Diagnosed with Interstitial Lung Disease, Grd Glass Opacity

[Carolyn Merritt, LPN]

I am a 56 year old female with severe Degenerative Disk disease, fibromyalgia and osteoarthritis. I am currently on long-acting morphine for chronic pain management. Yesterday I was told by my pulmonologist, who I was seeing for sleep apnea, that I have Interstitial Lung Disease with diffuse Ground Glass Opacities in the lung. This was after having a cat scan of the lungs done two weeks ago. I am a non-smoker with no history of lung disease in my family. My only symptom is an O2 sat of between 80-92 on room air and shortness of breath on exertion. I have asked the doctor for the cause of this disease and he tends to be vague and not answer my questions. He said RA or Lupus could be causes and this friday he will do a lung wash and biopsy for which he is coming in on his day off to do, saying it is urgent this be done quickly. What he refuses to discuss is whether there is a possibility of lung cancer. I have been researching this disease and everywhere I go it talks about this being a terminal disease with a survival rate of 2-6 years even if it is not a malignancy. If that is incorrect then what is the general prognosis for this type of lung disease? My question is what is the possibility that this could be a malignancy and if it isnt lung cancer, then is there any treatment for this disease that would have a better outcome in survival rate? Is there anything I can do to improve my prognosis. I know you cant diagnose me, but I want someone to be frank and open with me and let me prepare myself for the worst case scenario as well as take steps to improve my chances of survival.
Thanks,
Carolyn

[Dr. Safaa Mahmoud]

Dear CmMerritt,

The pattern of the radiological lung picture, helps the clinician in the diagnosis.

Causes of Ground-glass opacities in the lung include:
Drug-induced lung diseases, worthnoting that morphine is one of these drugs,
Idiopathic nonspecific interstitial pneumonia
Nonspecific interstitial pneumonia secondary to underlying diseases including connective tissue diseases like RA or Lupus.

The presence of diffuse alveolar infiltrates for a period of weeks to months are seen in cases of chronic infection, advanced bronchioloalveolar carcinoma or lymphoma.

Other lung problems can cause the same type of lung opacity include: respiratory bronchiolitis–associated interstitial lung disease, cryptogenic organizing pneumonia, chronic eosinophilic pneumonia and sarcoidosis (LN enalrgement is a mark of this disease).

Diagnostic tests include:
- high-resolution CT scan of the chest
- pulmonary function tests
- measurement of the blood oxygen level at rest or during exertion , as requested by your doctor.
- blood tests to evaluate for connective tissue diseases which is important in your case.
- bronchoscopy and transbronchial biopsy
- surgical lung biopsy if needed


The treatment of the underlying cause is the primary gaol although, anti-inflammatory drugs, such as corticosteroids or immunosuppressing drugs, are usually prescribed. If the underlying disorder, could not be identified or there is no specific therapy, supportive therapy including O2 is indicated.

The prognosis of the disease depend on the underlying cause.

I hope you find this information useful. Keep us updated with the results of the bronchoscopy and biopsy. Identifying the underlying cause is essential for definitive therapeutic approach.

We wish you best of luck,