What are the symptoms of pulmonary fibrosis?

We should pay attention to understanding the clinical manifestations of interstitial fibrosis so that we can detect and solve the disease in time. Patients usually show progressive shortness of breath or dry cough with little sputum, as well as hypoxemia and difficulty breathing.

1. Clinical manifestations

The onset is insidious and the disease worsens progressively. It manifests as progressive shortness of breath, dry cough with little sputum or a small amount of white sticky sputum, and respiratory failure with hypoxemia as the main feature in the late stage. Physical examination revealed weakened thoracic respiratory movement, and fine moist rales or crackles could be heard in both lungs. There is varying degrees of cyanosis and clubbing. Signs of right heart failure may appear in the late stage.

2. Diagnosis

1. Progressive shortness of breath, cough, moist rales or crackles in the lungs.

2. X-ray examination: ground-glass appearance in the early stage, typical changes include diffuse linear, nodular, cloud-like, reticular shadows, and reduced lung volume.

3. Laboratory examination: ESR and LDH may be elevated, but generally have no special significance.

4. Pulmonary function tests: decreased lung capacity, decreased diffusion capacity and hypoxemia may be seen.

5. Lung biopsy provides pathological evidence. This disease should be differentiated from asthmatic bronchitis.

Laboratory tests show nonspecific changes, which may include accelerated erythrocyte sedimentation rate, increased blood lactate dehydrogenase and increased immunoglobulin G; 10%-26% of patients have positive rheumatoid factor and antinuclear antibodies.

3. Diagnostic Criteria

1.1 Diagnosis criteria 1:

1. Surgical lung biopsy showed histological changes consistent with common interstitial pneumonia.

2. The following conditions must be met at the same time: ① Other known diseases that may cause ILD, such as drug poisoning, occupational environmental exposure, and connective tissue diseases, are excluded; ② Pulmonary function tests show restrictive ventilation dysfunction with decreased diffusion function; ③ Conventional chest X-ray or HRCT shows reticular changes or honeycombing mainly in the lower lungs and subpleural areas, which may be accompanied by a small amount of ground-glass shadows.

(II) Diagnosis criterion 2: When surgical lung biopsy is not available, all four of the following major indicators and three or more minor indicators must be met.

1. Main indicators: ① Exclude ILD with known causes, such as toxic effects of certain drugs, history of occupational exposure and connective tissue diseases; ② Abnormal lung function, including restrictive ventilation dysfunction [decreased vital capacity (VC), while FEV1/FVC is normal or increased] and/or gas exchange disorder; ③ Chest HRCT shows reticular changes or honeycomb lungs mainly distributed in the lower lungs and subpleura, which may be accompanied by a small amount of ground-glass shadows; ④ TBLB or BALF examination does not support the diagnosis of other diseases.