RATIONALEInterstitial lung abnormalities (ILA) are radiographic interstitial findings that are incidentally identified on chest imaging performed for other reasons. ILAs have been identified on chest computed tomography (CT) performed as part of lung cancer screening programs.OBJECTIVESThis study characterizes the prevalence and outcomes associated with ILA in a Canadian lung cancer screening cohort.METHODSPatients were identified from the Alberta lung cancer screening trial, a 5-year cohort study. CT reports were screened for terms associated with ILA including specific radiologic features and CT patterns. These were further characterized as non-subpleural, subpleural nonfibrotic and subpleural fibrotic, consistent with published definitions. Retrospective chart review was conducted for those with ILA to define demographics, lung function, and longitudinal outcomes including subsequent investigations for interstitial lung disease (ILD), treatment, and survival.MEASUREMENTS AND MAIN RESULTSOf 806 patients in the lung cancer screening study, 30 (3.7%) were identified as having ILA, with two-thirds (67%) having subpleural fibrotic abnormalities. Half of patients were referred to a Respirologist and underwent pulmonary function testing. Over a median follow-up period of two years, none were diagnosed with an idiopathic interstitial pneumonia, or started on immunomodulatory or antifibrotic therapy. Three of 30 (10%) patients demonstrated disease progression over time, all of whom had subpleural fibrotic ILA on baseline chest CT.CONCLUSIONSThe prevalence of ILA in this Canadian lung cancer screening cohort was 3.7%. These data should inform the development of standardized reporting and follow-up for ILA as lung cancer screening programs are implemented.

BACKGROUND: The SARS-CoV-2 pandemic necessitated novel health care delivery for patients with interstitial lung disease (ILD), including reduced in-person appointments and physiologic testing to minimize transmission. Clinicians often have been required to rely on patients' subjective assessments of their clinical status during phone follow-up appointments. It is unknown how accurate a patient's self-assessment is compared with that of their physician during an in-person evaluation.RESEARCH QUESTION: Are patients' self-assessments of their clinical status in agreement with their physicians' assessments, and are telemedicine vs in-person visits acceptable?STUDY DESIGN AND METHODS: Patients were enrolled prospectively from the University of Calgary ILD clinic. Participants were asked by phone before the in-person appointment and after the appointment to rate their clinical status on a five-point Likert scale. Physicians then rated the patient's clinical status after the appointment on a similar five-point Likert scale, masked to patient responses. Patients and physicians were asked if an in-person appointment was necessary or if telemedicine would have sufficed. Clinical variables associated with physician assessments were assessed.RESULTS: Fifty patients with mean age of 67 & PLUSMN; 11.8 years participated. Mean time since last follow-up was 5.0 & PLUSMN; 3.0 months. No correlation was found between the preclinical patient selfassessment and postclinical physician assessment (P = .18; K = 0.28). Correlation of postclinical assessment was statistically significant (P < .001), with moderate agreement (K = 0.49). Physicians thought telephone visits were acceptable for 58% of appointments, whereas only 12% of patients preferred telephone visits. Physician's assessment of clinical status seemed to be driven by change in diffusion capacity of the lungs for carbon monoxide (P = .039).INTERPRETATION: Telemedicine may improve access to care for patients during pandemic management, in rural communities, and for those with impaired mobility. Despite these benefits, our data support that patients and physicians may not agree on determination of clinical status and that patients generally prefer in-person patient-physician interactions.