Part 13 of 49 - Video Presentations of the "1st Conference on Integrating Early Detection of Heart and Lung Disease through Low-Dose CT": Day 1 Session 2: Interstitial Lung Disease
- miguel65063
- Jan 13
- 7 min read
Thursday, September 19, 2024 | New York Academy of Medicine (NYAM)
1216 5th Ave, New York, NY 10029
Dr. Maria Padilla, MD, Medical Director of the Interstitial Lung Disease Program at Sinai, emphasized the importance of early diagnosis and intervention for interstitial lung diseases (ILD), particularly pulmonary fibrosis. ILD often remain unnoticed until the disease progresses significantly. She highlighted the role of low-dose CT scans in detecting early signs of these diseases, which can lead to better patient outcomes, and urged physicians to be vigilant about these findings. Dr. Padilla also discussed the need for improved diagnostic protocols and the potential benefits of new therapeutic interventions.
Watch Dr. Maria Padilla's Presentation Below:
See Dr. Maria Padilla's Slides Below:
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Transcript of Dr. Maria Padilla's Presentation:
[Maria Padilla] [0.08s] Thank you very much.
[Maria Padilla] [1.68s] Okay.
[Maria Padilla] [2.96s] Yes.
[Maria Padilla] [3.44s] I am Maria Padilla.
[Maria Padilla] [4.88s] I'm the, medical director of the interstitial lung disease program here at Sinai, and have devoted my life to the, study of interstitial lung diseases and in particularly pulmonary fibrosis.
[Maria Padilla] [20.84s] And I am delighted to be here, and I wasn't here for the early morning part.
[Maria Padilla] [26.20s] But without a breath, you can't beat beat.
[Maria Padilla] [29.61s] So lungs, heart, which one wins?
[Maria Padilla] [33.61s] Okay.
[Maria Padilla] [35.21s] Okay.
[Maria Padilla] [36.25s] So, let's start because, it is truly a pleasure to be here to talk about how the, lung low dose CT scan, is contributing to the early diagnosis of interstitial lung diseases, particularly the fibrotic diseases.
[Maria Padilla] [58.18s] How do we go from these where I have okay.
[Maria Padilla] [63.38s] From the minimal changes that sometimes are called, atelectasis, some kind sometimes are called chronic changes, and nobody pays attention to them.
[Maria Padilla] [75.45s] And 5 years later, you see a patient who has well established pulmonary fibrosis, and we miss that window to operate to be able to, alter these.
[Maria Padilla] [87.90s] Okay.
[Maria Padilla] [90.22s] Alright.
[Maria Padilla] [90.46s] Okay.
[Maria Padilla] [91.10s] So what are these fibrosian lung diseases?
[Maria Padilla] [94.78s] They include IPF that you all know, progressive pulmonary fibrosis, both prevalence and incidence of these diseases are increasing.
[Maria Padilla] [105.69s] They have a dismal, prognosis.
[Maria Padilla] [108.97s] Their median survival is 3.8 years from the time of diagnosis.
[Maria Padilla] [114.58s] It compares, unfavorably or favorably to some other cancers for which we are putting a lot of effort into trying to make the earlier diagnosis.
[Maria Padilla] [125.62s] And so these, diseases have a delay in diagnosis.
[Maria Padilla] [130.58s] There is about, 2 point years before the diagnosis of an fibrotic lung disease is made in our patients.
[Maria Padilla] [140.10s] These, diseases also take some a toll on our patients even before they come to the attention of our our, physicians.
[Maria Padilla] [150.99s] And there is a high comorbidity burden that accompanies, these, diseases.
[Maria Padilla] [158.22s] What we have to date are very limited therapeutic interventions for these diseases, and we can only apply it once the patient is fibrosed.
[Maria Padilla] [168.87s] So if you don't have the fibrosis well established when you're not going to be able to change that outcome, you're not gonna be able to apply these things.
[Maria Padilla] [179.93s] So we do need to change the paradigm of managing and and diagnosing these diseases.
[Maria Padilla] [189.28s] And so we need earlier diagnosis.
[Maria Padilla] [191.84s] We need earlier intervention.
[Maria Padilla] [194.00s] Clinical trials are making a resurgence for this particular disease, and we are seeing that new, therapeutic interventions are going to become available very soon for the management of these diseases.
[Maria Padilla] [211.59s] So we must suspect it, and we must utilize any of the, tools that we have available.
[Maria Padilla] [219.03s] And what can be better than the low dose CT scan?
[Maria Padilla] [224.31s] Okay?
[Maria Padilla] [225.51s] This is truly the gift that keeps on giving.
[Maria Padilla] [229.94s] Okay?
[Maria Padilla] [230.34s] And we know that there are many incidental findings in the CT scan that have helped us to understand a little bit about the the course and the arc of the interstitial lung diseases.
