Identifying the type of ILD that a patient has can be a challenging process. The goal of the ILD team at NewYork-Presbyterian Hospital/Columbia University Medical Center is to complete each patient's diagnostic evaluation in a thorough, efficient, and expedient manner.
The evaluation begins with a physical exam, blood tests, a chest x-ray, a chest CT scan, and pulmonary function testing.
If a diagnosis cannot be made using these tests, a lung biopsy is often necessary. Lung biopsies can be performed in two ways. The first is via bronchoscopy. Bronchoscopy is a same-day procedure, during which a flexible tube (about the diameter of a pen) is inserted through a nostril and advanced into the tracheobronchial tree of the lungs. Small lung tissue samples can be removed during this procedure. The patient receives an anesthetic to maintain comfort during this procedure.
Some types of ILD are more amenable to diagnosis by bronchoscopy than others. For those diseases that are not easily diagnosed by bronchoscopy, a surgical lung biopsy may be necessary.
Lastly, exercise testing (such as a cardiopulmonary exercise test and a six-minute walking test) will be performed to help gauge the severity of disease.
Once diagnostic testing is complete, each case is presented and discussed at a multidisciplinary ILD conference, where an expert group of clinicians and researchers achieve a consensus on the diagnosis and treatment plan for each patient.