S107 Occupational lung disease specialist assessment for patients with usual interstitial pneumonia, as part of an interstitial lung disease multi-disciplinary team – a single centre experience

Abstract

<h3>Introduction and Objectives</h3> The characteristic radiological pattern of usual interstitial pneumonia (UIP)-pattern fibrosis is common to both idiopathic pulmonary fibrosis (IPF) and asbestosis. It is essential to exclude asbestosis when deciding on a working diagnosis of IPF, as the medical treatment for each condition differs. Currently, only patients with IPF are eligible for NICE-approved anti-fibrotic treatment, but medicolegal compensation may be available for patients with asbestosis. Between January -December 2019, we piloted a service arranging an Occupational Lung Disease (OLD) specialist assessment for all new patients with UIP-pattern fibrosis and a previous exposure to asbestos, prior to review in the Interstitial Lung Disease (ILD) clinic, to estimate the prior asbestos exposure in fibre/ml/years, in order to firmly diagnose or exclude asbestosis. <h3>Methods</h3> Referrals were received directly from primary or secondary care, or following ILD multidisciplinary team (MDT) discussion. Patients were then assessed by an OLD specialist, where a detailed occupational history was taken and each case was discussed between two consultants in the clinic MDT meeting. If asbestosis was excluded then subsequent review in the ILD clinic was arranged to consider anti-fibrotic treatment. If a diagnosis of asbestosis was made, medicolegal advice was offered. <h3>Results</h3> A total of 67 patients were seen by an OLD specialist team (mean age 80, 95% male). 39 (58%) were radiologically probable UIP pattern. 23 (59%) were diagnosed with asbestosis. Of these, 21 (91%) were given medicolegal advice in clinic (if a prior compensation claim had not already been made). 2 (9%) patients with asbestosis were referred for Nintedanib on the compassionate access scheme. The remaining 16 (41%) had MDT-ratified IPF. Out of which 8 (50%) were initiated on antifibrotic medication in the OLD clinic by the ILD team. <h3>Conclusions</h3> We demonstrated that introducing specialist OLD assessment into the review of patients with UIP-pattern fibrosis aids accurate diagnosis of asbestosis, facilitating the provision of medicolegal advice. In patients where asbestosis was excluded and the diagnosis was IPF, by initiating anti-fibrotic medication in clinic supported by the ILD team, we were able to ensure patients still received prompt and appropriate management of their IPF.