Physician News (Rong Media Reporter Cai Zengrui Correspondent Liu Kejun) Due to the atypical symptoms of interstitial lung disease (ILD), many patients do not pay enough attention, coupled with the lack of standardized diagnosis and treatment capacity of some hospitals, resulting in missed diagnosis and misdiagnosis from time to time, which in turn makes patients miss the best treatment opportunity, which has a significant impact on patients' health and quality of life.
"Many patients come to the clinic with the support of several family members or bring oxygen cylinders, and some patients even progress to the point where they can only be treated with lung transplantation." Professor Guo Lu, Deputy Director of the Department of Internal Medicine, Chief Physician of the Department of Respiratory and Critical Care Medical Sciences, Director of the Respiratory and Critical Care Center and Deputy Director of the Lung Transplant Ward of the Affiliated Hospital of University of Electronic Science and Technology of China/Sichuan Provincial People's Hospital, said that ILD treatment must seize the opportunity and timely standardize the diagnosis and treatment and management of patients, which can significantly improve disease outcomes and prolong patient survival.
There is a common misunderstanding of ILD
In recent years, the prevalence of ILD in mainland China has increased year by year [1]. Although the public's attention to ILD has increased, there are still common cognitive misunderstandings, such as the belief that the incidence of ILD is younger. In fact, ILD is a group of lung diseases that primarily involve the alveoli and surrounding tissues and the interstitium of the lungs, with chronic inflammation and interstitial fibrosis predominantly [2].
Regarding the belief that ILD patients are gradually getting younger, Guo Lu pointed out that there are two main reasons: first, because people did not pay attention to ILD in the past, and did not pay attention to young patients, such as young people who have worked in dust environments for a long time, and fell ill due to occupational exposure and other reasons; Second, patients with connective tissue disease-related ILD are usually younger, such as rheumatoid arthritis, lupus erythematosus, etc. She said, "The epidemiological characteristics of different diseases of ILD are different, and it cannot simply be said that patients are getting younger. ”
For the public's various misunderstandings, Guo Lu proposed to expand education and appropriate education, not only to improve the public's awareness of the disease, but also to avoid overkill - some patients found signs of pulmonary fibrosis during physical examination, and they thought they could only live for 3-5 years on the Internet, and they were afraid that they could not sleep. She prompted, "Scientific education is very important, not only to make patients pay attention, but not to be too nervous. ”
In particular, the new crown virus can cause pulmonary fibrosis, which has increased the fear of some patients. In fact, the prognosis of pulmonary fibrosis caused by the new coronavirus varies from person to person. "At present, more than 100 patients with pulmonary fibrosis caused by the new coronavirus are being treated in our department. Follow-up observation showed that most patients were able to achieve reversal with early intervention. Guo Lu introduced that for patients who have ILD and are infected with the new coronavirus and pulmonary fibrosis is aggravated, upgrade treatment in time, and then downgrade after the condition is stable, can also obtain a better prognosis.
The management of ILD patients needs to be standardized and humanized
In general, the natural duration of illness in patients with ILD is 3-5 years. With the continuous advancement of treatment, the survival of patients can be significantly extended. "Patients receiving antifibrotic drugs, or undergoing lung transplantation, can effectively improve the prognosis and even create miracles of life." Guo Lu said.
Years ago, Guo Lu saw a 75-year-old ILD patient. The patient is a painter who has lived and worked in Dunhuang for more than ten years, and his books have been sold at home and abroad. However, ILD seriously affected his work and life, and finally he came to Professor Guo Lu, a respiratory specialist at Sichuan Provincial People's Hospital, to seek medical treatment. After Guo Lu learned about the patient's condition in detail, on the one hand, she treated the patient with antifibrotic drugs, and on the other hand, gave psychological support, and constantly encouraged the patient to establish confidence in treatment. With standardized treatment and management, the patient extended his survival by up to 10 years to the age of 85.
Patient adherence is critical to ensuring treatment outcomes. Guo Lu emphasized, "Standardized and humanized patient management is the prerequisite for improving compliance. From the initial diagnosis of patients, Guo Lu will repeatedly emphasize that early treatment can minimize symptoms, prolong survival, and make patients trust the team. In the process of treatment, the team has always adhered to standardized diagnosis and treatment, cooperated with anti-fibrotic drugs such as nintedanib, and professional follow-up management, etc., to win the long-term trust and support of patients. "Whether it is routine treatment of ILD or lung transplantation, our department's diagnosis and treatment capabilities are among the best in the country, and we can provide patients with full life cycle management to optimize treatment outcomes."
