Idiopathic pulmonary fibrosis (IPF) is a serious chronic disease that affects the tissue surrounding the air sacs, or alveoli, in your lungs. This condition occurs when that lung tissue becomes thick and stiff for unknown reasons. Over time, these changes can cause permanent scarring in the lungs, called fibrosis, that make it progressively more difficult to breathe.
Your risk for IPF is higher if you smoke or have a family history of IPF, and the risk increases with age. The most common symptoms of IPF are shortness of breath and cough. Some people may not have symptoms at first, but signs and symptoms can develop and get worse as the disease progresses.
The way IPF advances varies from person to person, and scarring may happen slowly or quickly. In some people, the disease stays the same for years. In other people, the condition rapidly declines. Many people with IPF also experience what are known as acute exacerbations, where symptoms suddenly become much more severe. Other complications of IPF include pulmonary hypertension and respiratory failure, which happens when the lungs cannot deliver enough oxygen into the bloodstream without support. This prevents the brain and other organs from getting the oxygen they need.
There is currently no cure for IPF. However, certain medicines may slow the progression of IPF, which may extend the lifespan and improve the quality of life for people who have the disease.
Explore this Health Topic to learn more about IPF, our role in research and clinical trials to improve health, and where to find more information.
Causes – Idiopathic Pulmonary Fibrosis
IPF is a type of interstitial lung disease. It is caused by lung tissue becoming thick and stiff and eventually forming scar tissue within the lungs. The scarring, or fibrosis, seems to result from a cycle of damage and healing that occurs in the lungs. Over time, the healing process stops working correctly and scar tissue forms. What causes these changes in the first place is unknown.
To understand IPF it helps to understand How the Lungs Work. In IPF, the scarring makes it difficult to breathe and deliver oxygen from the lungs to the rest of the body. In healthy lungs, oxygen passes easily through the walls of the air sacs, called alveoli, into your capillaries and bloodstream. However, in IPF, the scarring makes the walls of the alveoli thicker. The thickened walls of the alveoli make it harder for oxygen to pass into the blood.
Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed view of the lung’s airways and air sacs in cross-section. Figure B shows fibrosis, or scarring, in the lungs. The inset image shows a detailed view of the fibrosis and how it changes the structure around the air sacs.
Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen.
Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. In most cases, the cause cannot be found. This is called idiopathic pulmonary fibrosis.
- Shortness of breath
- A dry, hacking cough that doesn’t get better
- Weight loss for no known reason
- Aching muscles and joints
- Clubbing, which is the widening and rounding of the tips of the fingers or toes
Your doctor may use your medical history, imaging tests, a biopsy, and lung function tests to diagnose pulmonary fibrosis. There is no cure. Treatments can help with symptoms and improve your quality of life. They include medicines, oxygen therapy, pulmonary rehabilitation, or a lung transplant.
NIH: National Heart, Lung, and Blood Institute
- Idiopathic Pulmonary Fibrosis(National Heart, Lung, and Blood Institute)
- Introduction to Pulmonary Fibrosis (American Lung Association)
- What Is Pulmonary Fibrosis? (Pulmonary Fibrosis Foundation)
Canon imagePROGRAF iPF Hardware Error 03130031-2F26
Hardware error 03130031-2F26 is a carriage motion error. In this blog, you will learn how to troubleshoot this error. Please be sure to carefully follow the instructions, as any deviation may cause further (potentially expensive) damage.
What The Code Means
Error 2F26 displays a message on the printer that says “Power On Again Carriage Motion Error”.
The longer explanation is “Carriage operation disabled. A PWM duty of 100% has lasted for 200 msec in a carriage operation. A collision has been detected in a carriage operation (with the speed predicted from the PWM output valve having a deviation of 25 ips or more from the actual speed”.
Yea, that one confuses us too, and we are certified technicians.
Here are the actual causes:
- If the motor could not be run at all or has resulted in an error after moving by a slight distance.
