Pulmonary rehabilitation to palliative

care

Emma Vincent
O ILD is a group of lung disorders in which
extensive alteration occurs to both the
alveolar and airway architecture as a
result of inflammation and fibrosis

O The tissue around the alveoli is called
the interstitium. In patients with ILD the
tissue becomes stiff or scarred

O Autoimmune RA, lupus, sarcoidosis,
Sjogrens
O Hypersensitivity pneumonitis dust,
fungus or mold
O Medications amiodarone, methotrexate,
nitrofuranatoin, narcotic &
chemotherapeutic
O Radiation to chest
O Occupational asbestos, coal dust, cotton
O Others - malignancy


O ILD can occur without a known cause
idiopathic

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

O UIP- Usual honeycomb
O NSIP- Non-specific ground glass
O AIP Rapid, diffuse damage ground
glass
O DIP now RB-ILD (Respiratory
Bronchiolitis)-smoking related
O LIP HIV & connective disorders,
Sjogrens


O HRCT always needed
O CT images when taken look like snow
splats
O BAL usually taken lymphocytes
O Autoimmune group


O Previously known as EAA
O Inflammation due variety of inhaled
foreign substance and drug induced
O Variety of appearances sometimes similar
to IPF


O Breathlessness faster breathing with
deep breaths
O Dry cough
O Weight loss
O Joint pain
O Tiredness


OHistory
OPhysical examination
OChest X-ray
OPFTs severity, obstruction, restriction,
combination
OBloods
OOxygen assessment
OHRCT- depending upon suspected type
O6 minute walk test


O An interstitial pattern with obstruction may
imply: sarcoidosis, HP, combined or
constrictive bronchiolitis.
O BAL sent for cell count, cultures and
cytology
O Less helpful with IPF no predictive role
for progression or response to therapy

O (VATS only taken in rapid
deterioration/sudden changes)
O Depends upon type and severity:

O Removal of offending agent
O Pirfenidone (IPF)
O Corticosteroids
O Oxygen
O Immunosuppressants & cytotoxic agents
O Treatment of complications
O Pulmonary rehabilitation
O Lung transplant
O Information and support
O Symptom control/emotional health
O Supporting treatment regimes
O Implementing evidence based care- NICE
2013
O Pulmonary rehabilitation
O Energy conservation
O Advanced life planning
O Financial advice


O Lung function and decline
O Oxygen
O Exercise
O Aiding co-morbidities- physical &
psychological
O Smoking cessation
O Hospital admissions
O Exacerbations
O The future

O Benefits of appropriate oxygen
assessment
O Value of MDT
O Value of pulmonary rehabilitation
O Symptom control
O Advance life planning
O End of life care

O Is there a particular type of ILD that is
more responsive to pulmonary
rehabilitation than another?
O Is time of diagnosis to PR referral
relevant?
O Exploring the value of the MDT
O Role of oxygen
O Advanced care planning

O Monitor disease severity during patient
support
O Note rate of progression
O Observe patient preference
O Symptom relief
O Management of co-morbities
O Support withdrawal of therapies
O End of life care
O ILD management is challenging and ever
evolving
O Communication of care is vital
O Listening to patient fears is invaluable
O The MDT builds a truer picture of patient
need
O Patient education is empowerment
O Aid their death with ease of breath