Approach to diffuse parenchymal lung disease (interstitial lung disease) for the Hospitalist

Abstract

Diffuse parenchymal lung diseases (DPLD, historically known as interstitial lung diseases) are a heterogeneous group of diseases that are uncommon and grouped together for their similarity in one or more clinical, radiological, and pathological findings. There is no universally acceptable classification system yet for such a varied group of diseases and hence impossible to have one unified diagnostic pathway. Diagnostic work up requires that the clinician have an initial list of differential diagnoses based on a thorough history and clinical evaluation. For acutely progressive diseases such as diffuse alveolar hemorrhage, urgent evaluation is necessary so that appropriate therapy can be quickly instituted; whereas, for the chronic progressive diseases like idiopathic interstitial pneumonia most of the evaluation can be done in the ambulatory setting. The decision for bronchoscopy and surgical lung biopsy should be individualized by incorporating informed decision making due to large variations in practice patterns among clinicians. Below is a brief summary of the most likely diseases to be encountered in hospital medicine practice.