Clinical Topics

Detailed Medical History Crucial for Lung Disease Diagnosis

by U.S. Medicine

January 21, 2019

BALTIMORE, MD–Both general medicine physicians and specialists can find interstitial lung disease (ILD) and pulmonary fibrosis confusing, according to a recent study.

A report in the Journal of Clinical Medicine notes the wide array of inflammatory and fibrotic lung diseases, pointing out, “In addition to the myriad of clinical and radiologic nomenclature used in ILD, histopathologic descriptors may be particularly confusing, and are often extrapolated to radiologic imaging patterns which may further add to the confusion.”1

To help, study authors from the Baltimore VAMC and the University of Maryland School of Medicine suggested that clinicians not focus on precise histologic findings but instead seek to identify an accurate etiology of ILD through a comprehensive and detailed medical history.

“Histopathologic patterns from lung biopsy should not be dismissed, but are often nonspecific, and overall treatment strategy and prognosis are likely to be determined more by the specific etiology of ILD rather than any particular histologic pattern,” the study team noted.

In a review, the authors do the following:

  • outline a practical approach to common ILDs,
  • highlight important aspects in obtaining an exposure history, and
  • clarify terminology and nomenclature.

The article also discusses six common subgroups of ILD likely to be encountered by general medicine physicians in the inpatient or outpatient setting, including smoking-related, hypersensitivity pneumonitis, connective tissue disease-related, occupation-related, medication-induced, and idiopathic pulmonary fibrosis.

Researchers cautioned that, to reach accurate diagnosis of these forms of ILD, healthcare professionals must supplement the medical history with results of the physical examination, autoimmune serologic testing, and chest radiographic imaging.

At the same time, the authors added that “the importance of a comprehensive environmental, avocational, occupational, and medication-use history cannot be overstated and is likely the single most important factor responsible for achieving the best possible outcomes for patients.”

1. Kalchiem-Dekel O, Galvin JR, Burke AP, Atamas SP, Todd NW. Interstitial Lung Disease and Pulmonary Fibrosis: A Practical Approach for General Medicine Physicians with Focus on the Medical History. J Clin Med. 2018 Nov 24;7(12). pii:

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