A comprehensive assessment of environmental exposures and the medical history guides multidisciplinary discussion in interstitial lung disease.
A comprehensive assessment of environmental exposures and the medical history guides multidisciplinary discussion in interstitial lung disease.
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DOI：
10.1016/j.rmed.2021.106333
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发表时间：
2021-04
影响因子：
4.3
通讯作者：
Todd NW
中科院分区：
文献类型：
--
作者：
Dodia N;Amariei D;Kenaa B;Corwin D;Chelala L;Britt EJ;Sachdeva A;Luzina IG;Hasday JD;Shah NG;Atamas SP;Franks TJ;Burke AP;Hines SE;Galvin JR;Todd NW
多学科讨论(MDD)被广泛推荐用于间质性肺病(ILD)患者，但已发表的MDD的初步数据很少，除了胸部CT和肺组织病理学解释之外，影响MDD的因素还没有得到很好的描述。179例ILD患者的单机构MDD。MDD的一致临床诊断包括自身免疫相关的ILD、慢性过敏性肺炎、吸烟相关的ILD、特发性肺纤维化、药物所致的ILD、职业相关的ILD、无法分类的ILD以及一些不常见的肺部疾病。在179名患者中的168名患者中，确定了一种或多种环境暴露或相关的病史特征，包括娱乐/业余、住宅和职业暴露、系统性自身免疫性疾病、恶性肿瘤、用药和家族史。MDD过程证明了全面评估这些暴露和特征的重要性，而不仅仅是指出它们的存在，以提供一致的临床诊断。MDD提供了精确、明确的胸部CT和肺组织病理学解释，包括普通型间质性肺炎、非特异性间质性肺炎和机化性肺炎，但这些解释与各种MDD共识临床诊断相关，在许多情况下显示了它们的非特异性。在77例MDD共识诊断与参考诊断不同的患者中，回顾发现环境暴露和病史评估是最有影响的因素。对环境暴露和病史指导的MDD的相关特征进行综合评估。除了提供一致的临床诊断外，MDD还为临床医生提供了启动环境补救、行为矫正或药物改变的机会，这些可能使ILD患者个体受益。
Multidisciplinary discussion (MDD) is widely recommended for patients with interstitial lung disease (ILD), but published primary data from MDD has been scarce, and factors influencing MDD other than chest computed tomography (CT) and lung histopathology interpretations have not been well-described. Single institution MDD of 179 patients with ILD. MDD consensus clinical diagnoses included autoimmune-related ILD, chronic hypersensitivity pneumonitis, smoking-related ILD, idiopathic pulmonary fibrosis, medication-induced ILD, occupation-related ILD, unclassifiable ILD, and a few less common pulmonary disorders. In 168 of 179 patients, one or more environmental exposures or pertinent features of the medical history were identified, including recreational/avocational, residential, and occupational exposures, systemic autoimmune disease, malignancy, medication use, and family history. The MDD process demonstrated the importance of comprehensively assessing these exposures and features, beyond merely noting their presence, for rendering consensus clinical diagnoses. Precise, well-defined chest CT and lung histopathology interpretations were rendered at MDD, including usual interstitial pneumonia, nonspecific interstitial pneumonia, and organizing pneumonia, but these interpretations were associated with a variety of MDD consensus clinical diagnoses, demonstrating their nonspecific nature in many instances. In 77 patients in which MDD consensus diagnosis differed from referring diagnosis, assessment of environmental exposures and medical history was found retrospectively to be the most impactful factor. A comprehensive assessment of environmental exposures and pertinent features of the medical history guided MDD. In addition to rendering consensus clinical diagnoses, MDD presented clinicians with opportunities to initiate environmental remediation, behavior modification, or medication alteration likely to benefit individual patients with ILD.
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影响因子：
9.6
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
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发表时间：
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DOI：
10.1164/rccm.200402-147oc
发表时间：
2004-10-15
影响因子：
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作者：
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通讯作者：
Martinez, FJ