Interstitial lung disease in Malta

Abstract

Aim: To establish the prevalence, management and response to treatment of interstitial lung disease (ILD) in Malta. Methodology: The personal files of 102 living and 26 deceased patients with ILD under the care of 4 respiratory physicians were reviewed retrospectively. The investigations utilised for reaching the diagnosis, patient management and response to treatment were analysed. Results: The prevalence of ILD was estimated at 24.9 per 100,000 population. Pulmonary function tests were performed at least once in 109 patients (n=128, 85%), and pletysmography and exercise oximetry in 36 patients (n=128, 28%). A chest x-ray (CXR) was performed in 120 patients (n=128, 93.7%), of which 8 (n=120, 6.66%) were normal, a computed tomography scan of the thorax in 113 patients (n=128, 88.3%), all of which showed fibrotic changes and a DTPA scan in 17 patients (n=128, 13.3%). Regarding more invasive investigations, bronchoalveolar lavage was performed in 10 patients (n=128, 7.8%), open lung biopsy in 4 patients (n=128, 3.1 %), video-assisted thoracoscopic surgery in 4 patients (n=128, 3.1%) and transbronchial lung biopsy in 7 patients (n=128, 5.5%). Corticosteroids were the most common drugs prescribed in 64 patients (n=128, 50%) followed by azathioprine in 23 patients (n=128, 18%) and cyclophosphamide in 3 patients (n=128, 2.3%). There was a definite worsening in lung function associated with increasing age. There was no standardisation of follow up for these patients. Conclusion: The method of diagnosis, management and follow up of patients with ILD locally requires improvement to optimise standards of care and hence compare with proposed international guidelines.