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Overview of Interstitial Lung Diseases ˌint-ər-ˈstish-əl

By Joyce Lee, MD, MAS, Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver

Interstitial lung disease (also called diffuse parenchymal disease) is a term used to describe a number of different disorders that affect the interstitial space. The interstitial space consists of the walls of the air sacs of the lungs (alveoli) and the spaces around blood vessels and small airways. Interstitial lung diseases result in abnormal accumulation of inflammatory cells in lung tissue, cause shortness of breath and cough, and have similarities in their appearance on imaging studies but are otherwise unrelated. Some of these diseases are very unusual.

Early in the course of these diseases, white blood cells, macrophages, and protein-rich fluid accumulate in the interstitial space, causing inflammation. If the inflammation persists, scarring (fibrosis) may replace the normal lung tissue. As alveoli are progressively destroyed, thick-walled cysts (called honeycombing because they resemble the cells of a beehive) are left in their place. The condition resulting from these changes is called pulmonary fibrosis.

Although the various interstitial lung diseases are separate and have different causes, they have some similar features. All lead to a decreased ability to transfer oxygen to the blood, and all cause stiffening and shrinkage of the lungs, which makes breathing difficult and causes cough. However, being able to eliminate carbon dioxide from the blood is usually not a problem.

Unusual Interstitial Lung Diseases

Disorder

Symptoms

Treatment

Comments

Slow-developing (over weeks to months) or sudden, severe symptoms

Shortness of breath

Cough

Stopping the drug that is causing symptoms

Corticosteroids (sometimes effective)

Many classes of drugs may cause this disease.

The disease is often more severe in older people.

The effects of some drugs on the lungs are similar to those of systemic lupus erythematosus (lupus).

The extent and severity of the disease are sometimes related to how large the drug dose was and how long the drug was taken.

Alveolar hemorrhage syndromes (bleeding in the lungs)

Most commonly, coughing up blood (hemoptysis)

Anemia due to chronic blood loss

Kidney failure (sometimes)

Corticosteroids and cytotoxic drugs (such as cyclophosphamide )

Blood transfusions if needed because of blood loss

Oxygen therapy for a low level of oxygen in the blood

In these rare disorders, blood leaks from the capillaries, often because of an autoimmune reaction.

People may have Goodpasture syndrome, granulomatosis with polyangiitis, systemic lupus erythematosus (lupus), idiopathic pulmonary hemosiderosis (iron in the lungs), or drug reactions.

Massive bleeding can cause death.

Difficulty breathing

Cough

Chest pain

Sometimes coughing up blood

Lung transplantation

Sirolimus

This rare disorder occurs in young women.

It may worsen during pregnancy.

Types of Interstitial Lung Diseases

Type

Examples

Autoimmune disorders

Ankylosing spondylitis (rare), Behçet disease (very rare), Goodpasture syndrome, mixed connective tissue disease, polymyositis, dermatomyositis, relapsing polychondritis, rheumatoid arthritis, systemic sclerosis, Sjögren syndrome, and systemic lupus erythematosus(lupus)

Infections

Fungal, mycoplasmal (a type of bacterial), parasitic, rickettsial, or viral infections and tuberculosis

Organic dust

Bird droppings and molds

Drug-related

Amiodarone, bleomycin, busulfan, carbamazepine, chlorambucil, cocaine, cyclophosphamide, gold, methotrexate, nitrofurantoin, sulfasalazine, and sulfonamides

Chemical-related

Aluminum powder, asbestos, beryllium, metals, sulfur dioxide, talc

Therapeutic or industrial radiation-related

Radiation therapy for cancer

Idiopathic* interstitial pneumonias

Other disorders

*Idiopathic means with no known cause.

Diagnosis

  • Chest x-rays and computed tomography

  • Pulmonary function testing

  • Arterial blood gas analysis

Because interstitial lung diseases cause symptoms that are similar to those of much more common disorders (for example, pneumonia, chronic obstructive pulmonary disease), they may not be suspected at first. When an interstitial lung disease is suspected, diagnostic testing is done. Testing can vary by the disease suspected but tends to be similar.

Most people have a chest x-ray, computed tomography (CT) of the chest, pulmonary function tests, and often arterial blood gas analysis. CT is more sensitive than chest x-ray and helps doctors make a more specific diagnosis. CT is done using techniques that maximize resolution (high-resolution CT). Pulmonary function tests often show that the volume of air that the lungs can hold is abnormally small. Arterial blood gas tests measure the levels of oxygen and carbon dioxide in the arterial blood and determine the acidity (pH) of the blood.

To confirm the diagnosis, doctors sometimes remove a small sample of lung tissue for microscopic examination (lung biopsy) using a procedure called fiberoptic bronchoscopy. A lung biopsy done this way is called transbronchial lung biopsy. Many times, a larger tissue sample is needed and must be removed surgically, sometimes with use of a thoracoscope (a procedure called video-assisted thoracoscopic lung biopsy).

Blood tests may be done. They usually cannot confirm the diagnosis but are done as part of the search for other, similar disorders.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CYTOXAN (LYOPHILIZED)
  • FURADANTIN, MACROBID, MACRODANTIN
  • CORDARONE
  • AZULFIDINE
  • RAPAMUNE
  • LEUKERAN
  • TEGRETOL
  • No US brand name
  • MYLERAN
  • OTREXUP