- A mechanical load error may be suspected
- The motor or drive circuit may be at fault
- If the carriage has run more or less out of control and resulted in an error, the encoder sensor may be at fault
How To Fix It
Before trying anything, we always recommend lifting the top cover to be sure there are no paper jams, and the carriage is securely in place on the right side of the printer.
Die Lungenfibrose ist eine chronische Erkrankung der Lunge mit dem Leitbefund einer fortschreitenden Fibrose des Lungengewebes. Sie entsteht durch chronische Entzündungsvorgänge des Interstitiums, die zu einem bindegewebigen Umbau des Lungengewebes führen, bei dem die alveolären Membranen mitbetroffen sind.
Man unterscheidet zwischen bekannten und unbekannten Ursachen der Erkrankung.
2.1 Bekannte Ursachen
- Infektionen, z.B. durch Pneumocystis jiroveci, Viren
- Inhalative Noxen
- Anorganische Stäube (z.B. Pneumokoniosen durch Quarz- oder Asbeststaub)
- Organische Stäube (z.B. Exogene allergische Alveolitis (EAA))
- Gase, Dämpfe, Haarspray
- Arzneimittel, z.B. Busulfan, Amiodaron
- Herbizide, z.B. Paraquat
- Ionisierende Strahlen
- Stauungslunge bei Linksherzinsuffizienz
- Fluid Lung
- Akutes Lungenversagen
- Sarkoidose (Morbus Boeck)
- Kollagenosen (u.a. Progressive systemische Sklerodermie)
- Vaskulitiden ( u.a. Wegenersche Granulomatose)
- Chronische Polyarthritis
2.2 Unbekannte Ursachen
Lungenfibrosen unbekannter Ursache werden als idiopathische interstitielle Pneumonien (IIP) bezeichnet. Dazu zählen:
(HRCT oder Histologie)
Idiopathische pulmonale Fibrose (IPF) Gewöhnliche interstitielle Pneumonie (UIP) Idiopathische nicht-spezifische interstitielle Pneumonie (NSIP) Nicht-spezifische interstitielle Pneumonie (NSIP) Respiratorische Bronchiolitis mit interstitieller Lungenerkrankung (RB-ILD) Respiratorische Bronchiolitis (RB) Desquamative interstitielle Pneumonie (DIP) Desquamative interstitielle Pneumonie (DIP) Kryptogene organisierende Pneumonie (COP) Organisierende Pneumonie (OP) Akute interstitielle Pneumonie (AIP) Diffuser Alveolarschaden (DAD)
Die Lungenfibrose ist durch folgende Symptomatik gekennzeichnet:
- evtl. Fieber (Hier erfolgt leicht die Fehldiagnose Pneumonie)
- trockener Reizhusten
Im fortgeschrittenem Stadium:
- Cor pulmonale
- Terminale respiratorische Insuffizienz
Das Endstadium einer Lungenfibrose wird durch die so genannte Wabenlunge markiert.
4.1 Klinische Untersuchung
Bei einer Lungenfibrose lassen sich teilweise klassische Phänomene in der klinischen Untersuchung nachweisen:
- Door-stop-Phänomen: Bei tiefer Inspiration kommt es zum plötzlichen Atmungsstopp.
- Sklerosiphonie: Bei Auskultation lässt sich beidseits ein basales Knisterrasseln in Inspiration nachweisen. Bei fortgeschrittener Fibrose geht das Rasseln in ein so genanntes Korkenreiben über.
- Hochgestellte Lungengrenzen: Durch bindegewebigen Umbau des Parenchyms verlagern sich die Lungengrenzen nach kranial. Dies zeigt sich im Röntgen-Thorax auch in Form von atemunabhängig fixiert hochstehenden Zwerchfellschenkeln.
