• Interstitial fibrosis

The terms interstitial lung disease (ILD) and diffuse parenchymal lung disease are often used synonymously to refer to a disparate group of pulmonary disorders affecting the alveoli and/or respiratory bronchioles. Whilst many ILDs are rare disorders, as a group they account for ∼15% of the workload for an average respiratory physician.1

Despite this, and unlike diseases of the airway or lung cancer, the approach to diagnosis and management of ILD has not yet embraced multidisciplinary or shared, pathway-driven models of care. This, together with a paucity of treatments and the aggressive nature of some ILDs, casts a dim light on an already murky field where definitions are changing and even the pathogenesis remains unclear.

It is noteworthy that in idiopathic pulmonary fibrosis (IPF), the most common ILD,2 there have been no prospective randomised therapeutic trials undertaken in the UK for almost 20 years, and indeed there have only been two placebo-controlled randomised trials in this disease.3 4 However, there is no justification for this nihilism. Rather, the recent publication of the new BTS Guideline on ILD, published by the BTS in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society, is a timely reminder of our current state of knowledge, or perhaps ignorance, regarding diagnosis and management of ILDs.5 It is now appropriate to look beyond the Guideline and consider opportunities for improving care for patients with ILDs and in particular IPF. In the absence of promising new pharmaceuticals, such improvements can only be achieved through improvements to the organisation of care.

A study from Michigan examined the effect a multidisciplinary team (MDT), composed of specialist respiratory physicians, radiologists and pathologists, had on diagnosis of ILDs.6 It was found that whilst the addition of pathological information had the greatest impact …