General Approach to Evaluation of the Patient Suspected to have Immune Mediated ChILD—The Importance of a Multidisciplinary Approach
Evaluation of ILD in patients with immunologic diseases ideally involves a multi-Candisciplinary team given the complexity of these patients, many of whom have multiple organ systems involved. Multi-disciplinary discussions (MDDs) are the current gold standard in diagnosis of ILD in adults. Prior studies show that clinicians working together have greater diagnostic accuracy [2-6] and that MDDs often result in a change in the diagnosis of ILD (over 50% of cases discussed in one case series [7]) with a significant reduction in disease categorized as “unclassifiable” [7, 8].
Given that pulmonary involvement can sometimes be the first, most prominent, most acutely life-threatening and/or most chronically life-limiting manifestations of these diseases, the pediatric pulmonologist is an essential member of the multi-disciplinary care team [9]. Because respiratory complaints can be the first presenting symptom, making a diagnosis of immune-mediated ILD requires a high index of suspicion, as initial clinical presenting signs of ILD may be subtle and frequently mistaken for more common respiratory conditions such as asthma or recurrent pneumonia. A generalized approach to diagnosis of suspected immune-mediated chILD [10] is outlined in Figure 1.