Early Experience of a Dedicated Clinical Pathway for Interstitial Lung Abnormalities (ILAs)

Résumé fourni par la source

Abstract RATIONALE Interstitial lung abnormalities (ILAs) are changes identified incidentally on thoracic CT without clinician suspicion of underlying interstitial lung disease (ILD) and are a common radiological finding. In the context of increased detection, there is an urgent need to develop robust and efficient management strategies for ILAs. We have developed a standardised follow-up pathway as part of the Interstitial Lung Abnormality Research Consortium UK (ILARC-UK). This is being piloted in Manchester (UK) as a virtual pathway following assessment in a dedicated ILA clinic. We present the first 12 months experience of this pathway.METHODS Referrals to the tertiary ILD service were offered assessment in the ILA clinic if they were deemed to be an incidental finding. Following assessment, virtual follow up was offered to individuals with an ILA or incidental interstitial changes identified in the context of rheumatoid arthritis (termed RA-ILA). Individuals were excluded from then ILA pathway, and offered traditional follow-up, if they had suspected sarcoidosis, post-Covid interstitial change, or a clinical suspicion of underlying ILD following assessment. The virtual follow-up pathway comprises periodic lung function testing, high resolution CT imaging and symptom questionnaire collection over a 5-year period from initial assessment.RESULTS Between March 2023 to March 2024, 868 referrals were received of which 79 patients were considered suitable for assessment in the ILA clinic. Figure 1 demonstrates the outcome of initial clinical assessment. Amongst 56 individuals with ILA and RA-ILA, 31 (55.4%) were male and mean age was 70.1 (±8.4). 35 (62,5%) were ever smokers. Mean baseline FVC % predicted was 102.3 (SD±17.4) and TLCO % predicted 71.7 (±17.2). Radiological subtypes of ILA were 25 (44.6%) subpleural fibrotic, 28 (50%) subpleural non-fibrotic and 3 (5.4%) non-subpleural non-fibrotic. 33 patients had reached the 6-month follow-up point from initial clinical review. Of those, 27 attend 6-month lung function, 1 patient died during follow-up and 5 did not attend. Mean absolute change in FVC % predicted and TLCO % predicted were -0.6% (±11.9) and -1.0% (±10.5) respectively.CONCLUSIONS We demonstrate the potential utility of a standardised ILA clinical pathway. The service has shown positive patient engagement and good compliance with virtual follow-up within the first twelve months of this new service.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.