Version May 2024
| Tobacco use |
| Do you smoke tobacco now or have you in the past? If yes, how many packs per day and how many years? |
| Respiratory symptoms |
| When did you first notice shortness of breath? What activities make it worse? |
| Do you have a cough or raise phlegm? Any chest pain? |
| Over time, have the symptoms remained stable, varied, worsened? |
| If working, are the symptoms worse at work? |
| Symptoms of rheumatic disease/sarcoidosis |
| Do you have joint pain or inflammation, digital ulcers, dry eyes, dry mouth, fatigue, fever, hair loss, muscle weakness or pain, photosensitivity, Raynaud phenomenon, skin changes such as thickening or telangiectasia? Any new rash, particularly around tattoos or scars? Any palpitations or fainting episodes? Any parotid swelling? |
| Exposures associated with hypersensitivity pneumonitis |
| Do you have pets or birds at home? How about livestock? |
| Any exposure to humidifiers, hot tubs, sauna, Jacuzzi, feather bedding, wind instruments, barns? |
| Any water damage at home or at work? |
| What are your hobbies? Do they involve exposure to dusts, feathers, fur, mold, fumes, or chemicals? |
| Occupational causes of ILD |
| What types of work have you had? Any exposure to animals, stables or barns, mushroom growing, brewery, winery, asbestos, silica, plastics, epoxy, metalworking, spray painting, sandblasting? |
| Medication and radiation-induced lung toxicity |
| What medications do you take? Have you ever taken nitrofurantoin, amiodarone, chemotherapy, or biologic agents? Have you had radiation therapy? If so to what part of the body? |
| Family history |
| Do you have any family history of lung disease, particularly ILD or lung fibrosis? Any history of premature graying, cirrhosis, aplastic anemia, other bone marrow diseases? |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
