What is the ILD Clinic:
The ILD clinic was created in May, 2013 by Dr. Onofre Moran-Mendoza, with the support and approval of Dr. Michael Fitzpatrick, then Head of the Division of Respirology and Critical Care Medicine. Before the creation of the ILD clinic, no such clinic was in existence.
This clinic was created due to the demand for a specialty clinic for patients suffering with interstitial lung disease (ILD) for diagnosis and management of these complex diseases.
In 2014, the ILD clinic rapidly evolved into an Interstitial Lung Disease Program that now includes:
- ILD Clinic
- ILD Nurse
- ILD Multidisciplinary Rounds
- ILD Fellowship Program
- ILD Research Program
- ILD Program Collaborators
ILD Clinic Protocol Creation:
The ILD clinics are currently held at Hotel Dieu Hospital on Thursdays and Mondays. In order to better understand the approach and procedures for the ICD clinic, Dr. Moran Mendoza attended the ILD Program at the University of Toronto to learn the approach and procedures used by Dr. Shane Shapera, Director of their ILD program.
All diagnostic and management protocols used in the ILD clinic are in compliance with the Guidelines for the Diagnosis and Management of Idiopathic Pulmonary Fibrosis (IPF), published by the American Thoracic Society (ATS, European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Asociacion Latino Americana de Torax (ALAT) as well as the International Guidelines for the Diagnosis of Idiopathic Interstitial Lung Diseases and the Guidelines on Bronchoalveolar Lavage (BAL) in ILDs.
The ILD clinic works collaboratively with Chest Radiology, Thoracic Surgery, Rheumatology, Palliative Care and Pulmonary Rehabilitation and several protocols for patient assessment and referrals have been created and implemented.
Patient Flow in ILD Clinic:
All patients attending the ILD clinic undergo the following standardized assessments to properly investigate the most common groups of ILDs: Hypersensitivity pneumonitis, Connective Tissues Diseases (CTD), and drugs, as per guidelines:
Questionnaires:
o American College of Chest Physicians (ACCP) ILD questionnaire
o Dyspnea questionnaires: MRC dyspnea questionnaire and University of California at San Diego Dyspnea Questionnaire
o Quality of Life (QOL) questionnaire: St George’s QOL questionnaire
o Connective Tissue Diseases Screening questionnaire
o High Resolution Chest CT (HRCT) with routine inspiratory and expiratory views
o Pulmonary Function tests (PFTs), and 6 minute walk test (6MWT)
o Laboratory work-up for CTD and Vasculitis
As per the ILD protocol, patients with either clinical or laboratory abnormalities suggestive of a connective tissues disease are referred to Dr. Clements-Baker in the Division of Rheumatology who assess the ILD patients within 2-4 weeks to determine if their ILD is related to a CTD.
Patients who have, as per the American College of Chest Physicians questionnaire, environmental exposures associated with hypersensitivity pneumonitis or have exposure to drugs reported to cause ILD, are routinely offered bronchoscopy with bronchealveolar lavage +/- transbronchial biopsies.
Once diagnosis is established, if anti-fibrotic treatment is required, patients are re-scheduled in clinic to discuss pros and cons of treatment, as well as the need to refer them to:
- Dyspnea Clinic to be assessed and managed by Dr. Ingrid Harle, Palliative Care, who has agreed to collaborate with the ILD clinic and manage the dyspnea patient population.
- Pulmonary Rehabilitation Program with Dr. Denis O’Donnell, to assess suitability for enrollment in the rehabilitation program at Providence Care.
- Lung Transplant Programin Toronto: Eligible patients diagnosed with IPF or with another advanced or progressive ILD despite treatment are referred to the lung transplant program in Toronto
After diagnosis and treatment are established, ILD patients are followed by the clinic every 3-6 months depending on the severity of their disease or presentation and progression.
Nursing Support for the ILD Clinic:
In 2015 the ILD clinic hired nursing support (Mrs. Lynda McCarthy).
Roles of the ILD Nurse:
- Before each appointment the ILD nurse ensures patients have the appropriate chest CT, Pulmonary Function Tests, and blood work.
- As patients arrive to clinic the ILD nurse collects information from all questionnaires that have been mailed to patients before their appointment, reviews all tests, updates medication lists etc.
- Post-appointment the nursing support enters all clinically relevant information into an electronic research database
- The ILD nurse also provides patients with the ILD Clinic Patient Recommendations form and anti-gastroesophageal reflux disease measures. The patient recommendations address environmental exposures of risk that patients should avoid, as well as the monitoring and proper titration of their oxygen (if applicable).
To refer to the ILD Clinic please fax your referral to: 613 549-1459