In der Lungenfunktionsdiagnostik zeigt sich eine restriktive Ventilationsstörung. Die totale Lungenkapazität (TLC) und die Vitalkapazität (VC) sind erniedrigt. Wegweisend ist jedoch ein TLC-Wert von < 80%, da die VC auch bei anderen Erkrankungen erniedrigt ist, so zum Beispiel im Rahmen einer Obstruktion mit Überblähung der Lunge. Auch die Diffusionskapazität sinkt. Daher kommt es im Verlauf zunächst zur partiellen respiratorischen Insuffizienz (Hypoxämie) und im Endstadium zur globalen respiratorischen Insuffizienz (zusätzliche Hyperkapnie).
Kann man bekannte Ursachen ausschließen, erfolgt die Diagnose nach den Diagnosekriterien der IIP (Idiopathische interstitielle Pneumonie) der American Thoracic Society bzw. European Respiratory Society. Dabei müssen alle Hauptkriterien, und 3 von 4 Nebenkriterien erfüllt sein, um die Diagnose IIP zu stellen:
This guideline covers diagnosing and managing idiopathic pulmonary fibrosis in people aged 18 and over. It aims to improve the quality of life for people with idiopathic pulmonary fibrosis by helping healthcare professionals to diagnose the condition and provide effective symptom management.
NICE has produced a COVID-19 rapid guideline on interstitial lung disease. It recommends changes to usual practice to maximise the safety of patients and protect staff from infection during the COVID-19 pandemic.
In May 2017, recommendation 1.5.11 was amended to add a link to the NICE technology appraisal on nintedanib for the treatment of idiopathic pulmonary fibrosis, and two outdated research recommendations were removed.
This guideline includes recommendations on:
Who is it for?
- Healthcare professionals
- Commissioners and providers
- Adults with suspected or diagnosed idiopathic pulmonary fibrosis and their families and carers
Is this guideline up to date?
We checked this guideline in May 2017. We found no new evidence that affects the recommendations in this guideline.
Guideline development process
This guideline was previously called idiopathic pulmonary fibrosis: the diagnosis and management of suspected idiopathic pulmonary fibrosis.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
In ILDs, scarring damages tissues in or around the lungs’ air sacs and airways. The lung interstitium is the space where the air sacs, called alveoli, come in contact with connective tissue and blood vessels to exchange oxygen and carbon dioxide . If you have an ILD, the interstitial tissue becomes thick and stiff, making it harder for oxygen to move out of the lungs and into the bloodstream and for carbon dioxide to move out of the bloodstream and into the lungs. Visit our How the Lungs Work Health Topic to learn more about what happens to the blood in the lungs.
ILDs may be caused by your genes , medicines, or other medical conditions such as sarcoidosis and certain autoimmune disorders. Exposures to substances in the environment can also lead to some types of ILDs, including asbestos-related lung diseases and hypersensitivity pneumonitis. For some ILDs, such as idiopathic pulmonary fibrosis, the cause of the scarring is unknown. Childhood ILDs can have the same or different causes as ILDs in adults.
signs and symptoms may include dry cough, shortness of breath, chest discomfort, and Fatigue . Pulmonologists and other doctors and nurses who specialize in lung disease may diagnose an ILD based on your medical and family histories and results from diagnostic tests and imaging procedures, including pulmonary function tests and a chest CT (computed tomography) scan.
ILDs can be mild or severe, and the amount of scarring can get worse over time. Depending on which ILD you have and how severe it is, your doctor may recommend avoiding environmental exposures if they trigger your condition. Alternatively, your doctor may recommend treating your condition and symptoms with medicines, pulmonary rehabilitation, oxygen therapy, or a lung transplant. Untreated ILDs can lead to complications such as growth problems in children, venous thromboembolism, lung cancer, pulmonary hypertension, heart failure, and respiratory failure.
Scarring in the lungs is often permanent, but early diagnosis and treatment can help slow or stop the scarring. Your medical team can help you learn how to manage your condition to improve your quality of life.
