Clinicians commonly see interstitial lung abnormalities (ILAs) on CT scans, including those used for lung cancer screening. These abnormalities are often incidental and of little clinical consequence—except when they aren’t.
“ILAs in someone with risk factors such as age, smoking status, or a family history of interstitial lung disease are not something to downplay,” said Sean Callahan, MD, Associate Professor of Pulmonology and Critical Care Medicine at the University of Utah. “And if there are other risk factors, like significant inhalational exposures, it may well be something that is more than just an incidental finding, and that could progress.”
Identifying patients who are high-risk and distinguishing the visual patterns of ILAs from similar, yet unrelated, findings will be a focus of the panel discussion, Interstitial Lung Abnormalities: When Are They Incidental? When Are They Interstitial Lung Disease?, on Wednesday, from 10:30 am to 11:30 am, in Room 310 of the convention center.
Dr. Callahan will chair the session, which will draw heavily from the most recent Fleischner Society guidelines for evaluating and managing patients with ILAs. Matthew Koslow, MD, from National Jewish Health, will discuss the salient features of ILAs. Lydia Chelala, MD, from the University of Chicago, will focus on ILA mimics.
It is important to convey the potential for interstitial lung disease (ILD) to patients whose scans display ILAs, Dr. Callahan said. It is too easy to suggest that patients check back with their primary care providers on any potential progression, he said. That kind of vague concern can easily be dismissed, ignored, and forgotten until the patient becomes symptomatic.
“Instead, you can say, ‘This is something I should keep an eye on,’ because these are people with whom you have an opportunity to catch their disease early,” Dr. Callahan said. “And if we can catch it early enough, we may be able to change the disease trajectory.”
A solid family history is vital in assessing any ILA, Dr. Callahan said. Recent data confirm that ILD can run in families and that family members tend to follow similar clinical courses. An ILA in someone with a family history of ILD is far more concerning than the same ILA in a similar patient with no family history of ILD.
Personal history is similarly important. Smoking history, especially heavy smoking, is a familiar risk factor for ILD. Environmental exposures are less familiar but can be similarly harmful.
Individuals with a history of working in mines or who may have asbestos exposure from working with older automobile parts or older buildings likely to contain asbestos are at elevated risk for ILD. Heavy and/or prolonged exposure to silica dust from stonecutting or similar activities also elevates ILD risk.
“An ILA in someone with a history of these kinds of activities can be our opportunity to follow and scan them more frequently,” Dr. Callahan said. “There are occupations and avocations that put people at risk. You can start appropriate medication earlier and maybe remediate risky living or working situations to alter disease progression. This session will walk you through the kinds of images and factors you should worry about and the things you can worry less about when you see an ILA.”
For tools and insights that you can use in your daily practice to shorten the time to diagnosis for patients with ILD, check out the ILD Clinician Toolkit from CHEST and Three Lakes Foundation.