eMedicine Specialties > Pulmonology > Interstitial Lung Diseases

Pulmonary Fibrosis, Interstitial (Nonidiopathic): Follow-up

Author: Eleanor M Summerhill, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Warren Alpert Medical School of Brown University; Director of Internal Medicine Residency Program, Memorial Hospital of Rhode Island
Contributor Information and Disclosures

Updated: Jun 20, 2008

Follow-up

Further Inpatient Care

  • Patients with interstitial lung disease generally are treated in an outpatient setting.
  • With advancing disease, progressive respiratory failure, pneumonia, pulmonary embolism, and cor pulmonale may all occur and require hospital admission.
  • Bronchogenic cancer occurs with increased frequency.13

Further Outpatient Care

  • See patients with diffuse interstitial lung disease every 3-6 months.
    • Order pulmonary function testing every 3-6 months to assess disease progression and response to therapy.
    • High-resolution CT scanning is becoming an increasingly important tool in making the initial diagnosis and subsequent assessments of disease progression and/or responses to therapy.

Inpatient & Outpatient Medications

  • Immunosuppressive and antifibrotic medications and supplemental oxygen may be indicated for some patients.
  • Prompt treatment is necessary for complicating pulmonary disease such as cor pulmonale (oxygen, diuretics), pulmonary embolism (anticoagulants), and infection (antibiotics).

Transfer

  • Most patients with DPLD can be treated in community settings.
  • Transfer to a tertiary care center is indicated when the diagnosis is in doubt or when treatment is ineffective.

Deterrence/Prevention

  • Prevention is predicated upon the specific diagnosis.

Complications

  • Progressive respiratory failure
  • Cor pulmonale
  • Pulmonary embolism
  • Pneumothorax
  • Pneumonia
  • Bronchogenic carcinoma

Prognosis

  • The prognosis is variable and depends on the specific diagnosis and clinical, physiologic, and pathologic severity.

Patient Education

  • Educate patients about the nature of the specific diagnosis and about potential toxicities of prescribed medications.

Miscellaneous

Medicolegal Pitfalls

  • When a patient presents with DPLD possibly resulting from an occupational exposure, the following important medicolegal questions should be considered:
    • Does the diagnosis represent a sentinel health event that requires notification of the particular state's Department of Public Health?
    • Is concern sufficient enough to merit notification of the US National Institute for Occupational Safety and Health?
    • Does a workplace investigation need to be conducted?
  • Often, important compensation, disability, and product-liability issues must be addressed. These and other issues are appropriate reasons to involve an occupational disease specialist.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Robert S. Crausman, MD, MMS, to the development and writing of this article.



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References
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Further Reading

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Keywords

interstitial lung disease, ILD, diffuse parenchymal lung disease, DPLD, diffuse lung disease, DLD, fibrotic lung disease, occupational interstitial lung disease, autoimmune pulmonary fibrosis, desquamative interstitial pneumonia, DIP, eosinophilic pneumonia, EP, respiratory bronchiolitis interstitial lung disease, RBILD, acute interstitial pneumonitis, AIP, Hamman-Rich syndrome, nonspecific interstitial pneumonia, NSIP, bronchiolitis obliterans-organizing pneumonia, BOOP, cryptogenic organizing pneumonia, COP, lymphocytic interstitial pneumonia, LIP, giant cell pneumonitis, granulomatous pneumonitis, sarcoidosis, hypersensitivity pneumonia, HSP, extrinsic allergic alveolitis, tuberous sclerosis, pulmonary Langerhans cell histiocytosis, PLCH, lymphangioleiomyomatosis, LAM

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Contributor Information and Disclosures

Author

Eleanor M Summerhill, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Warren Alpert Medical School of Brown University; Director of Internal Medicine Residency Program, Memorial Hospital of Rhode Island
Eleanor M Summerhill, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, Association of Program Directors in Internal Medicine, and Rhode Island Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi
Disclosure: See below for list of all activities None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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