>20 pack years. 2.The disorder is frequent in certain occupations such as silica, asbestos, heavy metals or mouldy foliage. 3.Environmental factors are pigeon breeding and contaminated ventilation systems. 4.Chronic viral infections particularly hepatitis C and Epstein-Barr viruses. 5.Gastro-esophageal reflux disorder Causes The cause and pathogenesis of PF is not known Symptoms When the patient has PF, the lungs become scarred and fibrotic. This makes it difficult for the patient to breathe Symptoms: 1.Chest pain 2.Cough (normally dry) 3.Not as active 4.Shortness of breath Signs: 1.Fine bilateral inspiratory crackles 2.Clubbing of the fingers (25-50%) 3.Normal spirometry or impaired spirometry 4.Pulmonary hypertension: loud P2 of the second heart sound, a fixed split S2, a holosystolic tricuspid regurgitation murmur, ankle edema Diagnosis The diagnosis of pulmonary fibrosis should be thought of in any patient with breathlessness Chest x-ray may show evidence of fibrosis changes Chest CT scan Performing CT scans of the thorax (including high-resolution images - HRCT) may reveal pattern of usual interstitial pneumonia Treatment There is no known cure for PF. Treatment is aimed at relieving symptoms and slowing disease progression: Other treatment are: 1.Encourage tobacco users to quit 2.Prescribe oxygen therapy Surgery Lung transplant (best treatment) Medicine Anti-fibrotic agents (pirfenidone) Tyrosine kinase inhibitors (nintedanib) TABLE OF CONTENT Introduction Chapter 1 Pulmon...
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