Respiratory Medicine - British Columbia Medical Association

Appendix E16Interstitial Lung Diseases ClinicInterstitial lung disease (ILD) is a heterogeneous group of disorders characterized byfibrosis and inflammation primarily located around the alveoli, the gas exchange unit of the lung.Most ILDs are fatal or are associated with substantial morbidity and loss of function (3-11).Based on information collected in other developed nations the prevalence of ILDs may be from30-80 cases/100,000 (10,11), meaning there may be between 1000 and 3000 affected individualsin BC.There are well over 200 causes or associated conditions that result in ILDs. Recognizingthe etiology requires a time consuming evaluation, investigations, and interactions with numberof physicians. After such an evaluation the most likely diagnosis and prognosis can be rendered.Many patients with ILD have involvement of other organ systems, such as the heart, kidneys,joints, skin, and muscles, which require concomitant care. Most therapeutic options for ILDsutilize immunosuppressive agents that result in substantial side effects and complications. Theprevention and meticulous care of complications is required and necessitates frequentassessment. In some instances the patient is assessed for suitability for lung transplantation.Lastly, the severe nature of these diseases takes an inordinate emotional toll on the patient andtheir families. The emotional burden requires substantial counseling and on-going adviceregarding nutrition, weight control, and fitness is also important.Currently, there is one ILD clinic at the VGH dealing with the full range of disorders anda second clinic at SPH. While each of these clinics functions with only one RespiratorySpecialist the clinic at SPH is unique in having a Respirologist (Dr. P Wilcox) work with aRheumatologist and as such is one of the first combined clinics in Canada.These clinics would see more than one hundred new patients each year along with manyfollow-up visits. As the two clinics are the only places in BC with access to many of the newerdrug routines for these disorders they receive referrals from throughout BC.The current physician remuneration for patients seen in these clinics is based on fee-forservicepayments. In view of the length of time involved in the assessment and management ofthese complex patients FFS payments are completely inadequate and put these physicians at asignificant disadvantage when compared to, for example, regular office-based RespiratoryMedicine practice.Another dedicated Respirologist, who has special interest and training in ILDs, isurgently needed. There is supportive evidence that patients with ILD who are followed by adedicated ILD physician and clinic have better outcomes in QOL, morbidity, and survival. Partof this benefit is from timelier referral for lung transplantation (1,2). This also represents apotential significant cost saving as comprehensive out-patient care can prevent and/or interruptworsening illness and thus prevent admission hospital or emergency department visits. Withmore appropriate and dedicated remuneration more Respirologists may be willing to accept thetime consuming responsibility of caring for patients with ILDs.References1. Snell GI, Walters EH, Kotsimbos TC, Williams TJ.Idiopathic pulmonary fibrosis: in need offocused and systematic management. Med J Aust. 2001 Feb 5;174(3):137-402. Lok SS Interstitial lung disease clinics for the management of idiopathic pulmonary fibrosis: apotential advantage to patients. Greater Manchester Lung Fibrosis Consortium. J Heart LungTransplant. 1999 Sept;18(9):884-903. Horowitz JC Thannickal VJ Treat Respir Med. 2006;5:325-342.4. Martinez FJ, Keane MP. 2005Am J Respir Crit Care Med. 2006 ;173:1066-71.5. Nathan SD. Clin Chest Med. 2006;27(1 Suppl 1):S27-35.