Introduction to assessment

Accurate diagnosis is important because disease behaviour, response to therapy and prognosis varies between the different interstitial lung diseases (ILDs). The rate of clinical progression from initial symptoms to end-stage disease can range from a few months to many years.

Specialist assessment is required to ensure diagnosis is accurate and not delayed; diagnosis usually involves discussion by an ILD multidisciplinary team. Access to specialised therapy, enrolment in clinical trials or referral to a lung transplantation service can also be facilitated by the ILD multidisciplinary team, if required.

Initial assessment to determine urgency of specialist referral should include:

Also consider investigations to exclude other causes of dyspnoea (eg full blood count [FBC] to exclude anaemia, echocardiogram to assess for heart failure).

Note: If ILD is suspected, refer the patient to a specialist to ensure diagnosis is accurate and not delayed.

Specialists may conduct further investigations to confirm diagnosis of ILD. These may include additional blood tests, complex pulmonary function testing (eg static lung volumes [including total lung capacity], diffusing capacity of the lung for carbon monoxide [DLCO]) or bronchoscopy (eg bronchoalveolar lavage [BAL] fluid analysis, transbronchial lung biopsy, endoscopic bronchial ultrasound [EBUS]–guided transbronchial lymph node biopsy). Occasionally, a tissue biopsy is required and a referral for video-assisted thoracoscopic surgery (VATS) biopsy will be made.