Tutorial presented by Professor Ben Hope-Gill, Respiratory Consultant.
In this tutorial, Ben outlines a structured approach to a consultation with a patient with ILD. Patients with ILD typically deteriorate over time, and although they are usually managed by specialist secondary care teams, there is a lot that can be done to support them in the community.
- Symptom management is important, and patients with ILD typically struggle with worsening breathlessness, cough and fatigue.
- Patients with ILD are at increased risk of lung cancer, so it’s important to check for red flag symptoms such as haemoptysis or chest pain.
- With disease progression, patients are more at risk of right-sided heart failure, so assessment for ankle swelling is important, as well as consideration for oxygen therapy and diuretic therapy.
- Patients with SpO2 of less than 92% at rest, OR evidence of cor pulmonale, should be referred to the home oxygen service for long-term oxygen therapy. Some patients might experience a reduced exercise tolerance due to breathlessness, and this is often associated with a decreased SpO2 on exertion, which should warrant a referral to HOS for ambulatory oxygen therapy.
- 40-50% patients with ILD experience anxiety and depression, often linked to increased symptom burden and reduced social activity, and should be considered for treatment.