Sarcoidosis can lead to severe lung scarring (pulmonary fibrosis). It can also sometimes be associated with pulmonary hypertension. These can significantly impact lung function and cause a drop in oxygen levels, particularly during exertion.

Watch this episode on YouTube: https://youtu.be/qi4D-vLiZJ4

Oxygen saturation levels (SpO2) can be monitored using an oximeter, and values below 90% warrant a check of blood oxygen levels. This can be done through blood gas analysis from the earlobe or an arterial blood sample. If oxygen levels are indeed low, supplemental oxygen therapy may be prescribed to improve oxygen levels, reduce the risk of complications, and potentially enhance exercise tolerance. However, it's worth noting that oxygen therapy may not alleviate all symptoms of breathlessness. Regular follow-ups and additional tests, including imaging and lung function assessments, are crucial to monitor the progression of the disease and manage any potential complications, such as cardiac involvement. Patients experiencing palpitations at rest, or randomly occurring, should inform their doctors, who may recommend further tests like a Holter ECG or cardiac PET to assess heart function and rule out cardiac sarcoidosis. Pulmonary rehabilitation and optimization of other treatments, such as those for other heart and lung conditions, may be beneficial. #sarcoidosis #oxygen #pulmonaryfibrosis

An overview of drug induced interstitial lung disease / pulmonary fibrosis. This video explains how the connection between a certain medication and pulmonary fibrosis is made. You can also watch the video on YouTube here: https://youtu.be/fVRf8Y-hwS4

Several drugs can induce lung reactions and fibrosis, but unless we have a clear timeline it can be very hard to confidently say it was a specific drug that caused the fibrosis.

Remember there may be other causes for pulmonary fibrosis that may need to be investigated.

Look up potential for lung toxicity of different medications here: https://www.pneumotox.com/drug/index/

(a star sign with a higher number in it suggests there is a higher potential of lung toxicity - i.e. number 4 or 5)

#pulmonaryfibrosis #ild #interstitiallungdisease

Overview of interstitial lung abnormalities (ILAs). ILAs represent incidental findings on a chest CT scan, which affect more than 5% of any lung zone (upper, middle or lower) in a person where interstitial lung disease / pulmonary fibrosis was not suspected.

You can also watch this on YouTube here: https://youtu.be/KCrniBdbZic

Interstitial lung abnormalities can be found in 2-9% of patients who have a CT scan (depending on the population studied). There is no clear consensus on how these should be followed up.

The main problem is that in some cases, ILAs may actually represent an early case of pulmonary fibrosis / interstitial lung disease. Therefore there is a risk that the abnormalities may worsen over time.

This is a useful overview of interstitial lung abnormalities: https://pubs.rsna.org/doi/10.1148/radiol.2021204367 #pulmonaryfibrosis #ild

In this episode - fibrotic non-specific interstitial pneumonia (or NSIP) - what does this diagnosis mean and how is it treated?

You can also watch this on YouTube here: https://youtu.be/YnBi1WBzy68

NSIP is a pattern that we can see on a chest CT scan or on a lung biopsy (on the pathology report). What does this mean for you as a patient or someone who cares for someone who has NSIP?

NSIP may be associated with inflammatory conditions affecting the body (i.e. connective tissue diseases, such as rheumatoid arthritis or others) or may occur without a known cause (and we call this situation idiopathic NSIP). We call NSIP fibrotic if there is lung scarring. If there is no fibrosis, sometime this may be referred to as just NSIP or "cellular" NSIP.

Treating NSIP is generally with anti-inflammatory medication as a first line, normally corticosteroids such as prednisolone. Sometimes this may not be enough, or we would want to use a lower dose of prednisolone, so we can introduce immunosuppressants, such as mycophenolate, as a second line. If despite these therapies, the NSIP fibrosis is still getting worse (progressive pulmonary fibrosis), antifibrotic treatments such as nintedanib may be added, in order to stabilize the condition as much as we can.

Obviously, the more treatments we add, the more careful we need to be about side effects. Routine blood monitoring is usually done with your healthcare team, and regular follow-up is essential.

Hope this info helps, although it's unlikely this one video will cover all the nuances in your case. Always check everything with your own healthcare team.