Visit Interstitial Lung Diseases for more information about this topic.
Research for Your Health
The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders including interstitial lung diseases (ILDs). Learn about current and future NHLBI efforts to improve health through research and scientific discovery.
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have an interstitial lung disease. Research on this topic is part of the NHLBI’s broader commitment to advancing scientific discovery on lung diseases.
- The NHLBI Stimulates New Treatment Approaches for Lung Disease. The Centers for Advanced Diagnostics and Experimental Therapeutics in Lung Diseases (CADET) program stimulates the development of new treatments for lung diseases and sleep disorders. The first stage, CADET I, supported research on how lung diseases develop. The second stage, CADET II, is funding research on new drugs. For information on CADET research on ILDs, visit NHLBI Supports CADET Researchers to Produce New Pulmonary Disease Drugs.
- Advancing the Understanding of Lung Development. The Molecular Atlas of Lung Development Program (LungMAP) is building a molecular map of the developing lungs in humans and mice. The program is helping advance lung research, in part through its Web-based data resource, called BREATH, that allows users to access LungMAP data and findings.
- Supporting Research Collaboration. The Pulmonary Trials Cooperative brings together patients, researchers, and healthcare professionals from more than 50 institutions, with a common goal of developing new treatments and testing current clinical care practices for ILDs and other lung diseases.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
- Outlining a research agenda for preventing ILD. In 2013, the NHLBI held a workshop to discuss the latest research on ILD and other chronic lung diseases and to identify key issues and gaps in knowledge. Workshop participants developed and presented a strategy for supporting research to promote lung health and prevent lung diseases. Visit Prevention of Chronic Lung Diseases for more information.
- A diabetes drug that may help treat lung fibrosis. Research partially supported by the NHLBI recently found that the medicine metformin, which is already approved to treat type 2 diabetes, has the potential to help treat progressive lung fibrosis. Visit Diabetes drug could treat lung fibrosis for more information.
- Determining which medicines are beneficial for scleroderma-associated ILD. Oral cyclophosphamide (CYC) helps improve lung function in scleroderma-related ILD, but it can be tolerated for only a year, because the medicine is toxic, and the beneficial effect quickly wears off. NHLBI-supported research tested another medicine, mycophenolate mofetil (MMF), and found that MMF was just as effective and was easier for patients to tolerate without feeling sick.
- NHLBI workshop on aging and lung disease biology. The Division of Lung Diseases held a workshop in 2015 to discuss the intersection of aging and lung biology, including why cellular aging is linked with idiopathic pulmonary fibrosis (IPF). Participants identified research directions to advance our understanding and management of aging-related lung diseases, such as developing new animal models of IPF. Visit NHLBI Workshop on Intersection between Aging Biology and Pathobiology of Lung Diseases for more information.
In support of our mission, we are committed to advancing interstitial lung disease research in part through the following ways.
- We perform research. Our Division of Intramural Research, which includes investigators from the Pulmonary Branch, performs research on interstitial lung diseases.
- We fund research. The research we fund today will help improve our future health. Our Division of Lung Diseases oversees much of the research on interstitial lung diseases we fund, helping us understand and manage the conditions. Search the NIH RePORTer to learn about research the NHLBI is funding on interstitial lung diseases.
- We stimulate high-impact research. Our Trans-Omics for Precision Medicine (TOPMed) program includes participants who have sarcoidosis or idiopathic pulmonary fibrosis, two types of ILDs, which may help us understand how genes contribute to differences in disease severity and how patients respond to treatment. The NHLBI Strategic Vision highlights ways we may support research over the next decade.
Learn about exciting research areas the NHLBI is exploring about interstitial lung diseases.
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A GP can refer you to hospital specialists for a number of tests to help rule out other conditions and confirm the diagnosis.
