Treatment-Related Interstitial Lung Disease - Episode 20

Multidisciplinary Care in ILD Management: Role of a Pulmonologist

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Shared insight on the benefit of multidisciplinary care and the pulmonologist’s role in identifying and managing interstitial lung disease.


Joyce A. O’Shaughnessy, MD: We have to have our pulmonologists on speed dial, which I do. We’re overwhelming our pulmonary colleagues right now. They don’t need to be overwhelmed, they’re already overwhelmed in the hospital, unfortunately with COVID-19, etc. I wanted to ask you Charles, you must get 1000 phone calls from your oncology friends. When is the right time to give you a call?

Charles A. Powell, MD, MBA: I’d say there are at least 2 scenarios that are frequently touch points for when we’re going to be of most help. First is for a patient who is considering different treatment options with their treating oncologist or is about to begin treatment who may have a history of lung disease or lung symptoms. Then we can be of help to better characterize the baseline lung function, the baseline lung status, and the baseline imaging findings. If there’s a choice between different agents, that information may be helpful but certainly gives us a baseline to follow as we move forward. The second is when the patients do develop a symptomatic potential ILD [interstitial lung disease], there’s now opportunity for pulmonologists to be of help in this process to exclude other potential causes. That is where we come in to help as well. We’re very used to evaluating patients who present with interstitial lung disease caused by a variety of different causes or who have findings on their imaging studies that may or may not represent interstitial lung disease. That’s what we do. That’s our bread and butter. We can be of help to distinguish whether there’s an alternative explanation for the findings there. Those are at least 2 scenarios that are the most common for which we can be of help.

I wanted to come back to a point that was raised when we were talking about education, monitoring and COVID-19. One of the lessons we’ve learned from COVID-19 is there are opportunities to continuously monitor patients at home using wearables and phones, for example, to be able to monitor vital signs such as pulse oximetry, and monitor pulse, heart rate, and symptoms. We’ve used that at our hospital in the setting of patients discharged after they survive COVID-19. We now also appreciate that there are applications in other lung diseases, and we’ve done that as well. What I’m getting toward is that there are opportunities to use these same approaches. People are much more comfortable using wearables, and now your watch can measure your oxygen oximetry at rest or with exertion. There are opportunities to then incorporate wearables and home monitoring devices remotely to aid in the earlier detection of potential pneumonitis or ILD that may be related to cancer drugs. And I think over time we’ll be seeing more experience with that.

Joyce A. O’Shaughnessy, MD: That’s awesome. One point you just made that is a take-home message for me is the idea of asking the pulmonologist to kindly get involved with someone who has lung issues to start off with, to characterize the baseline. I must admit I haven’t been doing that. Many people have a pulmonologist already, but I don’t exactly give the pulmonologist a heads up, “Hey, now we’re going to be starting X, Y and Z drug here. Could you please see the patient a bit more frequently, and would you please do any particular baseline that you need at this moment?” That’s really, really important. If they don’t have a pulmonologist, many of them do not, to get somebody involved with a longstanding smoking history, bad asthma, that’s a really important take-home point for me. Thank you.

Charles A. Powell, MD, MBA: Sure.

Transcript edited for clarity.