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• W4288080107 abstract "FOR RELATED ARTICLE, SEE PAGE 620Interstitial lung disease (ILD) has been suggested to have a prevalence of somewhere between 4 and 80 per 100,000 people.1Hyldgaard C. Hilberg O. Muller A. Bendstrup E. A cohort study of interstitial lung diseases in central Denmark.Respir Med. 2014; 108: 793-795Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar,2Coultas D.B. Zumwalt R.E. Black W.C. Sobonya R.E. The epidemiology of interstitial lung diseases.Am J Respir Crit Care Med. 1994; 150: 967-972Crossref PubMed Scopus (738) Google Scholar While there are many reasons for such variability (setting studied, ILD definition, era, data acquisition methods), such epidemiologic studies usually are also limited by the lack of inclusion of patients from primary care and other “nonpulmonologist” practice settings, which suggests that the number might be even higher. While accounting for such patients, one data set that looked at a French urban multicultural county suggested an ILD prevalence more like 100 in every 100,000.3Duchemann B. Annesi-Maesano I. Jacobe de Naurois C. et al.Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris.Eur Respir J. 2017; 50: 1602419Crossref PubMed Scopus (95) Google Scholar You could dream of a way to capture all such cases, because doing so would not only allow for more accurate epidemiology, but also (more importantly) could allow for early recognition and treatment intervention for such patients. FOR RELATED ARTICLE, SEE PAGE 620 Indeed, we know that late recognition of ILD is a problem.4Cosgrove G.P. Bianchi P. Danese S. Lederer D.J. Barriers to timely diagnosis of interstitial lung disease in the real world: the INTENSITY survey.BMC Pulm Med. 2018; 18: 9Crossref PubMed Scopus (54) Google Scholar Given the nonspecific symptoms (shortness of breath, cough, sometimes no symptoms), we often say that it is incumbent on a good clinician to listen for lung crackles5Cottin V. Cordier J.-F. Velcro crackles: the key for early diagnosis of idiopathic pulmonary fibrosis?.Eur Respir J. 2012; 40: 519-521Crossref PubMed Scopus (82) Google Scholar and to obtain at least a spirometry test (if not complete pulmonary function testing) before slapping on the label of “COPD” and prescribing an inhaler to the “former smoker with dyspnea and cough.” In fact, such delays in diagnosis of ILD result in delays in initiation of critical therapies (supplemental oxygen, pulmonary rehabilitation, smoking cessation, pharmacotherapy, palliative care, and referral to lung transplantation)6Ahmadi Z. Wysham N.G. Lundström S. Janson C. Currow D.C. Ekström M. End-of-life care in oxygen-dependent ILD compared with lung cancer: a national population-based study.Thorax. 2016; 71: 510-516Crossref PubMed Scopus (55) Google Scholar and probably contribute to an earlier death.7Lamas D.J. Kawut S.M. Bagiella E. Philip N. Arcasoy S.M. Lederer D.J. Delayed access and survival in idiopathic pulmonary fibrosis: a cohort study.Am J Respir Crit Care Med. 2011; 184: 842-847Crossref PubMed Scopus (159) Google Scholar Other than an outcry for better recognition of ILD by astute clinicians, what else can be done? The promise of machine learning and artificial intelligence in the use of pattern recognition has been proposed as way to improve on detection of everything from sepsis to ARDS to pleural disease.8Sanchez-Pinto L.N. Luo Y. Churpek M.M. Big data and data science in critical care.Chest. 2018; 154: 1239-1248Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 9Zeiberg D. Prahlad T. Nallamothu B.K. Iwashyna T.J. Wiens J. Sjoding M.W. Machine learning for patient risk stratification for acute respiratory distress syndrome.PLoS One. 2019; 14e0214465Crossref PubMed Scopus (15) Google Scholar, 10Khemasuwan D. Sorensen J. Griffin D.C. Predictive variables for failure in administration of intrapleural tissue plasminogen activator/deoxyribonuclease in patients with complicated parapneumonic effusions/empyema.Chest. 2018; 154: 550-556Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Could the use of “big data” help in the detection of ILD? In this issue of CHEST, Pugashetti et al11Pugashetti J.V. Kitich A. Alqalyoobi S. et al.Derivation and validation of a diagnostic prediction tool for interstitial lung disease.Chest. 2020; 158: 620-629Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar show us how it can be done. They developed a pulmonary function test (PFT)-derived diagnostic prediction tool (termed “ILD-Screen”) that generates a score based on clinical and physiologic variables that are contained in the PFT report, with the intention that it would be useful in the prediction of ILD for patients coming through the laboratory. They go on to validate the model in two different validation cohorts; in one, it was applied prospectively. The ILD-Screen showed good test performance with a high negative predictive value, and outperformed several clinical features that are used commonly for the prediction of ILD. Use of the tool prospectively resulted in a higher proportion of patients undergoing chest CT when compared with historic control and with shorter median time to chest imaging (which suggests that patients could come to an earlier diagnosis of ILD). And because this was based solely on PFT data, it could find ILD even in patients coming from nonpulmonologist practice settings. We still need the astute provider to order the PFT in the first place. And some logistics would need to be created, whereby the ordering physician can be prompted effectively to order the high resolution CT that will be needed as the screening test for ILD (such as, automatic reflex order through the PFT laboratory, standardized statement in the PFT report, practice alert through the electronic medical record). Ultimately, an effective process will lead to more consistent and earlier detection and likely lead to better outcomes for patients. Oh, and we can still work on getting everyone to listen for lung crackles! Derivation and Validation of a Diagnostic Prediction Tool for Interstitial Lung DiseaseCHESTVol. 158Issue 2PreviewThe ILD-Screen showed good test performance in predicting ILD across diverse geographic settings and when applied prospectively. Systematic ILD-Screen application has the potential to reduce diagnostic delays and facilitate earlier intervention in patients with ILD. Full-Text PDF" @default.
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