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Detection and Early Referral of Patients With Interstitial Lung Abnormalities : An Expert Survey Initiative

Detection and Early Referral of Patients With Interstitial Lung Abnormalities : An Expert Survey Initiative


Title: Detection and Early Referral of Patients With Interstitial Lung Abnormalities : An Expert Survey Initiative
Author: ILA Study Group
Date: 2022-02-01
Language: English
Scope: 13
Department: Faculty of Medicine
Internal Medicine and Emergency Services
Series: Chest; 161(2)
ISSN: 0012-3692
DOI: https://doi.org/10.1016/j.chest.2021.06.035
Subject: CT; fibrosis; interstitial lung abnormalities; interstitial lung disease; survey; Humans; Radiologists; Male; Tomography, X-Ray Computed; Disease Progression; Pulmonologists; Lung Diseases, Interstitial/diagnostic imaging; Female; Referral and Consultation/statistics & numerical data; Surveys and Questionnaires; Respiratory Function Tests; Early Diagnosis; Critical Care and Intensive Care Medicine; Cardiology and Cardiovascular Medicine; Pulmonary and Respiratory Medicine
URI: https://hdl.handle.net/20.500.11815/3753

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Citation:

ILA Study Group 2022 , ' Detection and Early Referral of Patients With Interstitial Lung Abnormalities : An Expert Survey Initiative ' , Chest , vol. 161 , no. 2 , pp. 470-482 . https://doi.org/10.1016/j.chest.2021.06.035

Abstract:

Background: Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral. Research Question: Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs? Study Design and Methods: Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement. Results: Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System “S-modifier” [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD. Interpretation: Guidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.

Description:

Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. M. H. reports consulting fees from Boehringer Ingelheim, Mitsubishi Chemical, and the Gerson Lehrman Group. J. G. G. reports receipt of consulting fees from Boehringer Ingelheim; and that he is the founder of MedQIA, LLC. J. A. K. reports grants or funds from Boehringer Ingelheim. R. Y. reports consulting fees from Boehringer Ingelheim, Genentech, and Bioclinica. H. M. L. reports employment with Boehringer Ingelheim at the time of the study. T. J. C. reports grants, funds or contracts from Boehringer Ingelheim, Hoffman La Roche, Bristol Myers Squibb, Biogen, Galapagos and Avalyn-Pharma; payment or honoraria from Boehringer Ingelheim and Hoffman La Roche; and participation on a data safety monitoring board or advisory board for Boehringer Ingelheim, Hoffman La Roche, Bristol Myers Squibb and Promedior. J. A. d. A. reports consulting fees from Boehringer Ingelheim and Roche/Genentech. K. A. J. reports honoraria from Boehringer Ingelheim and Hoffmann-La Roche; consulting fees from Boehringer Ingelheim, Theravance, Blade Therapeutics, and Three Lakes Foundation; and grants or funds from the University of Calgary, UCB Biopharma, Calgary Pulmonary Fibrosis Society, and The Chest Foundation. M. R. K. reports advisory council/committee roles for Boehringer Ingelheim, Roche, and Algernon; honoraria from Novartis and AstraZeneca; consulting fees from Pieris and Avalyn; and grants or funds from Boehringer Ingelheim, Pieris, and Patara. D. A. L. reports consulting fees from Parexel Inc, Boehringer Ingelheim Inc, and Veracyte Inc; and a patent (US Patent Office No. 10,706,533 [“Systems and methods for automatic detection and quantification of pathology using dynamic feature classification”]). J. M. O. reports honoraria from Boehringer Ingelheim and Genentech. M. E. S. reports honoraria and consulting fees from Boehringer Ingelheim; and grants or funds from Boehringer Ingelheim, Galapagos, and Novartis. S. T. reports advisory council/committee roles for, honoraria from, and consulting fees from Roche and Boehringer Ingelheim; and grants or funds from Roche. E. S. W. reports employment with Boehringer Ingelheim. G. R. W. reports grant support from Boehringer Ingelheim, as well as honoraria and consulting fees from Boehringer Ingelheim, Pulmonx, Janssen Pharmaceuticals, Novartis, Vertex, and CSL Behring. G. R. W. is a co-founder and equity share holder of Quantitative Imaging Solutions. G. M. H., J. G. G., M. A. K., J. A. K., I. O. R., A. U. W., and R. Y. received funding from Boehringer Ingelheim to conduct this research. The authors received no direct compensation related to the writing of the manuscript. None declared (F. G. A., P. S.). Role of the sponsors: Boehringer Ingelheim Pharmaceuticals Inc, was given the opportunity to review the manuscript for medical and scientific accuracy, and intellectual property considerations. Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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