This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #26, #28
Understand the spectrum of diffuse parenchymal lung diseases (DPLDs), particularly those found more commonly in older adults.
Describe the evaluation of patients with DPLD including exposure history, signs and symptoms, and results of diagnostic tests.
Understand current treatment of the DPLDs with a focus on the treatment of idiopathic pulmonary fibrosis.
Describe nonpharmacologic aspects of care of older adults with a DPLD.
Discuss management of DPLD in patients approaching the end of life.
Key Clinical Points
There are a large number of DPLDs many of which are more common in the older adult, specifically idiopathic pulmonary fibrosis.
A history focused on environmental and drug exposures, the clinical features, and high-resolution CT scan patterns help distinguish the types of DPLD.
Management of DPLD includes careful consideration of a pharmacologic approach with consideration of potential side effects associated with therapies.
Nonpharmacologic therapies, including lifestyle changes and multidisciplinary care interventions, play a fundamental role in optimizing care and outcomes for older patients with DPLD.
The overall prognosis of idiopathic pulmonary fibrosis, the most common DPLD in older adults, is poor. Therefore, it is critical to address goals of care and end-of-life planning as part of the clinical decision-making process.
Diffuse parenchymal lung disease (DPLD) refers to a large and heterogeneous group of pulmonary diseases that are characterized by replacement of extensive portions of the normal lung parenchyma with inflammation and/or fibrosis. The term DPLD is often used interchangeably with multiple others, including interstitial lung disease (ILD), restrictive lung disease, or fibrotic lung disease. The DPLDs share common features, including symptoms, radiographic characteristics, and physiologic derangement. However, despite these common clinical features, DPLD is a broad classification that refers to any one of more than 200 different clinical entities of highly variable etiology, clinical course, and prognosis (Figure 85-1 and Table 85-1). These diseases can be associated with a known cause, but there is a large proportion of these processes that are idiopathic in nature and are grouped together as idiopathic interstitial pneumonias (IIP). In this chapter, we will describe common features shared by most DPLPs and discuss in detailed specific conditions most relevant for the geriatric population.
Hierarchy of diffuse parenchymal lung diseases.
TABLE 85-1DIFFUSE PARENCHYMAL LUNG DISEASE CLASSIFICATION ||Download (.pdf) TABLE 85-1 DIFFUSE PARENCHYMAL LUNG DISEASE CLASSIFICATION
Idiopathic Intersitial Pneumonias
Major idiopathic interstitial pneumonias
Idiopathic pulmonary fibrosis (IPF)
Idiopathic nonspecific interstitial pneumonia (NSIP)
Respiratory bronchiolitis–interstitial lung disease (RBILD)
Desquamative interstitial pneumonia (DIP)
Acute interstitial pneumonia (AIP)
Cryptogenic organizing pneumonia (COP)
Rare idiopathic interstitial pneumonias
Idiopathic lymphoid interstitial pneumonia (LIP)
Idiopathic pleuroparenchymal fibroelastosis
Unclassifiable idiopathic interstitial pneumonias
Other DPLD of Unknown Cause
Pulmonary Langerhans histiocytosis ...