Medical history and examination
Your doctor will ask about your medical history and whether there are other factors that could be causing a problem with your lungs, such as whether you:
- smoke or have smoked in the past
- have been exposed to harmful substances at work, such as asbestos
- have other medical conditions
- check the sound of your breathing through a stethoscope – a crackling sound can suggest lung scarring (fibrosis)
- look at your fingers to see if the ends are swollen (finger clubbing)
- ask you to walk around for a few minutes to see if you become breathless
Breathing and blood tests
Lung function tests (also called pulmonary function tests) assess how well your lungs work and can help indicate what the problem may be.
These tests measure:
- how quickly you can move air in and out of your lungs
- how much air your lungs can hold
- how well your lungs transfer oxygen into your blood and remove carbon dioxide from it (this can be checked using a blood test)
A commonly used lung function test is spirometry. During the test, you breathe into a mouthpiece that’s attached to a monitor.
Chest X-ray and CT scan
A chest X-ray does not show the lungs in much detail, but can help doctors spot some more obvious problems that could be causing your symptoms, such as cancer or a build-up of fluid.
If IPF is suspected, the chest X-ray will be followed by a CT scan.
A CT scan is similar to an X-ray, but lots more images are taken and these are put together by a computer to create a more detailed image of your lungs.
This can help your doctor spot signs of scarring in your lungs.
If doctors are still not sure what the problem is after these tests, they may suggest having a bronchoscopy.
This is a test where a narrow, flexible tube with a camera (bronchoscope) is passed down into your airways.
Your doctor will look for anything abnormal and may take small tissue samples for testing.
You’ll usually be awake during a bronchoscopy and it may cause coughing.
Local anaesthetic will be used to numb your throat so it does not hurt, and you may also be given a sedative injection that’ll make you feel sleepy during the procedure.
If other tests are not conclusive, a lung biopsy may need to be carried out.
This involves keyhole surgery to remove a small sample of lung tissue so it can be analysed for signs of scarring.
This is performed under a general anaesthetic, where you’re asleep.
Your surgeon makes several small cuts in your side and an endoscope, a thin tube with a camera and a light at the end, is inserted into the area between the lungs and the chest wall.
The surgeon can see the lung tissue through the endoscope and is able to obtain a small sample.
In de longen geeft het bloed dat terugkomt van de organen koolstofdioxide af en neemt het zuurstof op. De longen zorgen ervoor dat dit proces goed kan verlopen door het zuurstof dat we inademen op te nemen en ons het koolstofdioxide uit te laten ademen. Zij zorgen dus voor de gaswisseling. Deze gaswisseling vindt plaats in de longblaasjes (de alveoli).
Als door het ziekteproces het interstitium dikker wordt, dan raakt die gasuitwisseling verstoord en wordt het steeds moeilijker om zuurstof op te nemen. De patiënt wordt daardoor toenemend benauwd.
De afkorting van interstitiële longziekten is ILD, dat is afgeleid van Interstitial Lung Disease. De oorzaak van de meeste ILD is onbekend. Bekende oorzaken zijn:
Op deze pagina snel naar
Meer over interstitiële longziekten
- aangeboren afwijkingen;
- contact met (giftige) stoffen.
In ons centrum werken verschillende specialismen samen om:
- de juiste diagnose te stellen bij mensen die misschien een ILD hebben en
- de beste behandeling en begeleiding te geven aan mensen met een ILD.
Zo zijn er geregeld multidisciplinaire overleggen (MDO’s), waarbij al deze verschillende behandelaars aanschuiven. Buiten deze MDO’s om is er ook regelmatig contact tussen de verschillende behandelaars. Wanneer er veel behandelaars bij een patiënt betrokken zijn, is een goede communicatie, korte lijnen en samenwerking immers van groot belang.
Wetenschappelijk onderzoek onmisbaar voor vooruitgang!
