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Pulmonary Fibrosis (ICD-9 Code 515)The term postinflammatory pulmonary fibrosis (ICD-9 code 515) is used for a group of chronic disabling lung disodiffuse scarring of the lungs. These conditions are often of unknown cause, but may occur after severe lung injury other known causes. The pathogenesis of these illnesses involves initiation and then continuation of an inflammatoexchange regions of the lung, with resulting progressive tissue injury. Involvement of the immunological system ipulmonary fibrosis is evident from the frequent association of these disorders with a variety of autoimmune manifeUpon careful evaluation, some cases of pulmonary fibrosis are found to be a consequence of the inhalation of agencrystalline silica, or organic dusts) found in occupational settings. When a specific agent is recognized as the causterminology for the particular pneumoconiosis (e.g. asbestosis, silicosis) or hypersensitivity pneumonitis (e.g., farmpreferred. However, in their later stages, illnesses caused by various inhaled agents may be difficult to distinguishclinically diagnosed as pulmonary fibrosis. Pulmonary fibrosis of occupational origin may be associated with extrapulmonary manifestations of an immune typsyndrome or scleroderma in silicosis) [Parker and Petsonk 1998]. In addition to hypersensitivity pneumonitis and pneumoconioses, agents that have been associated with pulmonary fibrosis include a variety of silicate minerals anand Petsonk 1996]. In addition, individuals who have experienced a high level inhalation exposure to toxic or irritacute respiratory distress which, in some cases, progresses to bronchiolitis obliterans with pulmonary fibrosis [SchReferencesParker JE, Petsonk EL [1998]. Coal workers’ lung diseases and silicosis. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser Fishman’s pulmonary diseases and disorders, 3rd ed. New York, NY: McGraw-Hill, pp.901-914.Raghu G [1998]. Interstitial lung disease: a clinical overview and general approach. In: Fishman AP, Elias JA, Fishman JA, Grippi Meds. Fishman’s pulmonary diseases and disorders, 3rd ed. New York, NY: McGraw-Hill, pp.1037-1053.Schwartz DA, Blaski CA [1998]. Toxic inhalations. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM, edsdiseases and disorders, 3rd ed. New York, NY: McGraw-Hill, pp.925-940.Short S, Petsonk EL [1996]. Nonfibrous inorganic dusts. In: Harber P, Schenker M, Balmes J, eds. Occupational and environmental Louis, MO: Mosby-Year Book, Inc., pp.345-361.
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Other Alveolar/Interstitial Diseases (ICD-9 Code 516)Alveolar and parietoalveolar pneumonopathy (ICD-9 code 516) is a heterogeneous diagnostic grouping that inclulung conditions, including pulmonary alveolar proteinosis, idiopathic pulmonary hemosiderosis, pulmonary alveolaidiopathic fibrosing alveolitis (e.g., diffuse interstitial pulmonary fibrosis). Overlap with the postinflammatory pulmCode 515) is likely, particularly if the diseases present in their later stages when more specific clinical or pathologilonger be recognizable. Risk factors for most of these conditions are not well understood, although occupational associations have been reinflammatory lung condition has recently been observed among workers producing nylon textile flock [Kern et al. fatal pneumonitis with fibrotic sequelae was caused by a textile printing process in which spraying procedures whihazardous respirable aerosol [Moya et al. 1994]. Fibrosing alveolitis caused by exposure to hard metal dusts has a[De-Capitani et al 1993; Lison et l. 1996]. Diffuse, severe alveolar damage due to inhalation of amitrole-containinreported [Balkisson et al. 1992]. Acute silicosis can resemble pulmonary alveolar proteinosis [Davis 1996]. Unrehypersensitivity pneumonitis, an interstitial lung condition most often caused by inhalation of organic dusts or aeroalveolitis and progress to pulmonary fibrosis [Rose 1996; Malmberg et al. 1993]. ReferencesBalkisson R, Murray D, Hoffstein V [1992]. Alveolar damage due to inhalation of amitrole-containing herbicide. Chest 101(4):1174-Davis GR [1996]. Silica. In: Harber P, Schenker M, Balmes J, eds. Occupational and environmental respiratory disease. St. Louis, Mpp. 373-399. De-Capitani EM, Saldiva PH, Pereira MC [1993]. Hard metal subacute pneumopathy: a case report. In: Hurych J, Lesage M, David Ainternational conference on occupational lung disease, Prague, Czechoslovakia: Czech Medical Society, pp. 1026-1031.Kern DG, Durand KTH, Crausman RS, et al. [1997] Chronic interstitial lung disease in nylon flocking industry workers—Rhode Isla46:897-901.Lison D, Lauwerys R, Demedts M, Nemery B [1996]. Experimental research into the pathogenesis of cobalt/hard metal lung disease. Malmberg P, Rask-Andersen A, Rosenhall L [1993]. Exposure to microorganisms associated with allergic alveolitis and febrile reactiChest. 103:1202-9.Moya C, Anto JM, Taylor AJ [1994]. Outbreak of organizing pneumonia in textile printing sprayers. Lancet 344:498-502.Rose C [1996]. Hypersensitivity pneumonitis. In: Harber P, Schenker M, Balmes J, eds. Occupational and environmental respiratory dMosby-Year Book, Inc., pp. 201-215.
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