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Pulmonary Fibrosis Diagnosis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
High Resolution Computed Tomography
Induced Sputum and Bronchoalveolar Lavage
Lung Biopsy
Pulmonary Function Tests
Ultrasound
Walking and Stress Tests
Pulmonary Fibrosis Antibodies

Overview

All systemic sclerosis patients should have regular screening for both pulmonary fibrosis and pulmonary hypertension. Exams may include pulmonary function test (PFT), Doppler ECHO, high-resolution computed tomography (HRCT), right heart catheterization (RHC), and six-minute walk test. (Also see What is Scleroderma?, Pulmonary Fibrosis, and Pulmonary Hypertension)

Detection and classification of systemic sclerosis-related interstitial lung disease: a review. Classification of SSc-ILD has shifted to a personalized approach that considers an individual patient's probability of progressive disease through identification of risk factors. PubMed, Curr Opin Rheumatol, 08/13/2019.

Augmented concentrations of CX3CL1 are associated with interstitial lung disease in systemic sclerosis (SSc–ILD). The CX3CR1/CX3CL1-biological axis may be involved in recruiting antibody secreting plasma cells to SSc lungs, thereby contributing to the immune–mediated pathobiology of SSc–ILD. PubMed, PLoS One, 2018 Nov 20;13(11):e0206545.

Interstitial lung disease (ILD) in patients with mixed connective tissue disease (MCTD): pilot study on predictors of lung involvement. The association of easily elicited historical and clinical features of MCTD with subtle, but worrisome, pulmonary pathology carries the promise of sensitising the unsuspecting clinician about the entity of ILD in MCTD. PubMed, Clin Exp Rheumatol. 2018 Jul-Aug;36(4):648-651. (Also see Connective Tissue Disease)

Is It Idiopathic Pulmonary Fibrosis or Not? The early and correct diagnosis is hampered by mimickers that include nonspecific interstitial pneumonitis, chronic hypersensitivity pneumonitis, and fibrotic sarcoidosis. PubMed Journals, J Am Board Fam Med, 31 (1), 151-162. 1 2018 2018 Jan-Feb.

Medical Tests: Pulmonary. Diagnostic tests for pulmonary fibrosis include CAT scan, echocardiogram, pulmonary function test, chest x-ray, bronchoscopy, and bronchoalveolar lavage. ISN.

High Resolution Computed Tomography (HRCT)

Performance of a new quantitative computed tomography index for interstitial lung disease (ILD) assessment in systemic sclerosis (SSc). This new composite CT index for SSc-ILD assessment could be sufficiently sensitive for capturing early lung density changes in visually ILD-free patients. PubMed, Sci Rep, 2019 Jul 1;9(1):9468.

Interstitial lung disease (ILD) in systemic sclerosis: progress in screening and early diagnosis. Prospective cohort data indicated poor performance of pulmonary function tests as a stand–alone method for ILD screening, although lung HRCT appeared promising, radiation is an issue. PubMed, Curr Opin Rheumatol, 2016 Nov;28(6):613-8.

Thoracic Scleroderma Imaging. Patients with suggested or known diagnosis of systemic sclerosis should undergo a CAT Scan. Medscape.

Induced Sputum and Bronchoalveolar Lavage Tests

Biomarkers from bronchoalveolar lavage fluid (BALF) in systemic sclerosis (SSc) patients with interstitial lung disease (ILD) relate to severity of lung fibrosis. In SSc related ILD, biomarkers from BALF and serum correlate to findings on HRCT suggesting usefulness as markers of presence and extent of lung fibrosis. PubMed, Respir Med. (Also see Pulmonary Fibrosis Research)

Lung Biopsy

Open lung biopsy. An open lung biopsy is surgery to remove a small piece of tissue from the lung. The sample is then examined for cancer, infection, or lung disease. MedLinePlus.

Histology of Pulmonary and Bronchiolar Disorders in Connective Tissue Diseases (CTD). In this review we describe the patterns of lung disease associated with common CTDs, lung disease in pediatric CTD patients, and newly recognized conditions. PubMed, Semin Respir Crit Care Med. 2019 Apr;40(2):147-158. (Also see Connective Tissue Disease)

Pulmonary Function Tests

Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease (SSc-ILD). Despite the current preference for forced vital capacity, available evidence suggests that DLCO and total lung capacity should not yet be discounted as potential surrogate markers for SSc-ILD progression. PubMed, Eur Respir Rev, 2018 May 15;27(148).

Pulmonary Function Tests. Pulmonary function tests are tests performed to make measurements of how your lungs and airways function. Results from pulmonary function tests enable your physician to evaluate your breathing, make diagnosis, recommend treatment and follow your progress. This article tells you how to prepare for the test and how it is conducted. National Jewish Medical and Research Center.

Ultrasound

A simplified lung ultrasound (LUS) for the diagnosis of interstitial lung disease in connective tissue disease: a meta–analysis. We found a modified and simplified method of LUS, by scanning 14 lung intercostal spaces in a short time, which had a very high sensitivity and specificity. PubMed, Arthritis Res Ther, 2019 Apr 11;21(1):93. (Also see Connective Tissue Disease)

Walking and Stress Tests

Six Minute Walk Test (6MWT). The original purpose of the six minute walk was to test exercise tolerance in chronic respiratory disease and heart failure. The test has since been used as a performance-based measure of functional exercise capacity in other populations including healthy older adults, people undergoing knee or hip arthroplasty, fibromyalgia, and scleroderma. American College of Rheumatology.

Factors associated with the 6–minute walk distance (6MWD) in patients with systemic sclerosis (SSc). During SSc, the 6MWD is independently associated with initial HR and HR variation; suggesting that pulmonary vasculopathy may have a greater impact than parenchymal involvement on functional limitation. PubMed, Arthritis Res Ther, 2017 Dec 15;19(1):279.

Pulmonary Fibrosis Antibodies and Biomarkers

Serum Clara cell 16-kDa protein levels and lung impairment in systemic sclerosis patients. Clara cell 16-kDa protein levels can be considered as a supplemental serum biomarker for systemic sclerosis associated interstitial lung disease. PubMed, Rev Bras Reumatol Engl Ed, 2016 Jul-Aug;56(4):309-13.

Interstitial lung disease (ILD) in systemic sclerosis (SSc): progress in screening and early diagnosis. Lung HRCT appeared promising, but radiation is an issue. Promising biomarker data indicate the possibility of new ILD screening algorithms in SSc. PubMed, Curr Opin Rheumatol, 07/06/2016.

Interstitial lung disease: is interstitial lung disease the same as scleroderma lung disease? Despite differences in clinical presentation and response to treatment, similarities are noted in proposed pathogenesis and putative biomarkers. Curr Opin Rheumatol.

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