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Pulmonary rehabilitation to palliativecare

Emma Vincent

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O ILD is a group of lung disorders in whichextensive alteration occurs to both the

alveolar and airway architecture as aresult of inflammation and fibrosis

O The tissue around the alveoli is called

the interstitium. In patients with ILD thetissue becomes stiff or scarred

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O Autoimmune RA, lupus, sarcoidosis,Sjogren s

O

Hypersensitivity pneumonitis

dust,fungus or moldO Medications amiodarone, methotrexate,

nitrofuranatoin, narcotic &chemotherapeutic

O Radiation to chestO Occupational asbestos, coal dust, cottonO Others - malignancy

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O ILD can occur without a known cause idiopathic

O Idiopathic pulmonary fibrosis (IPF) is themost common cause of this type of ILD

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O UIP-

Usual

honeycombO NSIP- Non-specific ground glassO AIP Rapid, diffuse damage ground

glassO DIP now RB-ILD (Respiratory

Bronchiolitis)-smoking relatedO LIP HIV & connective disorders,

Sjogrens

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O HRCT always neededO CT images when taken look like snow

splatsO BAL usually taken lymphocytesO Autoimmune group

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O Previously known as EAAO Inflammation due variety of inhaled

foreign substance and drug inducedO Variety of appearances sometimes similar

to IPF

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OHistoryOPhysical examinationOChest X-rayOPFTs severity, obstruction, restriction,combinationOBloodsOOxygen assessment

OHRCT- depending upon suspected typeO6 minute walk test

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O An interstitial pattern with obstruction may

imply: sarcoidosis, HP, combined orconstrictive bronchiolitis.

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O BAL sent for cell count, cultures andcytology

O Less helpful with IPF

no predictive rolefor progression or response to therapy

O (VATS only taken in rapid

deterioration/sudden changes)

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O Depends upon type and severity:

O Removal of offending agentO Pirfenidone (IPF)O CorticosteroidsO OxygenO Immunosuppressants & cytotoxic agentsO Treatment of complicationsO Pulmonary rehabilitationO Lung transplant

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O Information and supportO Symptom control/emotional health

O Supporting treatment regimesO Implementing evidence based care- NICE

2013O Pulmonary rehabilitationO Energy conservationO Advanced life planningO Financial advice

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O Lung function and declineO OxygenO

ExerciseO Aiding co-morbidities- physical &

psychologicalO Smoking cessationO Hospital admissionsO ExacerbationsO The future

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O Benefits of appropriate oxygen

assessmentO Value of MDTO Value of pulmonary rehabilitationO Symptom controlO Advance life planningO End of life care

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O Is there a particular type of ILD that is

more responsive to pulmonaryrehabilitation than another?O Is time of diagnosis to PR referral

relevant?

O Exploring the value of the MDTO Role of oxygenO Advanced care planning

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O Monitor disease severity during patientsupport

O Note rate of progressionO Observe patient preferenceO Symptom reliefO Management of co-morbitiesO Support withdrawal of therapiesO End of life care

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O ILD management is challenging and everevolving

O Communication of care is vitalO Listening to patient fears is invaluableO The MDT builds a truer picture of patient

needO Patient education is empowermentO Aid their death with ease of breath