Time Lost Is Lung Lost

Experts in pulmonary and primary care medicine come together to reduce delays in diagnosing complex lung diseases. 

Affecting around 400,000 people in the United States, interstitial lung diseases (ILDs) like pulmonary fibrosis (PF) present with symptoms that are similar to other more common lung diseases, frequently resulting in misdiagnosis or delayed diagnosis. Some studies show that reaching a proper diagnosis for rarer lung diseases can take upwards of several years.

In this time, conditions like PF that cause the lung tissue to become scarred and stiff, reducing its size and capacity, can cause irreparable damage. The scarring with PF cannot be reversed or repaired, and there is no known cure. Currently, approximately 30,000 to 40,000 patients are diagnosed with PF each year, while another 40,000 lose their lives to the disease annually.

To address the issue of delayed diagnosis or misdiagnosis, the American College of Chest Physicians (CHEST) and Three Lakes Foundation assembled a steering committee of primary care and pulmonary experts to come together over a shared goal of improved patient care and quality of life.

“While interstitial lung diseases do not affect a substantial amount of the population, those touched by the disease are impacted tremendously,” says steering committee member and pulmonologist Andrew H. Limper, MD, FCCP. “Any delay in receiving a diagnosis is time that could be dedicated to finding a treatment therapy that can improve their quality of life and reduce overall fibrosing of the lungs.”

Working collaboratively, the steering committee for the initiative, Bridging Specialties™: Timely Diagnosis for ILD, created a clinician toolkit  that aims to close the gaps in diagnosis by helping clinicians more quickly identify the potential indicators of ILDs.

Included in the toolkit:

• Patient questionnaire
  An ILD-specific patient questionnaire focusing on past and current medications, surgeries, occupational and environmental exposures and known comorbidities.
• Decision-making module
  An interactive module looking at three patients presenting with differing signs and symptoms that could be indicative of ILDs. The module includes actions to take, including completing a physical exam, ordering testing and making the determination to provide treatment or refer to a specialist.
• e-Learning modules
  e-Learning modules on symptoms of ILD, including the sound of crackles on auscultation that is commonly heard at the bottom of the lungs in patients with these rare diseases.
• Expert radiology review videos
  Videos exploring radiologic features of ILDs that provide clues of what a clinician should look for when reviewing a radiograph. The videos cover key patterns, common CT appearances and imaging features that can help in diagnosis.

“Having experts from both pulmonary and primary care medicine as members of the steering committee was critical,” says steering committee member and family medicine physician William Lago, MD. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”

To learn more about the Bridging Specialties™: Timely Diagnosis for ILD initiative and the clinician toolkit, visit the CHEST website.