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Which of the following is characteristically not associated with the development of interstitial lung disease? (AIIMS May 2008)

A Coal dust
B Sulfur dioxide

C Thermophilic actinomycetes
D Tobacco smokes

Ans. D

Tobacco smokes

Classification The ILDs can be broadly grouped into three categories: (Ref. Hari-18th ed., Table 261.1 Pg- 2161)

1). Those with known aetiology eg

a. Occupational/environmental eg asbestosis, berylliosis, silicosis, cold dust

b. Drugs eg nitrofurantoin, bleomycin, amiodarone, sulfasalazine, busulfan Q

c. Hypersensitivity reactions eg extrinsic allergic alveolitis

d. Infections eg TB, fungi, viral

2). Those associated with systemic disorders eg

a. Sarcoidosis

b. Systemic sclerosis

c. Ulcerative colitis, renal tubular acidosis, autoimmune thyroid disease

d. Rheumatoid arthritis

e. Mixed connective tissue disease

f. SLE,

g. Sjögren’s syndrome

3). Idiopathic

a. Idiopathic pulmonary fibrosis (IPF)/cryptogenic fibrosing alveolitis

b. Cryptogenic organizing pneumonia

c. Lymphocytic interstitial pneumonia

Extra Edge:

1). Tobacco is not a cause of ILDQ

2). Exposure to cobalt can lead to giant cell interstitial pneumonitis. Q

Extra Edge: - Interstitial lung disease (ILD)

1). This is the generic term used to describe a number of conditions that primarily affect the lung parenchyma in a diffuse manner.

2). They are characterized by chronic inflammation Q and/or progressive interstitial fibrosis, and share a number of clinical and pathological features.

3). Clinical features : Dyspnoea Q on exertion; non-productive paroxysmal cough Q, abnormal CXR or high resolution CT; restrictiveQ pulmonary spirometry with a reduced DLCO Q.

4). Pathological features: Fibrosis and remodeling of the interstitium; chronic inflammation; hyperplasia of type II epithelial cells or type II pneumocytes.