Management of interstitial lung disease: an audit at a university teaching hospital in Saudi Arabia.

To assess the management of interstitial lung disease (ILD) in relation to the published guidelines 122 consecutive cases were analyzed. Clinical features and non-invasive laboratory tests led to the diagnosis in nearly one sixth of the patients (16%), mainly CTD and a few miscellaneous disorders. In another sixth the diagnosis was reached by means of a transbronchial lung biopsy, particularly in sarcoidosis. Nearly a third had surgical lung biopsies, which were diagnostic in 98%. The diagnoses were reached in 82 patients (67%) and include: cryptogenic fibrosing alveolitis (20), sarcoidosis (16), connective tissue disease (17) and miscellaneous (29). The remaining third were undiagnosed, and this group had a higher mean age and was much less likely to receive immunosuppressive therapy than any group with a specific diagnosis. It is concluded that while physicians reached a specific diagnosis in most cases of ILD, commonly through a lung biopsy. A sizeable proportion (nearly a third), or remained undiagnosed and those were less likely to be treated and had a poorer prognosis. The availability of less invasive techniques should encourage physicians to obtain a biopsy since this is likely to lead to a more active approach to therapy.