Interstitial lung diseases: course report

Faculty

Overview

This European Respiratory Society (ERS) course, held in Heidelberg, Germany on April 18–20, 2018, provided an overview of the field of interstitial lung diseases (ILDs). Participants learnt which diagnostic procedures should be applied based on given clinical circumstances, and what difficulties can arise in ILD diagnosis. Special emphasis was given to practical courses including high-resolution computed tomography courses, as these typically guide the diagnosis of many ILDs; this was accompanied by sessions on ILD pathology and a hands-on session on cryobiopsy. Therapy remains a challenging aspect of treating many ILDs, so this course provided participants with insights into the pros and cons of specific ILD treatments and practical issues were discussed in a workshop. Interdisciplinary ILD board discussions were held between specialists and course participants, and course attendees had the opportunity to bring their own challenging cases and discuss them with leading experts. Furthermore, there was a dedicated discussion session on the impact of comorbidities on the clinical course of ILD treatment. 84 participants from 27 different countries took part in this course.

One of the main challenges during the course was the different levels of previous knowledge of the participants. While many had basic comprehension of ILD, others were already very advanced. This also reflected the different challenges identified during the course; for many the complex diagnostic approach to ILDs, its sophisticated treatment approach and its complications as acute exacerbations were challenges before the course. For more advanced colleagues, difficulties in the management of chronic diseases such as chronic hypersensitivity pneumonitis or the complex approach to the diverse forms of connective tissue disease associated ILDs was challenging.

Participants’ involvement in the course was intense and they were eager to learn about all aspects of ILD: the aspects on diagnostics including a hands-on session for cryobiopsy, the various diseases including their management, but also more complex facets like palliative care, management of comorbidities and finally the differences in management between countries and continents. Moreover, a future in ILD session was included to enable participants to discuss the future in this challenging area with leaders in the field.

There were many different interactive sessions including workshops, interactive ILD boards and discussion rounds. Here, participants and faculty were engaged in lively discussions and in a hands-on session for cryobiopsy participants learnt to collect biopsies from swine lungs using a cryoprobe.

While we have experienced significant progress in the field of ILD in the past 10–15 years, there are many open questions for future research in this field. One example is the optimised treatment for chronic fibrosing ILDs, where we are able to decelerate disease progression in some (e.g. idiopathic pulmonary fibrosis) but are uncertain of the choice of optimal treatment in others (e.g. in chronic hypersensitivity pneumonitis). Other more relevant research questions are the approach to ILD-associated complications such as acute exacerbations or the importance of “early” ILD, namely interstitial lung abnormalities. For educational activities the combined efforts of ERS school courses on the various aspects of ILDs, online modules, postgraduate courses during the ERS International Congress and interactive webinars were identified as essential for future education in this field.

The field of ILDs is one of the most challenging and exciting in pulmonary medicine where significant new developments are to be awaited on an annual basis. In light of this, participants demanded updates on ILDs on a regular basis. Therefore, the faculty and the course organisers think that it is imperative to repeat this ERS course on ILDs on a regular basis with adaptions on contents and course format as needed.

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Diana Calaras, Republic of Moldova, a participant

ILD is a field of special interest for me. Also, it is a domain that, unfortunately, is poorly known by specialists in our country, this is why I was very optimistic about this course. By the end of the first day I knew the course had fulfilled all my expectations and even surpassed them.

Besides the very informative and up-to-date presentations on a broad spectrum of topics, the interactive sessions were the part I enjoyed the most, because it gave us the possibility to learn how to apply all this information in the clinical setting, and because it is also a very efficient way of emphasising the appropriate steps in diagnosing an ILD.

On the second day we were divided into four smaller groups and this was actually the day where we got a closer interaction with the other participants and found out about their experience, which was in fact quite diverse. In this session, I was introduced to palliative care for ILD patients. This turned out to be a very sensitive topic and these discussions emphasised a problem that we have in my country since palliative care is provided mostly for oncology patients.

The hands-on workshop session on cryobiopsy gave us an important insight into this innovative, for the majority of us it was easy to perform and a very efficient modality for obtaining lung tissue samples.

During the multidisciplinary discussion session with cases from the participants, I realised that pneumologists all over the world are dealing with the same difficulties with respect to establishing a diagnosis or choosing the optimal treatment, especially for fibrotic lung diseases. I also learned that multidisciplinary discussions are a very useful way of making an ILD diagnosis and probably should be the only way a case with an ILD should be approached.

For me, this course was very inspiring, and I would like to congratulate the organisers for such a comprehensive course. I have enjoyed every single moment of it.