الفهرس 
Introduction &Aim of the workOnly 14 pages are availabe for public view
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Abstract
The terms Interstitial Lung Diseases (ILDs) and diffuse parenchymal lung disease (DPLD) are imprecise clinical terms for a diverse range of diseases that involve inflammation and fibrosis of the alveoli, distal airways, and septalinterstitium of the lung.
The worldwide increase in diagnosis of interstitial lung disease because of the help of recent advance diagnostic tools.
Idiopathic pulmonary fibrosis (IPF) is the most common type of Idiopathic interstitial pneumonia. Diagnosis of IPF requires exclusion of other known causes of interstitial lung disease,presence of a UIP pattern on high-resolution computed tomography(HRCT) in patient not subjected to surgical lung biopsy or specific combinations of HRCT and surgical lung biopsy pattern in patient subjected to surgical lung biopsy.
Smoking is considered now as a risk factor for different types of interstitial lung disease.The term smoking-related ILD has increasingly been used,including most of cases of desquamative interstitial pneumonia and nearly all cases of RB-ILD.
HRCT is considered the most beneficial diagnostic tool for diagnosis for different types of interstitial lung diseases.
Our study was done at chest department of sohag university hospital during the period from March 2014 toFebruary 2015 and included one hundred and 5 patients with ILDs,34.3% were males and 65.7% were females with mean age 48.9±16.4 years.
Regarding smoking among the studied patients 5.7% (6 pts.) were current smokers, 14.3% (15 pts.)were ex-smokers and 80%(84 pts.)werenonsmokers.
According to clinical examination, 13.3% ofILD patients in our study had elevated blood pressure, 50.5% (53 pts.)had central cyanosis,38.1%(40 pts.)had raised jugular venous pressure and 38.1%(40 pts.)had lower limb oedema ,56.2%(59 pts.)hadclubbing , 19%(20 pts.)had fever ,9.5%(10 pts.)had pallor and jaundice only was found in 1% of patients.
According to laboratory investigations, we found high ESR in 76.2%(80) of patients, positive CRP in 65.7%(69 pts.), leukocytosis in 31.4%(33pts.), leucopenia in 1% pts., anemia in 10%(14 pts.), polycythemia in 2.9%(3pts.), thrombocytopenia in 8.6%(9pts.),increase serum creatinine only in1.9%(2pts.), high blood sugar in17.1%(18pts.), prolonged PT and PC in 6.7%(7pts.),rheumatoid factor was positive in 28.6%(30pts.),LE cell positive in 8.5%(9pts.),ANA positive with10.5% (11pts.)and anti-double stranded DNA positive with 1%patients.
According to Arterial blood gases, we found respiratory failure type I in27.6%(29 pts.),respiratory failure type II with 22.9%(24pts.), while normal arterial blood gases was found in 49.5%(52patients).
According to pulmonary function test,restrictive pattern was found in45.7%(48pts.)while mixed pattern(restrictive and obstructive)was found in 49.5%(52 pts.).
Our study was showed that most common patterns of clinical presentation were:
increasing dyspnea that was found in all patients among our study,DCP was foundin 40 (38.1%) pts.,RF I was found in 29 (27.6%)pts.,RF II was found in 24 ( 22.8%) pts., acute exacerbation was found in 14( 13.3%) pts.,pneumothorax was found in 5 (4.8%)pts. ,pneumonia was found in 4(3.8%)pts.,haemoptysiswas found in(1%)pts.,lupus pneumonitis was found in ( 1%)patients.
Duration of hospital stay in our study observed to be longer with pneumothorax, respiratory failure II and DCP (with mean duration 32.2, 21.04, 20.6 days, srespectively) than other patterns of presentation.
Our study found that most possible causes of ILD were ,IPF presented with 53.3%,ILD associated with connective tissue disease with 21.9%(rheumatic arthritis 10.4% ,SLE 8.6%, MCTD 1.9%, behcets disease 1%) ,extrinsic allergic alveolitis presented with 7.7%,occupational lung disease with 4.8%,combined ILD with COPD with 5.7%,other types of ILD presented with 2.8%.
In our study we found that comorbid diseases in patients with ILD were:
Hypertension 17.1%, diabetes mellitus 17.1%, gastritis and gastroesophageal reflux 11.4%, anaemia 13.3%, ischemic heart disease 6.7% ,,emphysema 5.7%, depression 3.8%,anxiety 1% ,pneumonia 3.8% OSAS 1%, polycythemia 2.9% ,pulmonary aneurysm and I.V.C thrombosis 1% and liver disease in 1%.
In our study we found that most common complicatin occurred with ILD were:
Acute exacerbation 13.3%, pneumothorax 5%, pneumonia 3.8%,while other complications as lung cancer and pulmonary embolism not observed during the study.
In our study most of patients with ILDs showed improvement with medical treatment alone (in 83 (79%) cases) or additional home O2 therapy was advised (in 15 (14.3%) cases) . While more severe cases that needed transfer to I.C.U occurred only with 2 cases (1.9%) and death occurred in 5 cases (4.8%).
Conclusion
The diagnosis and treatment of the various types of ILD present aconsiderable challenge to clinicians.
A comprehensive clinical evaluation combined with appropriate imaging and diagnostic procedures can achieve a confident diagnosis of a specific type of ILD, and invasive testing with bronchoscopy or surgical lung biopsy may not be required, this method of diagnosis can reduce false diagnosis which occur due to presence of similarity in symptoms in other chest diseases.
The diagnosis and treatment of comorbid conditions associated with ILD may provide significant benefit to the patients.
IPF is the most common cause of ILDs .CTDs are more common in females than in males.
HRCT is very useful non-invasive diagnostic tool for interstitial lung disease.
Different patterns of clinical presentations of ILDs occur as sequels of disease progression or as a complication of the disease or due to presence of comorbid disease, and with all these patterns careful management can improve prognosis and outcome of the patients.