A structured approach to a consultation

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.

  1. Symptom management is important, and patients with ILD typically struggle with worsening breathlessness, cough and fatigue.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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