis- A systemic disorder that is caused by the inflammation of the lymph nodes affecting the cardiovascular system, skin, nerves and eyes.

SYMPTOMS

ILD presents the same as the presentation of community-acquired pneumonia which includes:

  • Fever (low to high grade)
  • Cough without mucus production
  • The difficulty of breathing (this symptom is more severe among patients with ILD)
  • Loss of appetite
  • Chest pain characterized as squeezing or associated with pinprick sensation on deep breathing

Diagnosis & Medications

DIAGNOSIS

Ancillary procedures that can aid the clinician with the diagnosis include: 

  • Radiographic imaging (CXR)- The initial test usually requested in patients presenting with the difficulty of breathing and cough. 
  • Computed Tomography scan (CT scan)-Serves to visualize the lung parenchyma better than other radiographic imaging modalities.
  • Pulmonary function test- This test measures the full inspiratory volume of the lungs, which is often decreased in cases of ILD.
  • High-resolution CT scan- shows a much more detailed picture of the lung parenchyma to identify scar formation from consolidation produced by infectious agents alone.

TREATMENT

  • Antibiotics- First line of treatment for patients with interstitial pneumonitis
  • Steroids- These type of drugs decreases the inflammatory sequelae that are responsible for the formation of scars.
  • Oxygen therapy-  this will help ease the discomfort caused by the scarring of interstitial lung disease. It helps perfuse the lungs necessary amount of oxygen for it to perform its vital function.
  • Lung transplantation- This is usually reserved for patients who have moderate to a severe reduction in lung volume capacity secondary to scar formation.

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