ILD

[Purelygolden]

Mother worked in hosiery mills and then in 1966 @ Corning Glass Works working with glass cane cutting them down into various lengths to make resistors. She would come home covered in this "glass dust". Immediate family members that lived together with my mother had some sort of lung issues (i.e. grandfather had 1 lung removed due to cancer in the 1970's, grandmother died of lung cancer in 1968, my mother had many lung issues, placed on prednisone, had a heart attack, passed away in 1993. Sister, 5 yrs older than myself hospitalized 3 yrs ago due to lung issues) I was born in 1963 and have been diagnosed with "chronic interstitial lung disease" with COPD & persistent dyspnea" by my family physician. When I was 16 yrs old and a non-smoker, I contracted pleurisy, went to the emergency room at the local hospital was given Tylenol 3, told to get moderate bed rest, see our own doctor in a few days if symptoms did not get better (we didn't have a regular doctor). Anyway, I started smoking at age 18, have had pneumonia and the flu which took 2 weeks to get over. I quit smoking for two years, the started back again. I am now 49, have had 3 PFT's all of which show a "severly low diffusing capacity" which is 27% as of 4/27/11. I have had 2 CT scans which did not change that showed "lungs mildly hyperinflated"..."the lung bases demonstrate dependent atelectasis"..."a suggestion of prominent reticulonodular opacities observed along the interlobular septa"...and "there is a 3mm noncalcified pulmonary nodule within the right lung base". Otherwise, everything else shows normal on the CT scan, including heart. I do have severe breathing problems during any activity and have had very sharp chest pains from doing just minor things such as washing/drying my hair & changing out air filters in the a/c unit. I am on Spiriva, Flovent 110mcg 2 puffs daily & ProAir rescue inhaler. From just this information given to you, which type of ILD would you or could you say this would or could be??

[Purelygolden]

Thank you for your response. I do have a pulmonologist; I was referred to him by my family physician. His practice is where I had my last PFT completed in 4/11 showing the 27% diffusing capacity. He suggested CT Scan be completed, in which there were 2 taken within 3 months of one another with no changes. I have an upcoming appointment with him in May to review the results and he may complete another PFT along with ordering a HRCT to be done. Again, thank you for taking the time to respond.

[David Tinkelman, M.D.]

It would be purely speculative for me to suggest what type of interstitial lung disease (ILD) you might have and any such attempt would be further complicated by your history of smoking cigarettes and the clinical diagnosis of COPD.  Suffice it to say, both your family history of lung disease (especially if it includes members who were not exposed to the “glass dust”) and the exposure of you and your immediate family to the “dust” might also be relevant to your lung disease.

The diffusing capacity of 27%, if valid, is consistent with quite significant problems in gas transfer in your lungs and likely to be associated with low blood oxygen levels.  Your level should be checked.Your family physician may be correct with his/her assessment of your having ILD and COPD but you might wish to consider seeking consultation with a pulmonary specialist with expertise in the diagnosis and treatment of interstitial lung disease.

Two of note are:  Dr. Kevin Brown at the Respiratory Center, National Jewish Health in Denver, Colorado and, Dr. Talmadge King at the University of California Hospitals in San Francisco.

Good luck