Review of Care in Patients Dying of Pulmonary Fibrosis in A District General Hospital

Introduction: Interstitial Lung Disease (ILD) is increasingly recognised as a specialist condition with new insights into classifications and treatment options. Dedicated ILD physicians are now increasingly managing ILD9s even in non-specialist centres. Aims and Objectives: Our aim was to ascertain overall care of patients who died with pulmonary fibrosis and review differences, if any, in overall care between respiratory physician with special interest in ILD and others. Methods: Case note review of 30 patients who died of 9Pulmonary Fibrosis9 between 2014 and 2016. We reviewed diagnosis, referral to tertiary centre for anti-fibrotic medication/lung transplant and symptom management. Results: Of thirty patients, 2 (7%) did not have ILD, and 7 (24%) not known to respiratory team were admitted with acute interstitial pneumonia and died. 15/21 (71%) were under the care of ILD specialist physician and 6 (29%) were under other respiratory physicians. 14/15(93%) under ILD physician received diagnosis with a subtype classification compared to 3/6 (50%), 5/15(33%) under ILD physician vs. 0/6 (0%) were referred to a tertiary centre for anti-fibrotic medication, 10/15(60%) vs. 3(50%) were referred for best supportive care. 1 (6 vs 16%) patient each was referred for lung transplant but both died whilst on waiting list. Conclusions: Physician with special interest manages majority of patients with ILD in our centre. Overall disease sub typing, onward patient referral to tertiary centre and symptom management seemed to be higher in patients under the care of an ILD physician however numbers are small to make any definitive conclusions. The awareness of ILD needs to improve in the wider community to prevent poor outcomes.