ILD: Diagnostic Considerations and Socioeconomic Barriers

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ILD: Diagnostic Considerations and Socioeconomic Barriers
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Daniel Dilling, MD, FCCP, FACP, FAST

Click to view more from Pulmonology Data Trends 2022.

References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

Publications
CHEST Physician
Author(s)
Daniel Dilling, MD, FCCP, FACP, FAST
Author(s)
Daniel Dilling, MD, FCCP, FACP, FAST

Click to view more from Pulmonology Data Trends 2022.

Click to view more from Pulmonology Data Trends 2022.

References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

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ILD: Diagnostic Considerations and Socioeconomic Barriers
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When navigating the multiple layers of interstitial lung disease (ILD), new American Thoracic Society (ATS) guidelines recommend a diagnostic approach through the lenses of radiologic progression, worsening symptoms, and physiologic progression. An interdisciplinary approach to diagnosis and treatment of patients with ILDs is key for informed decision-making and for optimizing outcomes.1 Also, guidelines presented by CHEST on ILD dive deeper, addressing diagnostic decision-making, evaluation, gaps, challenges, and risk management failures, as they specifically pertain to hypersensitivity pneumonitis.2

Radiologists, pathologists, and pulmonologists look at newer methods of ILD diagnosis–such as transbronchial lung cryobiopsy and genomic classifiers–from a systemic point of view and utilize artificial intelligence to explore new techniques that may be beneficial to patients.3 Additionally, characteristics associated with health disparities, inequities, social determinants, and neighborhood-level disadvantages all affect patients and show clear differences in access to care in the United States.4

Given the nature of ILD, patients may experience disease progression culminating in the need for lung transplantation or in death from their disease.1,4 Ensuring proper care for patients with ILD is an urgent priority for pulmonologists. With further research and, hopefully, with changes to how we approach ILD care in society, our goal is to eradicate these socioeconomic disparities, so patients receive proper diagnosis and care.

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