ILD are a spectrum of different nosographic entities, that can be differentiated on an etiologic and/or a histopathological ground. Little is known about specific differences in their clinical presentation.
We systematically checked for the presence of dry cough and/or fine crackles our series of 108 ILD patients (pts) affected with : sarcoidosis (Sarc), Wegener granulomatosis (WG), miliary tuberculosis (TB), extrinsic allergic alveolitis (EAA), usual interstitial pneumonia (UIP), non-specific interstitial pnemonia (NSIP) and post-attinic fibrosis (post-RT). All the diagnosis were biopsy-proven, except for TB and post-RT.
Data are reported in the following table.
n. of ptsCrackles % yesCough % yesSarc24013WG14079TB7057EAA10030UIP3410082NSIP133892post-RT61000Dyspnea is not included because it depends on the severity of the lung damage and not on its cause.The different nosographic entities show a quite typical pattern. In particular, crackles significantly differentiated granulomatous (Sarc, WG, TB, EAA) from non-granulomatous (UIP, NSIP, RT) diseases, and UIP from NSIP (X2 : p<0.01). Cough was more prevalent among WG than among Sarc pts (X2 : p<0.01), but not different comparing UIP and NSIP pts (X2 : NS). Interestingly, among 10 pts affected whit systemic sclerosis (not shown as a specific group), histopathologic pattern (5 UIP and 5 NSIP) was predictive of the presence of crackles (100% and 40% respectively, as for the general UIP and NSIP series), within the same etiologic group.
These data demonstrate that crackles and cough show distinctive patterns and turn out to be powerful diagnostic tools in ILD. Since we refer to a population of pts with long lasting ILD, we can not extend these features to early ILD (for differential diagnosis) nor to different phases of ILD clinical evolution.
In addition to imaging and functional tests, clinicians dealing with ILD pts should consider the clinical relevance of cough and crackles, that are simple and inexpensive parameters.
R.G. Carbone, None.