[Maria Padilla] [244.25s] We start with those, interstitial lung abnormalities that were defined by the Fleischner Society in 2020 as incidental findings for on CT scans that were performed for reasons other than ILD.
[Maria Padilla] [260.43s] They are part of this spectrum of ILD that we have.
[Maria Padilla] [264.27s] They are the early precursors of pulmonary fibrosis so that we do need to report these, and the physicians who who get the report need to pay attention to these.
[Maria Padilla] [277.26s] And I think that I'll I'll show you later, the European population in academic centers are truly ahead of us in this regard by, having some, panels that review these CT scans on these patients.
[Maria Padilla] [296.87s] So the other thing is that low dose CT scan detects unrecognized ILD.
[Maria Padilla] [303.63s] So this is a golden opportunity for us to be able to look at these.
[Maria Padilla] [308.59s] So why are these ILAs so important?
[Maria Padilla] [312.75s] They are prevalent in the, lung cancer screening population.
[Maria Padilla] [318.64s] They're prevalent in the general population.
[Maria Padilla] [321.76s] And in those patients who have at risk for development of ILD, either because they have a genetic mutation or because they have a family history of ILD, the risk and the incidence and the prevalence in these, patients is certainly much higher.
[Maria Padilla] [341.68s] We know that some ILAs, not all of them progress, but some progress to development of ILD over time.
[Maria Padilla] [348.64s] It may be 3, it may be 4, it may be 5 years, but they're heading that way.
[Maria Padilla] [353.82s] So, and we also know from all the studies that have been conducted that there are functional, impairment in these subjects who have ILAs and that they have overall, increased mortality.
[Maria Padilla] [370.85s] So these are very important things that we should be looking at and making sure that if we had a crystal ball, we can determine that a minor changes that we see on, on these CT scans will eventually, in 5 years, become established disease.
[Maria Padilla] [391.63s] We don't have that yet, and we need to further study these.
[Maria Padilla] [396.19s] So what have we have found about the low dose CT scan when it comes to ILD?
[Maria Padilla] [402.75s] This was an early work that we did, here with the group when we looked at these patients.
[Maria Padilla] [408.03s] And we discovered that unrecognized ILD was already present in low dose CT scans.
[Maria Padilla] [415.81s] These are actionable diagnoses that we could have done something, with.
[Maria Padilla] [421.65s] But we don't have as yet a well established way to assessing them and to, and to follow them or to evaluate them.
[Maria Padilla] [434.70s] Okay?
[Maria Padilla] [435.18s] And that's where the European people are way ahead of us.
[Maria Padilla] [439.63s] So this is, this is the studies that looked at 1800, subjects from the Brompton, and they found that if you classify an ILA as greater than 5% involvement, they detected it in 4.2% of their population.
[Maria Padilla] [460.45s] Those subjects were then, evaluated and determined to have actual ILD disease, and those subjects would then refer, to the ILD center and were treated.
[Maria Padilla] [474.81s] So the small amount of, of patients that ended up treating is small by comparison and percentage wise, but it is a huge number when we talk about the many, CT scans that we are, performing.
[Maria Padilla] [492.16s] Okay.
[Maria Padilla] [492.56s] The same thing happened in the Yorkshire, lung screening trial where they did discover that the ILE ILAs, there were 2.5%, but they used a greater than 10% as the diagnostic criteria for reporting ILAs.
[Maria Padilla] [510.10s] And when they did that, they also found that there were patients who had, who were referred to the ILD center and who were diagnosed with the ILD and were treated for the ILD in at this point.
[Maria Padilla] [525.26s] And they also found that lung cancer in this population has a high, percentage rate.
[Maria Padilla] [533.18s] So we talk about following our patients with fibrotic lung disease and getting CT scans on a yearly basis because we are looking for that cancer.
[Maria Padilla] [544.07s] When the cancer is very small, we can do something for the patient with ILD.
[Maria Padilla] [548.87s] When the cancer has progressed, beyond the point where resection or intervention is not possible.
[Maria Padilla] [556.83s] It just adds more to the mortality of these patients.
[Maria Padilla] [560.90s] So with this, I wanna thank all of you who participate in the low dose, CT scan, programs across the world because this is a, a CT scan that alerts us to the potential for ILD.
[Maria Padilla] [576.75s] It also unmask ILD that is already unrecognized and allows us to, be able to do the same thing that you do with everything.
[Maria Padilla] [587.79s] Disease modifying interventions are gonna be there.
[Maria Padilla] [591.32s] We may start appropriate in the interventions for those patients who are fibrotic or inflammatory, and we offer the opportunity to participate in research and, and, trial participation.
[Maria Padilla] [606.31s] So and with that, I think that we're going to see that the survival and outcomes of the patients with, fibrotic lung disease is going to be better.
[Maria Padilla] [616.61s] So thank you.
The presentations were hosted by I-ELCAP – The International Early Lung Cancer Action Program.
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