- Idiopathic Pulmonary Fibrosis (IPF)
- Hypersensitivity Pneumonitis (organic dust exposure eg moulds, birds, hay. Many cases are idiopathic, and no obvious cause is identified)
- Connective tissue disease (eg Rheumatoid arthritis, Scleroderma, SLE, Sjogren’s Disease, Mixed Connective Tissue Disease)
- Drug reactions (eg nitrofurantoin, methotrexate, statin therapy)
- Smoking related ILD
- Sarcoidosis
Patients with ILD usually present with:
- Breathlessness on exertion
- Dry cough
- Non-specific fatigue
- Bilateral inspiratory crackles on auscultation
- Clubbing of the fingers suggests IPF
- Normal spirometry or a restrictive pattern but sometimes with an obstructive pattern as IPF may coexists with emphysema/COPD.
- Consider heart failure, bronchiectasis in differential diagnosis
Assess everyone with suspected ILD by taking a detailed history including drug, occupational and smoking history, carrying out a clinical examination and performing initial investigations to help exclude alternative diagnoses.