Core IM | Internal Medicine Podcast #170 ILD and High-Risk Medication Prescribing: Gray Matters Segment
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Feb 5, 2025 Rob Palowell, a pulmonologist from Massachusetts General Hospital, and Kelly Graham, a primary care physician at Beth Israel Deaconess Medical Center, delve deep into interstitial lung disease (ILD). They discuss the challenges of diagnosing incidental lung findings and the nuances between antifibrotics and immunosuppression. The conversation also highlights the complexities of patient care, especially when social barriers hinder treatment. Both emphasize a holistic approach, addressing patients' basic needs alongside their medical conditions for better care outcomes.
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Incidental ILD Findings on CT
- For incidental ILD findings on CT, consider an ILD-protocol CT scan to differentiate fibrosis from atelectasis or aspiration.
- Consult with radiology or pulmonology if concerned about ILD, especially if there are no pulmonary symptoms.
Broad ILD Categories over Acronyms
- Focus on broad categories of ILD (infections, exposures, autoimmune diseases, syndromes, idiopathic) rather than specific acronyms.
- This approach drives therapy and actions more effectively than focusing on the "alphabet soup."
Pigeon Racing and Asbestos Exposure
- Dr. Treanor recalls a patient with ILD whose social history revealed participation in an underground pigeon racing league.
- The patient frequented an old factory containing asbestos, highlighting the importance of a thorough social history.