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Toxicologic Pathology
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Articles

Environmental, Inhaled and Ingested Causes of Pulmonary Fibrosis

Nasreen Khalil1, Andrew Churg2, Nestor Muller3 and Robert O’Connor2

1 Department of Medicine, Respiratory Division, Vancouver General Hospital, V5Z 1M9, and The University of British Columbia, V6T 1Z4, Canada
2 Department of Pathology, Vancouver General Hospital, V5Z 1M9, and The University of British Columbia, V6T 1Z4, Canada
3 Department of Radiology, Vancouver General Hospital, V5Z 1M9, and The University of British Columbia, V6T 1Z4, Canada

Correspondence: Address correspondence to: Nasreen Khalil, Clinical Professor of Medicine, Respiratory Division, The University of British Columbia, Jack Bell Research Centre, 2660 Oak Street, Room 350, Vancouver, BC, V6H 3Z6; e-mail:nkhalil{at}interchange.ubc.ca

Pulmonary fibrosis is a general term that refers to a collection of connective tissue around alveolar structures. There are over 200 disorders where the lungs may be involved in a fibrotic response. To determine the cause of pulmonary fibrosis requires an in depth understanding of the pathogenesis of pulmonary fibrosis and breadth of knowledge of the causative agents and associated disorders that may lead to pulmonary fibrosis. A comprehensive evaluation of the patient is absolutely essential, starting with detailed history that includes an occupational and environmental history because fibrogenic exposures can occur in many settings. Equally important is a history of ingestion of pharmaceutical or nonpharmaceutical substances. A physical examination and judicious investigations are always a part of any comprehensive clinical assessment but they are not commonly helpful in elucidating the cause of most pulmonary fibrotic disorders. Although, a chest film is invariably done, a logical and strongly recommended next step is a high-resolution computed tomography (HRCT). HRCT provides a better assessment of the radiological pattern, may suggest a diagnosis as well as direct the site, and type of lung biopsy. If the history and investigations do not lead to a diagnosis then a lung biopsy is required. Prevention or removal of the inciting agent is critical to the treatment of these disorders and in some instances corticosteroids may be of help.

Key Words: Pulmonary fibrosis • hypersensitivity pneumonitis • pneumoconiosis • berylliosis • silicosis • coal workers pneumoconiosis • asbestosis • drug-induced lung disease

Toxicologic Pathology, Vol. 35, No. 1, 86-96 (2007)
DOI: 10.1080/01926230601064787
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