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Atlas of Diffuse Lung Diseases a Multidisciplinary Approach Review

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Editorial

Multidisciplinary Approach to Interstitial Lung Diseases: Nada Is Better than All of Usa Together

1

Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Eye for Rare Lung Diseases, University Hospital "Policlinico–Vittorio Emanuele", via Southward. Sofia 78, 95123 Catania, Italy

2

Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Infirmary "Policlinico–Vittorio Emanuele", 95123 Catania, Italia

*

Author to whom correspondence should be addressed.

Received: six July 2020 / Accepted: vii July 2020 / Published: 17 July 2020

Abstract

Interstitial Lung Diseases (ILDs) are a large family of disorders characterized past inflammation and/or fibrosis of areas of the lung defended to gas exchange. In this Special Outcome entitled "Clinical and Radiological Features of Interstitial Lung Diseases", we collected a series of contributions in which a multidisciplinary approach was crucial for the correct diagnostic cess of ILD. Sharing knowledge between different specialties can significantly improve diagnostic approaches and the management of ILD patients.

Interstitial Lung Diseases (ILDs) are a big family unit of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. The impairment of lung parenchyma causes the occurrence of symptoms, and in some ILDs, such as idiopathic pulmonary fibrosis (IPF), it may lead to respiratory failure and death. Some ILDs, including IPF and sarcoidosis, are idiopathic, others such as hypersensitivity pneumonia and drug-induced ILDs recognize specific etiologic agents, some others are instead associated with systemic diseases, as in the case of connective tissue diseases (CTD-ILDs) [one]. ILDs represent about 20% of lung diseases routinely seen by pulmonologists during their daily activity, and their number, due to the improvement of the diagnostic procedures, is increasing [ii]. It is also plausible that exposures to known risk factors such every bit smoking, but also new and unknown ecology and professional person agents or drugs may exist responsible for this alarming trend. All this may explicate the increasing scientific attention to ILDs past researchers and clinicians, attracted by the broad array of "intriguing" basic and clinical issues associated with pathogenesis, diagnosis, follow-up, and treatment of this group of diseases. In detail, the large number of clinical, functional, and radiological overlaps among ILDs makes their diagnosis extremely difficult and challenging. For these reasons, a multidisciplinary approach to the diagnosis of ILDs is strongly recommended, representing the best way to improve the diagnostic accuracy of these diseases [3]. In this Special Issue, defended to the "Clinical and Radiological Features of Interstitial Lung Diseases", the two editors nowadays a series of articles where pulmonologists, radiologists, rheumatologists, and other experts, put their knowledge together with the unique aim of underlining specific clinical and radiological aspects of ILDs that might be useful to the diagnostic approach to ILDs for a larger audition of clinicians. Some of the articles in this Special Issue are opportunely dedicated to Loftier-Resolution Computed Tomography (HRCT), one of the most important diagnostic tools in ILDs. In nearly ILDs, symptoms are non-specific, making the differential diagnosis particularly difficult. Only in some cases is the radiological pattern typical for a specific disease, whereas in many others, the estimation of the radiological moving-picture show is more than difficult and needs to exist reviewed past an expert lung radiologist. In any case, the interpretations based on qualitative evaluations of HRCT are limited by a visual analysis, which is time-consuming, and above all, subjective. Stefano et al. show in this outcome that reckoner-based assay might be a useful tool for the radiological assessment of patients with IPF. In particular, they constitute a specific parameter measuring the percentage of normally attenuated lungs that, together with qualitative HRCT assessment and pulmonary part exam, increases the accuracy of the diagnostic procedure in IPF [iv]. The whole affair is farther complicated by the pleiomorphisms of radiological presentations in different ILDs, but besides in the aforementioned illness at unlike stages. Tiralongo et al. draw the evolution of morphological patterns at HRCT in cryptogenic organizing pneumonia in response to handling with steroids [5]. Aquilina et al. have instead focused their attention on cystic lung diseases, one of the near typical radiological presentations of ILDs [vi]. Their study aims to offering a practical guide to radiologists and pulmonologists for an easier estimation of these particular lesions. To do this, the different cystic lesions were effectively and nicely described through free-hand drawings that are related to HRCT images, helping to recognize the correct differential diagnosis between similar weather condition. Sambataro et al. observed that ground-glass opacities at HRCT correlate with disease activity in Systemic Sclerosis (SSc), whereas the fibrosis grade correlated with disease elapsing and pulmonary artery pressure level [vii]. Besides, they observed that the quantification of pulmonary involvement using the Wells score could be a useful tool for assessing the appropriate treatment in SSc patients. Remaining in the field of SSc and autoimmune diseases, Sambataro et al. also present some interesting data on nailfold videocapillaroscopy, described in this manuscript as a useful tool for the recognition of SSc and idiopathic inflammatory myopathies in patients with ILDs [viii]. Furthermore, in a unlike article of this Special Issue, the office of the rheumatologist within the multidisciplinary team is underlined, and how a set of first-line clinical, laboratory, and instrumental tests might increase the frequency of diagnosis of autoimmune diseases among patients with ILD [nine]. In some other interesting paper, Galioto et al. described the near peculiar clinical and radiological features of complications in IPF [x]. The last 2 articles, singled-out from all the others, are dedicated to the possible relationship betwixt the radiological patterns of sarcoidosis and its clinical event, and the last commodity is an interesting clarification of HRCT patterns in drug-induced ILDs [eleven,12].The diagnosis of drug-induced-ILDs, as a consequence of the introduction of new drug therapies, is constantly increasing. Unfortunately, the morphological HRCT patterns are not specific for a given drug. Therefore the diagnosis should be based on clinical-anamnestic data, radiological, and laboratory features, confirming once once more the need for a multidisciplinary squad arroyo for the diagnosis of ILD.

All manufactures of this Special Consequence are comprehensive and innovative in their approaches, addressing practical and still controversial or unresolved clinical issues related to the diagnosis, follow-up, and prognosis of ILDs. The ii editors, Stefano Palmucci and Sebastiano Torrisi, both take the merit to involve and coordinate in this Special Issue, a number of young clinicians and experts. Looking at the list of authors who contributed to the different articles, it is squeamish to notation the variety of their specialties: Biologists, physicists, immunologists, rheumatologists, radiologists, internists, computer scientists, and pulmonologists accept all contributed to the success of this issue dedicated to ILDs. The participation and commitment of immature experts to this group of diseases, coming from very dissimilar scientific settings, confirm the relevance and the broad clinical involvement for this of import chapter of the respiratory diseases.

Funding

This research received no external funding.

Conflicts of Involvement

C.V. is part of the F. Hoffmann-La Roche Ltd. Scientific lath. He has received consulting fees and/or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, F. Hoffmann-La Roche Ltd., and Menarini.

Abbreviations

CTD Connective Tissue Disease
HRCT High-Resolution Computed Tomography
ILD Interstitial Lung Diseases
IPF Idiopathic Pulmonary Fibrosis
MDT Multidisciplinary Team
SSc Systemic Sclerosis.

References

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Source: https://www.mdpi.com/2075-4418/10/7/488/htm

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