Multidisciplinary Discussion Benefits Diagnosis, Management of ILD, Study Finds

Implementing a multidisciplinary discussion (MDD) has positive implications for both the diagnosis and management of interstitial lung disease (ILD), according to a recent retrospective observational study published in Canadian Respiratory Journal.​

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While expert MDD is considered the reference standard for ILD diagnosis, there remains concerns over the lack of validation and relatively limited information on the impact of the strategy in real-life clinical practice.

In the current study, leveraging MDD in the diagnosis ILD allowed researchers to not only offer patients a specific diagnosis in more than half (62%) of the 126 patients, the strategy also resulted in a new diagnosis or altered pre-existing diagnosis in 37% of cases, including 22 that were given an ILD-not otherwise specified (ILD-NOS) diagnosis based on MDD.

Finding that the overall agreement for specific pre-MDD and MDD diagnosis was 41%, the researchers explained,“Our results, corroborating previous studies that showed change in diagnosis following MDD in 40%-53% of cases, emphasize the importance of expert review and of an integrated radiological and clinical approach in patients with chronic ILD.”

The highest concordance was seen among IPF (81%) diagnoses, the most common diagnosis made by referring physicians. Meanwhile, the concordance rate for hypersensitivity pneumonitis (HP) was low.

While a significant amount of patients referred to MDD had ILD not specified, 74 (54%) patients had a specific pre-MDD ILD diagnosis, most of which were IPF (idiopathic pulmonary fibrosis) (32%) and HP (27%).

When it came to the management of patients, MDD continued to reap benefits; the strategy altered management of the disease in 39% of cases, mostly initiation of medical therapy (30/50). There were 6 cases in which MDD resulted in a change or stop to medical treatment that was deemed inappropriate, including 1 case of a patient being treated with an immunosuppressant who had no clinical or radiological evidence of ILD based on MDD.

“While comprising a relatively small proportion of patients, the implication of this in an individual case cannot be underestimated. It often affected management even when diagnosis even when diagnosis remained the same and for cases deemed unclassifiable after initial MDD,” noted the researchers. “Interestingly, even for cases with concordant pre-MDD and MDD diagnoses, management was altered in a considerable portion (46%) of patients emphasizing the central role of expert opinion not only for diagnosis but for institution of appropriate treatment, remarkably antifibrotic drugs for IPF and immunosuppressive/anti-inflammatory therapy for non-IPF ILD.”

There were 21 patients who continued their treatment that was initiated before MDD, 5 of which were on antifibrotic therapy and 16 of which were on an immunosuppressant.

Reference

Ageely G, Souza C, Boer K, et al. The impact of multidisciplinary discussion (MDD) in the diagnosis and management of fibrotic interstitial lung diseases. Can Respir J. Published online August 15, 2020. doi:10.1155/2020/9026171