Pulmonary function tests Diffusion study Steps to diagnose ILD Part 3 Dr. Sheetu singh

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Pulmonary function tests Diffusion study

• Moderate - severe reduction in DLCO but normal
  lung volumes in a patient with ILD suggest
• - COPD with ILD
• - Pulmonary Vascular Disease
• - LCH
• - LAM
• A reduction in DLCO is common but nonspecific.
• The severity of the DLCO reduction does not
  correlate well with disease stage.

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3. Six minute walk test

• Simple and easy to perform
• Ask patient to walk for 6 minutes in atleast a
  30m long corridor
• Measure SpO2 before and after the test
• A fall in SpO2 gt4 indicates ? ILD, Pulmonary
  vascular disease

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Diagnostic algorithm for evaluation of ILD
Cough and Exertional dyspnoea
Chest radiograph, PFT, 6MWT
Either reticular/nodular/cystic shadow on
CXR OR Restrictive spirometry diffusion
defect OR Desaturation on 6MWT
dUIP ?IPF CTD-ILD
HRCT Chest
Confident clinical diagnosis
Sarcoid, HP, PAP, Lymphangitis carcinomatosis
Other idiopathic IIP
Bronchoscopy BAL, Endobronchial biopsies, TBLB,
EBUS-TBNA
Open lung or VATS assisted lung biopsy
or Transbronchial cryobiopsy
If inconclusive
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Suspect ILD in OPD
1. Look at breathing pattern rapid
breath/repetitive short dry cough/very
breathless while reaching to stool comfortable
soon 2. Listen base Velcro strip sound
sometimes clubbing 3. Ask to walk 6 min SpO2
dips 4. X Ray chest shows dirty lungs
spirometry is abnormal Investigate HRCT