Abstract

Introduction:
NICE made recommendations for MDT management of IPF in 2013 against which we have audited our results.

Methods:
Following presentation of the history, examination, physiology, immunology and any biopsies, the MDT decides whether there is sufficient evidence to make a confident diagnosis; if not it recommends further investigations that should lead to a definitive diagnosis. If the disease is too advanced for safe further investigations the MDT makes a most likely diagnosis.

Results:
Patients discussed have risen from 81 in 2005 to 203 in 2013. The commonest diagnoses in 2013 were IPF (60), NSIP alone (19), Sarcoidosis (25), HP (17), ILD with CVD (12) and Asbestosis (9). The proportion where VATS was recommended or carried out for UIP has reduced from 41% in 2007 to 22% in 2013. Histological confirmation of sarcoidsis was low (12/25). Only 15 of the 51 patients with definite IPF had FVC <80% required for Pirfenidone prescription in the UK.

Fig 1
shows the relationship between VC and DLCO % pedicted for IPF patients at presentation.

Conclusions:
The prescription criteria for Pirfenidone in the UK exclude most patients with IPF. Compared with guidelines the biopsy rate for probable sarcoidosis is low (48%). The workup of patients with possible chronic HP/NSIP is often hampered by the lack of occupational, environmental, drug and immunological data.

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