Detailed clinical history

A detailed clinical history may assist in determining the likely cause of ILD (eg drug-induced, occupational exposure, concomitant autoimmune disease).

If ILD is suspected, take a detailed clinical history consisting of the following:

• age—idiopathic pulmonary fibrosis occurs more frequently in older people (typically older than 65 years of age); connective tissue disease–associated interstitial lung disease (CTD–ILD) and sarcoidosis are more common in younger people
• sex—idiopathic pulmonary fibrosis is more common in men, while CTD–ILD is more common in women. Pulmonary lymphangioleiomyomatosis only occurs in women. Most other ILDs are not strongly associated with sex
• family history—ILD occurring in families is increasingly recognised, and may present at a younger age compared to cases without a familial predisposition
• drug history—over 350 drugs have been associated with ILD including amiodarone, leflunomide, methotrexate, nitrofurantoin, and some oncology and immunomodulatory drugs¹
• occupational history—especially exposure to dusts such as coal, asbestos and silica; coal workers, miners and stonemasons are some examples of occupations at risk of developing occupational lung disease
• environment—exposure to birds, compost, manure, spas, and other antigens associated with hypersensitivity pneumonitis
• smoking history—acute eosinophilic pneumonia, respiratory bronchiolitis–ILD and idiopathic pulmonary fibrosis are more common in smokers
• history of connective tissue disease—ILD may be associated with conditions including rheumatoid arthritis, systemic sclerosis and polymyositis
• history of gastro-oesophageal reflux—may cause ILD, as well as acute exacerbations of established ILD
• history of receiving radiotherapy.