Naast hoogwaardige patiëntenzorg, is het ILD Expertisecentrum wereldwijd bekend door wetenschappelijk onderzoek (sarcoïdose, Longfibrose, IPF en overige ILD.
Met als doel: Voorkomen en genezen van ILD.
Om dit te bereiken doen we onderzoek naar de oorzaak, het ziekteproces en het ziektebeloop en behandeling van ILD. Met meer kennis kunnen we de diagnose, behandeling en informatievoorziening verbeteren. Door onderzoek met wereldwijde samenwerking kunnen we mogelijk aangrijpingspunten vinden voor nieuwe medicijnen.
Bij ILD kunnen allerlei klachten optreden. Kortademigheid, vooral bij inspanning komt het meest voor. Daarnaast kunnen vermoeiheidsklachten, hoesten, verminderde conditie, pijn, en nog vele andere klachten optreden. Dit is mede afhankelijk van het type ILD.
Enkele voorbeelden van ILD zijn:
Om de juiste diagnose te stellen zijn bij interstitiële longziekten vaak meerdere onderzoeken nodig. Veel voorkomende onderzoeken zijn bloedonderzoek, een longfoto en weefselonderzoek. Soms zijn aanvullende onderzoeken nodig.
Hydrogen Peroxide is a popular home remedy with many uses! It is typically purchased at local pharmacies, chemists, grocery stores or markets.
In the United States a 3% solution of hydrogen peroxide is sold in a brown bottle. It is commonly used to clean mild wounds or as an mouth rinse.
Do not use a stronger concentration of hydrogen peroxide in the mouth or on the skin. 35% hydrogen peroxide (commonly called “food grade hydrogen peroxide,”) can burn the skin or mouth and care must be taken when diluting.
For sensitive individuals, 3% hydrogen peroxide may need to be further diluted. To make 1 ½ % hydrogen peroxide, mix equal parts of 3% hydrogen peroxide with distilled water.
If 3% hydrogen peroxide is called for, it is not necessary to dilute what comes in the brown bottle of 3% any further; it is already diluted to 3%. If you have a higher percentage of hydrogen peroxide that needs to be diluted, consult the information below to dilute the solution to 3%.
When diluting hydrogen peroxide, always mix it with distilled water. Impurities in tap water or other waters could affect the final solution, which is why distilled water is called for.
How to Dilute 35% Hydrogen Peroxide to 3% Hydrogen Peroxide
- Mix 1 part 35% hydrogen peroxide with 11 parts distilled water.
- In other words – 1 tablespoon 35% hydrogen peroxide plus 11 tablespoons distilled water.
- Or 1 cup 35% hydrogen peroxide plus 11 cups distilled water.
To be exact, this will make a slightly less than 3% solution of hydrogen peroxide – 2.92%.
How to Dilute 20% Hydrogen Peroxide to 3% Hydrogen Peroxide
- Mix 1 part 20% hydrogen peroxide with 5.5 parts distilled water.
- Or 1 cup 20% hydrogen peroxide with 5.5 cups distilled water.
- Or 1 tablespoon 20% hydrogen peroxide with 5.5 tablespoons distilled water.
How to Dilute 17% Hydrogen Peroxide to 3% Hydrogen Peroxide
- Mix 1 part 17% hydrogen peroxide with 5 parts distilled water.
- Or 1 cup 17% hydrogen peroxide with 5 cups distilled water.
- Or 1 tablespoon 17% hydrogen peroxide with 5 tablespoons distilled water.
To be exact, this will make a slightly less than 3% solution of hydrogen peroxide – 2.83%.
How to Dilute 12% Hydrogen Peroxide to 3% Hydrogen Peroxide
- Mix 1 part 12% hydrogen peroxide with 3 parts distilled water.
- Or 1 cup 12% hydrogen peroxide with 3 cups distilled water.
- Or 1 tablespoon 12% hydrogen peroxide with 3 tablespoons distilled water.
This will make exactly a 3% solution of hydrogen peroxide.
