From the Guidelines
Envisia testing is a valuable tool in the diagnosis of interstitial lung diseases (ILD), particularly when traditional methods are inconclusive, and should be considered as part of a comprehensive diagnostic approach. When diagnosing ILD, it is crucial to consider the risks and benefits of various diagnostic methods, including bronchoalveolar lavage (BAL), transbronchial lung biopsy (TBLB), and surgical lung biopsy (SLB) 1. Key considerations include:
- The diagnostic yield of each method: BAL has a low rate of adverse events but limited diagnostic value, while TBLB has a higher diagnostic yield but is poorly sensitive for complex histopathological patterns such as usual interstitial pneumonia (UIP) 1.
- The risks associated with each method: SLB is considered the reference standard but is associated with significant morbidity and mortality, particularly in older patients or those with significant lung function impairment 1.
- The potential benefits of less invasive methods: transbronchial lung cryobiopsy (TBLC) has been explored as a less invasive alternative to SLB, offering larger samples without crush artefacts 1. In the context of Envisia testing, it is essential to prioritize a comprehensive diagnostic approach that includes clinical history, physical examination, pulmonary function tests, and radiographic findings. This approach can help reduce the need for invasive surgical lung biopsies and improve diagnostic accuracy, particularly in patients with indeterminate patterns on high-resolution CT scans 1. Ultimately, the use of Envisia testing should be guided by the principles of minimizing morbidity, mortality, and improving quality of life, and should be considered as part of a multidisciplinary discussion (MDD) that integrates clinical, laboratory, and radiological data 1.
From the Research
Envisia Testing for ILD
- Envisia testing is not explicitly mentioned in the provided studies, however, the diagnosis and treatment of Interstitial Lung Disease (ILD) are discussed in detail 2, 3, 4, 5, 6.
- ILD is a group of pulmonary disorders characterized by inflammation and/or fibrosis of the lung parenchyma, and it can be diagnosed using thoracic computed tomography, which is approximately 91% sensitive and 71% specific for diagnosing subtypes of ILDs such as IPF 2.
- The treatment of ILD typically involves antifibrotic therapy with nintedanib or pirfenidone, which can slow the annual decline in forced vital capacity (FVC) by approximately 44% to 57% in individuals with IPF, scleroderma-associated ILD, and in those with progressive pulmonary fibrosis of any cause 2, 3, 4, 5, 6.
Diagnosis and Treatment of ILD
- The most common forms of ILD are idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis, and connective tissue disease (CTD) 2.
- ILD typically presents with dyspnea on exertion, and approximately 30% of patients with ILD report cough 2.
- Physiologic assessment provides important prognostic information, and a 5% decline in FVC over 12 months is associated with an approximately 2-fold increase in mortality compared with no change in FVC 2.
- Antifibrotic therapy with nintedanib or pirfenidone can slow the annual decline in FVC, and immunomodulatory therapy, such as tocilizumab, rituximab, and mycophenolate mofetil, may slow decline or even improve FVC at 12-month follow-up in patients with connective tissue disease-associated ILD 2, 3, 4, 5, 6.
Side Effects and Treatment Outcomes
- Pirfenidone and nintedanib have side effects that affect patients in different ways and have different levels of severity, making treatment even more challenging for patients and clinicians 4, 6.
- The most widely accepted method for evaluating the progression of ILD is through the decline in FVC, as determined by respiratory function tests 4, 6.
- A decrease in FVC over a 6-12-month period correlates directly with increased mortality rates, and antifibrotic drugs pirfenidone and nintedanib have been extensively validated to slow disease progression and decrease all-cause mortality 4, 6.