How to conduct the first consultation for ILD?

This is the 8th episode of the Interstitial Lung Disease podcast. Today I discuss about how to conduct the first consultation for interstitial lung disease (ILD) patients.

What questions do you ask during the initial consultation?

This is my own personal structure and template, and I cover the points in the podcast below:

1. Chest symptoms and timeline

2. Other relevant systemic symptoms

3. Past medical history

4. Medication history

5. Smoking

6. Occupation and environmental exposures

7. Family history

8. Physical examination

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Collecting all this data can be challenging. In real-life scenarios, it may take 30-60 minutes to obtain the relevant information. While this can be difficult depending on local arrangements, it is quite important to cover these areas at least over several patient visits. This will allow you to select relevant investigations and to give you clues about the potential cause for pulmonary fibrosis.

It is quite important to then bring each case to a multi-disciplinary team (MDT) discussion. While formal ILD MDT’s are not always possible (depending on local resources), at least informal discussions with relevant medical colleagues add a lot of diagnostic confidence. I would recommend discussing any symptoms suggestive of connective tissue disease with a rheumatologist and to seek advice from an experienced radiologist regarding the CT scan patterns of ILD.