Multiple risk factors are likely for ILD development

Mary E. Strek, MD, FCCP
Mary E. Strek, MD, FCCP

Mary E. Strek, MD, FCCP, has dedicated the past 15 years to researching why patients develop interstitial lung disease (ILD), a potentially deadly condition. Sunday’s session Occupational and Environmental Exposures and Interstitial Lung Disease will explore the inhalational risk factors that have been identified to contribute to the development of ILD. The Sunday session starts at 3:30 pm in room 281 of the convention center.

Clinicians and researchers have recognized that a subset of patients with ILD have hypersensitivity pneumonitis (HP). That process is thought to be due to inhaled antigens from the environment, with the majority of the exposures falling into two groups: avian antigens and mold/organic matter antigens, Dr. Strek said, noting sometimes it’s easier to figure out why HP occurs than others. For example, the patient may have a pet bird at home for years, develop a cough and shortness of breath, and on further investigation, the HRCT scan shows findings suggestive of typical HP. Another patient with similar findings on HRCT scan might have mold identified in a musty basement where they sleep or work; it’s easy to pinpoint that as the cause of HP.

“But that’s not always the case,” she explained. “It’s increasingly evident that some patients with ILD have mold or avian markers in their blood and HRCT scan findings of HP, yet we can’t find the source of the antigen to which they’ve been exposed.”

Some patients have been exposed to these antigens through their hobbies or work without realizing it. For example, a realtor could be exposed to antigens at a home staging or a musician’s wind instrument could be colonized with mold. Dentists have also been found to be at risk of developing pulmonary fibrosis.

“One of our goals with this session is to raise awareness of the possibility of inhalational exposures in a variety of hobbies, the workplace, and home and, thus, to encourage physicians to take a really careful history of the patient’s home and work environment,” Dr. Strek said.

During the session, Dr. Strek will set the stage during her talk “Recognizing Exposures and Overlap With Autoimmunity.” She will encourage doctors to perform a comprehensive evaluation in every patient and to recognize that patients with autoimmune diseases may be at equally or at even greater risk for the development of ILD from environmental sources.

Steven M. Montner, MD, FCCP, an academic chest radiologist who is part of the multidisciplinary ILD team at the University of Chicago, has years of experience reading chest CT scans in patients with ILD, both in clinical practice and for research studies. He will use his expertise to inform physicians about the recognized presentation of occupational exposures during his talk “Chest Imaging Patterns That Suggest Exposures in ILD.”

“We know that a plumber who is exposed to asbestos can get asbestosis,” Dr. Strek said. “We know that people who grind sand and stone can get silicosis. Dr. Montner will show CT scans that are typical for those professions when they develop occupational interstitial lung disease, and he will present typical CT findings of HP.”

But Dr. Montner is also going to show CTs that suggest the possibility of an inhaled exposure where the CT scan doesn’t quite fit into some of these classically recognized ILD patterns. This will be an opportunity for the participants to learn new information about how to use chest CT scan imaging to recognize that an exposure might be present, Dr. Strek said.

Mridu Gulati, MD, faculty member at Yale, has trained in occupational health medicine as well as pulmonary medicine. In her talk, “Professional Resources for Exposure Assessment in ILD,” she is going to provide resources and tips to make it easier to elicit the home, hobby, and work exposure history and to understand the potential relationship of exposures to the development of ILD.

“We hope this session will give physicians the tools to go back to their clinic and actually elicit, in a systematic fashion, these exposures,” Dr. Strek said. “We hope this will identify patients who have ongoing exposures to potentially slow progression of their ILD or possibly prevent an acute ILD exacerbation that can be life-threatening.”