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. 2019;36(2):108-115.
doi: 10.36141/svdld.v36i2.8107. Epub 2019 May 1.

Multidisciplinary management of interstitial lung diseases: A real-life study

Caroline Biglia  1 , Benoît Ghaye  1 , Gregory Reychler  1   2 , Sandra Koenig  1 , Halil Yildiz  1 , Valérie Lacroix  1 , Farah Tamirou  1 , Delphine Hoton  1 , Thierry Pieters  1 , Antoine Froidure  1   2
Affiliations

Multidisciplinary management of interstitial lung diseases: A real-life study

Caroline Biglia et al. Sarcoidosis Vasc Diffuse Lung Dis. 2019.

Abstract

Background: The guidelines on idiopathic pulmonary fibrosis (IPF) diagnosis established the crucial role of multidisciplinary discussion (MDD) in the diagnosis of interstitial lung diseases (ILD). However, real-life evaluation of MDD remains scarce. Our aim was to study the impact of a well-structured MDD on etiological assessment, diagnosis, and management of ILD.

Methods: We collected and analysed all relevant data on patients concerning diagnosis and treatment before and after MDD during the year 2017.

Results: One hundred fifty patients were included in the analysis. MDD had a significant impact on management: 42% of diagnoses were revised and the number of unclassifiable ILD was significantly reduced. Lung biopsy was performed in 26 patients (12 cryobiopsies and 14 surgical biopsies). The most prevalent diagnoses were connective-tissue disease associated ILD (32%), idiopathic pulmonary fibrosis (23%), hypersensitivity pneumonitis (13%) and granulomatous ILD (7%). MDD led to a change or initiation of treatment in 55% of cases. Nine patients were evaluated for transplantation, 23 patients were screened for academic or sponsored clinical trials and an 8-fold increase in rehabilitation inclusion was observed.

Conclusion: Our results confirm the benefits of MDD on ILD management and diagnosis. MDD also facilitates access to non-pharmacological therapies and clinical trials.

Keywords: interstitial lung diseases; multidisciplinary management.

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Figures

Figure S1.
Figure S1.
Structured form to fill prior to MDD for every patient. Items in blue are mandatory for form validation. Some items are filled with text (i.e. past medical history); others are simply ticked (i.e. smoking status). Biological values are automatically filled from our informatics system. Lung function values can be added in the appropriate box.
Figure S2.
Figure S2.
Schematic view of changes in diagnoses following MDD. The width of the arrows is proportional to the number of patients. As expected, most changes in final diagnosis occurred in the “unclassifiable fibrosis” subgroup
Fig. 1.
Fig. 1.
Proportion of MDD final diagnoses
Fig. 2.
Fig. 2.
Comparison between suspected diagnosis at referral (light grey bars) and final MDD diagnosis (dark grey bars)
Fig. 3.
Fig. 3.
Flowchart describing patients addressed for unclassifiable fibrosis, including interventions leading to a change in diagnosis and the consequences on treatment
Fig. 4.
Fig. 4.
Changes in pharmacological and non-pharmacological treatment in CT-ILD. Light grey bars represent treatment before MDD, dark grey bars correspond to treatment after MDD
See this image and copyright information in PMC

References

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