Diagnosing DIRD

1

Drug and radiation history

Careful history taking is essential and should include Any therapy drugs even if taken for years or discontinued days-to-years before OTC medications Drugs kept at home from a former or remote prescription Street, illicit and 'Internet' or recreational drugs Radiation therapy to the chest, breast, spine or injected upstream from the lung Any substance (environmental, occupational, household)

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment