Time Is Lung: Inpatient Transbronchial Lung Cryobiopsy Decreases Wait Time to Treatment Initiation for Newly Diagnosed Interstitial Lung Disease

Although performing lung biopsies on hospitalized patients with interstitial lung disease (ILD) has risk, initial studies have shown transbronchial lung cryobiopsy (TBLC) may be safely performed in this patient group. Data evaluating the value of this intervention in establishing a diagnosis and impacting management is lacking. We present a comparison of TBLC for inpatients and outpatients and provide data on the impact on medical therapy initiation and wait times from consultation to biopsy and treatment. Demographic data, pulmonary function values, chest imaging patterns, procedural information, diagnosis, and medical therapy changes, defined as medication initiation, adjustment, or cessation guided by TBLC results, were recorded from enrolled patients with newly identified ILD. Changes in medical therapy were the primary outcome. Time from consultation to biopsy and treatment was the secondary outcome. Fifty-four (54) patients (40 outpatient, 14 inpatient) were included. Inpatients underwent biopsy 2.5 ± 4.4 days after consultation compared to 15.5 ± 16.1 days for outpatients (p < 0.001). Medical therapy changes occurred 10.3 ± 7.9 days after biopsy for inpatients compared to 34.6 ± 37.0 days for outpatients (p < 0.001). There were no significant differences in medical therapy changes between the groups (p = 0.45). Our initial study suggests that performing TBLC on inpatients with newly identified ILD decreases wait times to treatment initiation and diagnosis. Efforts to understand the impact of a decreased wait time on ILD prognosis, including the development of progressive disease or fibrosis, symptom evolution, and quality of life, require further evaluation.