'Multidisciplinary teams are crucial for the treatment of ILD.'

Portuguese professor Carlos Robalo Cordeiro is a specialist in pulmonology and head of the pulmonology department at Coimbra University Hospital. In this hospital he works with a dedicated multidisciplinary team on the treatment of patients with interstitial lung disease (ILD). According to Cordeiro, spreading awareness of ILD can make all the difference in the treatment of this condition. 'It's very important to identify ILD's as early as possible.'

'It's crucial to have this kind multidisciplinary team'

Different forms of ILD

In the Coimbra University Hospital, a multidisciplinary team gathers every week to discuss patients with ILD. 'We meet each other at least one hour every week, says Cordeiro. 'At these meetings there are a radiologist, a pathologist, a thoracic surgeon and a rheumatologist present. Sometimes a cardiologist also joins us, because they deal with pulmonary hypertension.' During these multidisciplinary meetings, the different doctors discuss studies and present cases to each other. 'It's crucial to have this kind multidisciplinary team', says Cordeiro. 'In Portugal, we have for example a high prevalence of hypersensitivity pulmonitis, an inflammatory and/or fibrotic condition caused by inhalation of organic dusts and it is very important to disinguish a disease like that from other forms of ILD.' The clinical picture of someone with chronic hypersensitivity pulmonitis can be very similar to someone with idiopathic pulmonary fibrosis (IPF), or for instance to someone with an ILD related to a connective tissue disorder. 'To recognize this last condition, it can be important to have a rheumatologist in the team, who is an expert in this field. So you really need this multidisciplinary approach. We aim to keep the number of unclassified ILD's as low as possible. With a team you can have a good discussion about whether a condition is really an IPF or maybe something else after all.' 

Tests and procedures

Cordeiro's hospital is a Reference Center, which means other hospitals often present their clinical cases to them. 'Other hospitals don't have the facilities to do all sorts of test and procedures', says Cordeiro. 'We have a research lab for example, where we do some approaches concerning bronchoalveolar-lavage (BAL).' During this specific procedure, a scope is passed through the mouth or nose into the lungs. Fluid is squirted into a small part of the lung and then collected for examination. 'In this fluid (the so called 'BAL') we can easily check for asbestos bodies in our lab', says Cordeiro. 'And we can also do a “lymphoblastic transformation test”, which can be used to detect some types of hypersensitivity and drug induced pneumonitis.'

Awareness 

Because ILD's are rare and relatively unknown diseases, Cordeiro puts a lot of effort into creating more awareness about ILD in the medical community. 'Last year, we published a consensus document in the Portuguese Journal of Pulmonology', says Cordeiro. 'That document was about the diagnosis and treatment of IPF. We spread this paper within the Portuguese societies of pulmonology, radiology and pathology and also delivered it to the society of general practitioners (GP's).' Another way to create awareness about ILD in Portugal, is by organizing meetings and workgroups. 'We focus on different kind of specialists with this', says Cordeiro. 'We organize meetings through the working group within the Portuguese society of pneumology about ILD, but we also focus on GP's. These are crucial, because they are the first doctors that see the patients. We want to teach GP's how they can identify ILD early, by noticing crackles in the lungs and other characteristics. And we also have meetings with radiologists from more distant parts of Portugal to exchange information about the symptoms, the diagnosis and the main imaging features of ILD. During these meetings, top radiologists speak about ILD and for example the patterns on high resolution scans with which you can identify it. So in all sorts of ways we are trying to create more awareness about ILD in different departments of medicine, so we can treat ILD patients better and earlier.'