Physicians brief pulmonology dec14

Physician’s Brief clinical and research highlights for our colleagues in pulmonology Ye a r- E n d 2014

A Team Approach to ILD The term Interstitial Lung Disease (ILD) characterizes more than 100 distinct disorders with vastly different treatment approaches and responses to therapy. Such a wideranging disease portfolio requires an equally comprehensive approach to diagnosis and treatment, and for that the University of Michigan

utilizes a multidisciplinary team approach.

Anchored by weekly conferences, the U-M Interstitial Lung Disease Program brings together experts from pulmonology, radiology and pathology to review case material and assign an accurate diagnosis

(or determine if additional tests are required to achieve a diagnosis). Once a diagnosis is achieved, the U-M ILD program utilizes collaborative expertise from additional specialties to aid in treatment. These specialists may include rheumatology, cardiology, gastroenterology, pulmonary hypertension, sleep medicine, lung transplantation, pulmonary rehabilitation, nursing and other support services. This collaborative team approach to treatment allows for consideration of the best standard and/or research approaches to each case. Communication between the U-M ILD program and the patient’s referring physician helps to coordinate ongoing care locally when possible.

Idiopathic pulmonary fibrosis is a specific type of ILD. Two drugs (pirfenidone and nintedanib) were approved for the treatment of IPF (but not other ILDs) by the FDA in October, 2014. The approval of these drugs specifically to treat IPF Continued on page 2

The U-M ILD Program treats the full range of related conditions, including but not limited to:

U-M’s Kevin Flaherty to network and registry

■ Idiopathic Pulmonary Fibrosis (IPF) ■ Sarcoidosis ■ Non-specific Interstitial Pneumonia (NSIP) ■ Scarring disease of the lung associated with autoimmune diseases

such as lupus, scleroderma, myositis, rheumatoid arthritis and mixed connective tissue disease ■ Respiratory bronchiolitis ■ Pulmonary alveolar proteinosis ■ Granulomatosis with polyangiitis ■

Pulmonary Fibrosis

Hypersensitivity pneumonitis

■ Rheumatoid lung ■ Evaluation for lung transplant

Continued from page 1

further highlights the importance of an accurate diagnosis.

trials, including many trials that originate here.

The University of Michigan Interstitial Lung Disease Program is also at the forefront of researching, developing and testing novel therapeutic approaches, from basic science studies through translational research. U-M is among the top centers in the U.S. participating in ILD clinical

Ours is one of the first programs in the U.S. to demonstrate how well this approach works for ILD. We have published extensively on our methods, setting the nationwide standard of multidisciplinary care and innovative research in ILD.

For an interstitial lung disease referral, call us at 888-287-1084.

One number. Unlimited assistance.

800-962-3555

Your physician-to-physician connection to over 3,000 U-M doctors and 26 departments, 24 hours a day. Schedule an appointment, coordinate a patient transfer, request a consultation or inquire about any clinical service.

Kevin R. Flaherty, M.D., M.S., medical director of the U-M Interstitial Lung Disease Program, has been appointed chairman of the steering committee of the Pulmonary Fibrosis Foundation (PFF) Care Center Network (CCN) and Patient Registry, a national collaborative formed to improve the understanding and treatment of interstitial lung diseases.

Michigan is one of nine elite treatment centers that currently make up the CCN. Together they are working to provide comprehensive, multidisciplinary patient care. Although each site has individual experience in treating lung fibrosis, the network’s strength comes from the ability of sites to share ideas, advance research and determine best practices. The goal is to bring more centers into the network in the near future so that their progress will benefit many more patients.

The PFF Patient Registry is collecting information from patients with a range of fibrotic pulmonary disorders whose care is not determined by a clinical study protocol. This will make it possible for investigators to study the distribution of disease types, and how diseases behave within different demographic and geographic groups, to help determine best practice patterns.

The registry also collects patient-

Update lead national IPF care

Kevin Flaherty, M.D., M.S.

reported outcomes and includes a centralized biorepository, a resource for investigators studying the pathobiology of lung fibrosis, identifying prognostic markers and developing potential therapies.

Because the network is organized and supported by the Pulmonary Fibrosis Foundation, there is hope that a broad coalition of stakeholders will participate, speeding the development of promising therapies. Dr. Flaherty’s role as the chairman of the steering committee is to encourage collaboration and help move promising projects forward.

Patients and families stand to benefit from the network in numerous ways, including greater access to the expert medical care and support services necessary to manage these complex conditions, and up-to-date information on the latest advances and clinical trials.

To learn more about the network and the registry, visit www.pulmonaryfibrosis.org.

Anticipating New U.S. Lung Screening Guidelines, U-M Opens Dedicated Clinic In a major policy change, the U.S. Preventive Services Task Force recently issued new guidelines recommending annual CT scans for adults at high risk for developing disease, specifically, men and women age 55-80 with at least 30 pack years of exposure (one pack of cigarettes a day for 30 or more years), whether they are still smoking or have quit within the last 15 years. Medicare coverage has also been approved through a draft recommendation issued recently.

The change was driven by data from the National Lung Screening Trial, a randomized trial involving 53,454 current or former heavy smokers ages 55 to 74. The trial compared low-dose helical CT with standard chest X-ray for detecting lung cancer. Participants screened with CT scans had a 20 percent lower risk of death from lung cancer than those screened with X-rays.

In part as a response to the new guidelines, the U-M Lung Cancer Screening Clinic opened in a new location in the fall of 2014 at U-M’s newest outpatient health center in Northville, MI. The screening process includes shared decision-making, an initial lowdose CT scan and an office visit to discuss the results and promote tobacco cessation. Yearly scans for high-risk individuals with limited

Douglas Arenberg, M.D.

co-morbidity between the ages of 55 and 80 are the current USPSTF recommendation.

“This is an important finding for those of us who care for lung cancer patients,” says Douglas Arenberg, M.D., who leads the new clinic. “We’ve waited 40 years for proof that lung cancer screening saves lives. This study proves that, in the right population, screening performed by experienced institutions can reduce the number of people dying from lung cancer.”

Through the U-M Lung Cancer Screening Clinic, patients have access to an interdisciplinary team with significant experience identifying and monitoring lung nodules while minimizing unnecessary invasive procedures.

For more information or to make a referral, visit lung-cancerscreening@umich.edu.

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University of Michigan Health System Division of Pulmonology & Critical Care Medicine Theodore J. Standiford, M.D., Division Chief tstandif@med.umich.edu | 734-936-5010 Executive Officers of the University of Michigan Health System

The Regents of the University of Michigan

Michael M.E. Johns, M.D., Interim Executive Vice President for Medical Affairs; James O. Woolliscroft, M.D., Dean, U-M Medical School; T. Anthony Denton, J.D., MHA, Acting Chief Executive Officer, U-M Hospitals and Health Centers; Kathleen Potempa, Ph.D., Dean, School of Nursing.

Mark J. Bernstein, Julia Donovan Darlow, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mark S. Schlissel, ex officio.

The University of Michigan, is a non-discriminatory affirmative action employer. Š 2014 The Regents of the University of Michigan