This will make a solution that is slightly above 3% – It will be 3.08% hydrogen peroxide.
The Epworth Sleepiness Scale is used to diagnose obstructive sleep apnoea (OSA).
If you suspect you might have OSA, answer the following questions and take your answers to your GP.
Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations, in comparison to feeling just tired? This refers to your usual way of life in recent times.
Even if you haven’t done some of these things recently, try to work out how they would have affected you.
Use the following scale to choose the most appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
It’s important that you answer each question as best you can.
What does my score mean?
Talk to your GP about your circumstances. Scores can be interpreted as follows:
- 0-5 lower normal daytime sleepiness
- 6-10 normal daytime sleepiness
- 11-12 mild excessive daytime symptoms
- 13-15 moderate excessive daytime symptoms
- 16-24 severe excessive daytime symptoms
It may be useful to print this page to show your GP.
Reference: Dr Johns’ personal website about the ESS. Available at: http://epworthsleepinessscale.com/about-the-ess/. Accessed November 21, 2011
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Last medically reviewed: February 2019. Due for review: February 2022
This information uses the best available medical evidence and was produced with the support of people living with lung conditions. Find out how we produce our information. If you’d like to see our references get in touch.
A doctor can often diagnose pneumonia based on the symptoms and by examining your chest. But you may need to have a chest X-ray to confirm that you have it.
Sometimes it can be difficult to tell whether you have pneumonia or another kind of chest infection. If it’s not clear, your GP may do a blood test or take a sputum sample to help decide if you need antibiotics.
How is pneumonia treated?
Pneumonia can be serious so it’s important to get treatment quickly. The main treatment for pneumonia is antibiotics, along with rest and drinking plenty of water. If you have chest pain, you can take pain killers such as paracetamol.
Treatment depends on how severe your pneumonia is. Treatment with antibiotics should be started as soon as possible after diagnosis. If you’re admitted to hospital, this should be within 4 hours of admission.
If you have mild pneumonia, you may be able to manage it at home with treatment from your GP, especially if you have support from family and friends. Your GP will prescribe a 5-day course of antibiotics, which you’ll probably take as tablets. If you don’t start to feel better after 3 days, tell your GP – you may need a longer course of antibiotics.
More severe pneumonia
Some people are too ill to be treated at home and need to go to hospital.
If you’re too ill to drink and take tablets, you can have fluids and antibiotics through a drip in your arm. You’ll also be given oxygen if you need it, and the hospital staff can regularly check your temperature and breathing.
You’ll usually be given 2 different kinds of antibiotics at the same time, usually for 5 to 7 days but possibly up to 10 days. But you won’t necessarily have to stay in hospital that long.
People who are in hospital for other medical problems and then develop pneumonia have a high risk of becoming very ill. They may need different, more powerful antibiotics.
It’s very important to finish your full course of antibiotics – don’t stop taking your antibiotics before the end of the course, even if you start to feel better.
Complications caused by pneumonia
Pneumonia can sometimes have complications. They include:
- pleurisy – where the pleura, the thin linings between your lungs and ribcage, become inflamed, leading to chest pain. If you have pleurisy, you are more likely to develop fluid on the lungs.
- fluid on the lungs – about 1 in 10 people with pneumonia develop fluid around the lung, called a pleural effusion which can become infected. This may require a sample of the fluid to be taken by inserting a needle between the ribs under local anaesthetic, and if infected is likely to need a longer course of antibiotics. Occasionally, a tube is inserted into the lung to remove fluid as well. – a rare complication that’s mostly seen in people with a serious pre-existing illness or history of alcohol misuse. – this is where infection spreads from the lungs to the blood stream. This can cause low blood pressure and a severe illness that might need intensive care treatment.
- respiratory failure – this is where pneumonia causes low levels of oxygen in the blood even in people given oxygen. This might also require intensive care treatment.
