Last reviewed 05/2019

The investigations of fibrosing alveolitis should include:

  • chest radiology
  • blood tests:
    • ESR usually raised
    • anti-nuclear factor positive in about 45%
    • rheumatoid factor in about 35% of patients - there is an association with rheumatoid arthritis
    • increased gamma-globulin
  • CT is sensitive for the diagnosis and monitoring of pulmonary fibrosis
  • bronchoscopy and bronchoalveolar lavage:
    • neutrophils and/or eosinophils are increased
    • lymphocytes may also be raised (may be suggestive of favourable treatment response)
  • pulmonary function tests:
    • restrictive defect
    • lung volumes reduced
    • lung compliance reduced
    • blood gases are normal until advanced disease when there may be arterial hypoxaemia and hypocapnia
    • transfer factor is characteristically reduced

Transbronchial or open lung biopsy allows histological analysis. This is not often indicated because of the sensitivity of diagnosis via CT scan