A comprehensive assessment of environmental exposures and the medical history guides multidisciplinary discussion in interstitial lung disease.
Aged
Autoimmune Diseases
/ complications
Consensus
Environmental Exposure
/ adverse effects
Female
Humans
Interdisciplinary Communication
Lung
/ pathology
Lung Diseases, Interstitial
/ diagnosis
Male
Medical History Taking
Middle Aged
Occupational Exposure
/ adverse effects
Risk Factors
Smoking
/ adverse effects
Tomography, X-Ray Computed
Autoimmune
Hypersensitivity
Idiopathic pulmonary fibrosis
Interstitial lung disease
Multidisciplinary discussion
Occupation
Smoking
Journal
Respiratory medicine
ISSN: 1532-3064
Titre abrégé: Respir Med
Pays: England
ID NLM: 8908438
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
22
11
2020
revised:
24
01
2021
accepted:
04
02
2021
pubmed:
7
3
2021
medline:
30
10
2021
entrez:
6
3
2021
Statut:
ppublish
Résumé
Multidisciplinary discussion (MDD) is widely recommended for patients with interstitial lung disease (ILD), but published primary data from MDD has been scarce, and factors influencing MDD other than chest computed tomography (CT) and lung histopathology interpretations have not been well-described. Single institution MDD of 179 patients with ILD. MDD consensus clinical diagnoses included autoimmune-related ILD, chronic hypersensitivity pneumonitis, smoking-related ILD, idiopathic pulmonary fibrosis, medication-induced ILD, occupation-related ILD, unclassifiable ILD, and a few less common pulmonary disorders. In 168 of 179 patients, one or more environmental exposures or pertinent features of the medical history were identified, including recreational/avocational, residential, and occupational exposures, systemic autoimmune disease, malignancy, medication use, and family history. The MDD process demonstrated the importance of comprehensively assessing these exposures and features, beyond merely noting their presence, for rendering consensus clinical diagnoses. Precise, well-defined chest CT and lung histopathology interpretations were rendered at MDD, including usual interstitial pneumonia, nonspecific interstitial pneumonia, and organizing pneumonia, but these interpretations were associated with a variety of MDD consensus clinical diagnoses, demonstrating their nonspecific nature in many instances. In 77 patients in which MDD consensus diagnosis differed from referring diagnosis, assessment of environmental exposures and medical history was found retrospectively to be the most impactful factor. A comprehensive assessment of environmental exposures and pertinent features of the medical history guided MDD. In addition to rendering consensus clinical diagnoses, MDD presented clinicians with opportunities to initiate environmental remediation, behavior modification, or medication alteration likely to benefit individual patients with ILD.
Sections du résumé
BACKGROUND
Multidisciplinary discussion (MDD) is widely recommended for patients with interstitial lung disease (ILD), but published primary data from MDD has been scarce, and factors influencing MDD other than chest computed tomography (CT) and lung histopathology interpretations have not been well-described.
METHODS
Single institution MDD of 179 patients with ILD.
RESULTS
MDD consensus clinical diagnoses included autoimmune-related ILD, chronic hypersensitivity pneumonitis, smoking-related ILD, idiopathic pulmonary fibrosis, medication-induced ILD, occupation-related ILD, unclassifiable ILD, and a few less common pulmonary disorders. In 168 of 179 patients, one or more environmental exposures or pertinent features of the medical history were identified, including recreational/avocational, residential, and occupational exposures, systemic autoimmune disease, malignancy, medication use, and family history. The MDD process demonstrated the importance of comprehensively assessing these exposures and features, beyond merely noting their presence, for rendering consensus clinical diagnoses. Precise, well-defined chest CT and lung histopathology interpretations were rendered at MDD, including usual interstitial pneumonia, nonspecific interstitial pneumonia, and organizing pneumonia, but these interpretations were associated with a variety of MDD consensus clinical diagnoses, demonstrating their nonspecific nature in many instances. In 77 patients in which MDD consensus diagnosis differed from referring diagnosis, assessment of environmental exposures and medical history was found retrospectively to be the most impactful factor.
CONCLUSIONS
A comprehensive assessment of environmental exposures and pertinent features of the medical history guided MDD. In addition to rendering consensus clinical diagnoses, MDD presented clinicians with opportunities to initiate environmental remediation, behavior modification, or medication alteration likely to benefit individual patients with ILD.
Identifiants
pubmed: 33676119
pii: S0954-6111(21)00039-1
doi: 10.1016/j.rmed.2021.106333
pmc: PMC7992253
mid: NIHMS1680168
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
106333Subventions
Organisme : BLRD VA
ID : I01 BX002499
Pays : United States
Organisme : CSRD VA
ID : I01 CX000101
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126897
Pays : United States
Informations de copyright
Published by Elsevier Ltd.
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