#NSIP #fibrotic #pulmonaryfibrosis

A general overview of hypersensitivity pneumonitis (HP) based on the example from a comment received. We discuss the types of HP: acute, subacute and chronic, pulmonary fibrosis in hypersensitivity pneumonitis.

You can also watch this on YouTube here: https://youtu.be/jlKR6oiAKNs

It is also important to identify the triggers (antigen) for HP and this can be difficult. Sometimes exposure questionnaires may help, and we have blood tests to look for sensitization to birds (pigeon, budgie) or farmer's lung triggers.

Breathlessness in HP is not always due to the pulmonary fibrosis alone so we need to look for other causes as well. Treatment for hypersensitivity pneumonitis aims to first remove the trigger (if identified and possible), followed by anti-inflammatory or immunosuppressant medication if indicated, or antifibrotic ("anti-scarring") treatment to slow down the worsening in the fibrosis if the disease is progressive.

A very complex disease indeed! #hypersensitivity #pneumonitis #ild

It is really important to have more awareness of the risks of developing cardiovascular diseases in patients who have interstitial lung disease / pulmonary fibrosis.

You can also watch this episode on YouTube here: https://youtu.be/sYev_0Uhr2A

Many patients with ILD can develop something called pulmonary hypertension, which is an increased pressure between the right side of the heart and the lungs. This can cause blood oxygen levels to drop significantly and lead to severe breathlessness and other heart complications.

Screening for pulmonary hypertension with an ultrasound scan of the heart (echocardiogram) is really important in most patients who have interstitial lung diseases.

Patients with ILD are also at potentially a higher risk of developing coronary artery disease which increases the risk of heart attacks. Also, they may be at a higher risk of blood clots and pulmonary embolism.

Actively looking for cardiovascular disease is important, as in many cases there are effective medications for many of these conditions. While we may not be able sometimes to completely stop the worsening of the ILD, we may be able to optimize treatments for the heart and vascular diseases, for better long term outcomes and potentially symptom improvement. #cardiovasculardisease #pulmonaryfibrosis #ild

Why would breathing suddenly start to worsen for people who have pulmonary fibrosis? This can be the sign of worsening fibrosis (scarring of the lungs), but often there are some other factors involved (other medical problems).

You can also watch this episode on YouTube here: https://youtu.be/Z93wEslRRX0

Normally, pulmonary fibrosis can be progressive, and in these cases we expect a slow worsening of breathlessness over time (months to years). In some cases, the progression can be fairly quick. Sometimes, there may be flare-ups of the fibrosis (exacerbations) which can be extremely severe (but fortunately are quite rare). Most often, when the breathing gets worse over days-weeks-months, there may be another medical problem that has appeared or worsened. If it's over a few days, most commonly there may be a chest infection (acute bronchitis or pneumonia) that could require antibiotic treatment. If it happens over weeks to months, there may be worsening in the lung inflammation associated with the pulmonary fibrosis (if there is an inflammatory ILD present), or there may be a new heart condition developing (such as heart failure, atrial fibrillation, heart valve problems etc. Sometimes, there may be anemia present.

A lot of other causes of breathlessness may be present, and sometimes there could be overlapping factors. Having regular follow-up with your doctor is essential especially if you are suffering from progressive pulmonary fibrosis. It is very important to look for and treat any other potential conditions which exist at the same time as the pulmonary fibrosis. #pulmonaryfibrosis #ild #breathlessness

What do genetic test results mean in cases of pulmonary fibrosis / interstitial lung diseases (ILD)? How are genetic testing results interpreted?

You can also see this episode on YouTube here: https://youtu.be/jKETy4etrME

OR

Get episode updates and more on X: Interstitial Lung Disease Info (@ILDinfo) / X (twitter.com) Super complex topic in this episode:

• When do we request genetic (genomic) testing for patients with ILD / pulmonary fibrosis?
• Where is genetic testing conducted?
• What tests are normally done for pulmonary fibrosis? (telomere length, telomere-related genes, surfactant-related genes)
• How are abnormal genetic variants identified? Do all variants carry the same risk?
• Gene panels and telomere length measurement
• Why do we need genetic counselling to correctly interpret the results?

#pulmonaryfibrosis #ILD #genetictesting #interstitiallungdisease #genetics