Physical examination

Physical signs that may suggest the presence of ILD include:

• fine ‘velcro-like’ crackles on chest auscultation—crackles may also be present with pulmonary oedema or pneumonia (although often with a more acute presentation); more coarse crackles are usually present in bronchiectasis
• ‘squeaks’ or ‘squawks’ (short duration, high-pitched sounds similar to a wheeze) on chest auscultation—may indicate small airways narrowing in hypersensitivity pneumonitis
• clubbing of the fingers or toes—present in a minority of patients (particularly in idiopathic pulmonary fibrosis)
• skin and musculoskeletal signs of connective tissue disease—including Raynaud phenomenon, sclerodactyly, skin rash, telangiectasia, skin thickening, arthritis, arthralgias and myalgias
• other findings such as premature greying of hair can be associated with short telomere syndromes and familial ILD.