The vast majority of people recover from pneumonia and return to good health. However, pneumonia can be very serious and some people with severe pneumonia don’t survive, despite the best available care. Those who are elderly or have other health problems are most at risk of severe or fatal pneumonia.
Next: recovering from pneumonia >
Last medically reviewed: October 2019. Due for review: October 2022
This information uses the best available medical evidence and was produced with the support of people living with lung conditions. Find out how we produce our information. If you’d like to see our references get in touch.
Diffuse interstitial (in-tur-STISH-ul) lung disease refers to a large group of lung disorders that affect the interstitium, which is the connective tissue that forms the support structure of the alveoli (air sacs) of the lungs. Normally when you inhale, the air sacs fill with air and oxygen passes into the blood stream. When you exhale, carbon dioxide that passed from the blood into the air sacs is expelled from the body. When interstitial lung disease is present, the lung is inflamed and stiff, preventing the air sacs from fully expanding. This limits both the delivery of oxygen to the blood stream and the removal of carbon dioxide from the body. As the disease progresses, the interstitium thickens, which further impedes lung function.
Blood tests, pulmonary function tests (spirometry), pulse oximetry, chest x-ray, chest CT, bronchoscopy with biopsy, surgical biopsy, or a combination of the above may be performed to help diagnose your condition. Treatment may depend on the underlying cause of the disease and your health status. Medication, respiratory therapy or surgery may be prescribed to help improve lung function.
What is diffuse interstitial lung disease?
It may also be caused by exposure to drugs, such as:
- chemotherapy agents
- antiarrythmics (used to treat irregular heart rhythm)
- statins (used to lower cholesterol levels)
It may also stem from the inhalation of substances, such as
- animal proteins
Interstitial lung disease related to the inhalation of cigarette smoke can occur as a spectrum of injury that includes respiratory bronchiolitis-interstitial lung disease and desquamative interstitial pneumonia.
In some cases, interstitial lung disease may be associated with a collection of inflammatory cells (granuloma), as is seen in sarcoidosis. Other interstitial lung diseases associated with inflammation include idiopathic pulmonary fibrosis (IPF), usual interstitial pneumonia (UIP), acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP), and non-specific interstitial pneumonia (NSIP). Occasionally, interstitial lung disease is associated with a familial cause or specific genetic disease. Although there are many causes of interstitial lung disease, in some cases, the cause cannot be determined.
The most common symptoms of diffuse interstitial lung disease are shortness of breath and dry cough. As the disease progresses, a patient may experience weight loss, muscle and joint pain, and fatigue. At a more advanced stage, an individual may develop an enlarged heart, enlargement of the fingertips top of page
How is diffuse interstitial lung disease diagnosed and evaluated?
To determine the cause of interstitial lung disease, a physician may perform a physical examination and order diagnostic tests, including:
Blood tests: These tests may help identify autoimmune diseases, such as scleroderma and rheumatoid arthritis, which can be associated with interstitial lung disease. : The patterns of lung damage associated with various interstitial lung diseases are often identifiable on chest x-rays. Chest x-rays may also be used to track the progression of interstitial lung disease. See Radiation Dose in X-ray and CT Exams for more information about x-rays. : Computed tomography (CT), including a specific technique known as high resolution CT, is used to see fine detail of the interstitium that may not be visible on a chest x-ray. In some cases, a specific diagnosis (such as idiopathic pulmonary fibrosis) can be confirmed based on the CT appearance, potentially avoiding the need for lung biopsy. A CT scan can also often help determine the extent of damage to the lungs, guide biopsy when needed, and help determine appropriate treatment(s). See Radiation Dose in X-ray and CT Exams for more information about x-rays.
How is diffuse interstitial lung disease treated?
Treatment depends on the cause of the interstitial lung disease and the overall health of the patient. Various drugs may be prescribed to reduce inflammation in the lungs and/or to suppress the immune system.