PeerDirect Program: The Role of APPs in ILD
In a recent PeerDirect program from Boehringer Ingelheim, Corinne Young, MSN, FNP-C, FCCP, and Jessica Glennie, CNP discuss the role of Advanced Practice Providers (APPs) in diagnosing and treating interstitial lung diseases.
ILD is an umbrella term for nearly 200 diseases categorized by inflammation. There are several risk factors for this disease. And, there are about 250k cases in the United States, making it somewhat rare compared to the 22 million people suffering from Asthma. However, incidents are increasing.
Corinne and Jessica discuss the importance of being a detective when it comes to diagnosing patients with ILD. APPs use a combination of patient health history, smoking history, and family history, as well as a deep dive into patients’ current medication usage and autoimmune disease diagnoses.
Jessica hones in on the importance of asking about symptoms and especially looking at patients’ hands and skin during examinations. Understanding any occupational or environmental exposures like mold, silica, hard metal dust, or even exposure to the dander and feather from birds can also be helpful in diagnosing ILD.
Testing and imaging are important for ILD detection and management. For testing, Jessica suggests a high-resolution scan of the chest. A CAT scan tells providers about the pattern of injury with much more detail than an X-ray. While monitoring a patients after diagnosis, both Jessica and Corinne suggest Pulmonary Function Testing.
After dianosing ILD, Jessica monitors if and how the disease is progressing and prioritizes talking to patients about preferences and goals of care. Providers have 2 pathways for ILD treatment: 1. Inflammatory, immunosuppression, or 2. fibrotic pathway. Depending on the patient, Jessica may use one option or a combination of both. It’s also important to remind patients of non-pharmacologic care pathways, including supplemental oxygen, pulmonary rehab, and for very progressive cases, palliative medicine/hospice and lung transplant.
Pearls for the APP: if you feel uncomfortable, always send your patients to an ILD provider or utilize resources on the Pulmonary Fibrosis Foundation site. ILD’s are diffucifult diseases, and every patient follows a different trajectory. You are not alone as an APP in treating your ILD patients. For more support, check out both parts of the PeerDirect ILD program HERE.