At the same time, in order to timely understand the condition of ILD patients and provide guidance, Guo Lu's team also spontaneously established a number of patient WeChat groups, and often posted disease science knowledge and answered patients' questions in the group. To date, they have managed nearly 700 patients. During long-term interactions, many patients have developed deep bonds with healthcare professionals.
The sentinel points for the prevention and treatment of ILD must be grassroots
For most ILD patients in mainland China, the first diagnosis unit is usually the primary hospital, so the diagnosis of the primary hospital often directly affects the follow-up treatment of the patient. In order to make the grassroots have the conditions for diagnosing ILD, Guo Lu pointed out that the grassroots should be equipped with pulmonary function meters and high-resolution CT to ensure that the grassroots have the corresponding detection capabilities.
When the patient goes to the primary hospital for examination, after completing the initial diagnosis, if the primary hospital cannot treat it, the patient can be transferred to the higher-level hospital to further clarify the type of disease, evaluate the condition, and carry out standardized treatment. In the long-term follow-up stage, the higher-level hospital can transfer the patient to the primary hospital for management, and once the patient's condition progresses, it will immediately transfer to the higher-level hospital for re-evaluation and treatment.
"With the close cooperation of higher and lower level hospitals, a two-way referral and closed-loop management mechanism is formed to ensure the full life cycle management of patients and ensure long-term treatment results." Guo Lu pointed out that through this diagnosis and treatment model, there is better collaboration between upper and lower level hospitals, and grassroots patients can also significantly reduce the burden of medical treatment.
In order to improve the diagnosis and treatment capacity of grassroots ILD, Guo Lu led the team to carry out a lot of work. For example, with the help of multidisciplinary remote collaboration platform, regular case discussions or expert consultations with the grassroots level are carried out to guide the standardized diagnosis and treatment of ILD; Hold ILD training courses, invite more primary doctors to come to the hospital for training, and learn multidisciplinary diagnosis and treatment methods in practice.
"The sentinel unit for ILD prevention and treatment must be the grassroots, which is one of the reasons why we established the Multidisciplinary Interstitial Diseases Group." She stressed that only by strengthening the standardized diagnosis and treatment of ILD and patient management capabilities at the grassroots level can we improve the level of ILD prevention and treatment in the country and truly benefit the majority of patients. ”
Strive for the discipline of respiration all your life
For more than 20 years of medical practice, Guo Lu has always done all kinds of work, through clinical, scientific research and teaching, constantly for the welfare of patients and contribute to the development of respiratory discipline, which is closely related to her growth environment and study experience.
Born into a medical family, Guo Lu grew up among doctors, with a home full of medical books and elders' chats often about healing and saving people. Under the influence of her family, she has felt the hardship and sanctity of being a doctor since she was a child, and she aspires to become a doctor when she grows up. To this day, she still remembers the saying that her grandfather often said, "If you are not a good look, you are a good doctor."
During her studies, the teachings of her master's and doctoral supervisors, Professor Li Weimin, had a profound impact on her. "The instructors are extremely rigorous in their studies and very demanding of their students, but they are very approachable in life." Guo Lu recalls that under the teachings of her mentor, she increasingly believes that respiratory science is a career worth fighting for for her life.
During her studies in the United States, she studied under Professor Jeffrey L. Curtis, a respiratory disease expert at the University of Michigan, during which she carried out a lot of research and practical work related to respiratory chronic diseases. Professor Curtis often teaches her to focus on clinical research, make full use of China's patient resources, and optimize clinical research by analyzing patient data to improve clinical practice.
With the teachings of the teachers, Guo Lu led the team to deeply cultivate the clinical research field of respiratory chronic diseases and achieved many important research results. Today, she has grown into an academic and technical leader of the Sichuan Provincial Health Commission, and is working with her team to reach a higher and more dangerous medical peak.
epilogue
After years of clinical practice and thinking, Guo Lu believes that in the process of diagnosing and treating patients, "holistic view" and "family view" are very important. The holistic view is not only the overall consideration of patients as "social people", but also the concept of co-existing disease treatment and overall management of multiple diseases, while the family view is to understand and coordinate the family relationship of patients, support the physical and mental health of patients and their families, and win their trust and cooperation.
"Doctors guard the entire life cycle of a patient. In this process, doctors will feel the continuation of life, and then want to help patients improve their quality of life and let them return to their families and society as soon as possible. She sighed that there is a light in the hearts of doctors, that is, not to forget their original intention, to treat diseases and save people, and to be the guardian of life.
[1] Contemporary Chinese Medicine. Pan Feng, 2019,26(07)
[2] LIU Mengying,WANG Tianzhen,CAO Mengshu. Advances in the treatment of interstitial lung disease[J].International Journal of Respiratory, 2021, 41(21):9.)