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Your Good Health: Chest X-ray reveals a finding of interstitial lung disease

There are two issues here: The first is that ILD does need to be treated. The second is whether it’s better to tell your mother about the diagnosis.
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Dr. Keith Roach

Dear Dr. Roach: My mother is 86 years old. She is in relatively good health. She recently saw her primary care physician for her routine checkup. Prior to her visit, she had developed cold symptoms. When her physician listened to her lungs, she heard some mild crackles at the base of her lungs. As a result, she was sent in for a chest X-ray. Her X-ray revealed a new finding of mild basilar interstitial lung disease.

Symptom-wise, she has a rare cough with mild dyspnea on exertion. She remains active for a woman her age. She drives, does her own housework, shops, etc. How concerned should we be, and at her age, would you recommend treatment? We have opted not to tell her about her diagnosis as she is pretty savvy with a computer. We are concerned that if she reads about ILD, she will become very alarmed.

C.F.

There are two issues here: The first is that ILD does need to be treated. The second is whether it’s better to tell your mother about the diagnosis.

It’s difficult for me to be precise about her prognosis because there are many different ILDs. Some ILDs are related to other conditions; exposures that are usually occupational, such as with coal or silica; or drugs, whether prescribed (amiodarone is common) or recreational (like cocaine).

Then there are many primary diseases that can cause an ILD, like sarcoidosis, Langerhans cell histiocytosis and lymphangioleiomyomatosis. Some infections, like nontuberculous mycobacteria, can look like an ILD. Finally, there are people who get an ILD for unknown reasons, and they fall into the general category of having an idiopathic interstitial pneumonia. Idiopathic pulmonary fibrosis is the most common.

Because a correct diagnosis is necessary for treatment, I can’t give you any information on whether treatment is appropriate until you have a diagnosis. The initial test would be a CT scan of the lungs. But in general, for an 86-year-old woman who sounds like she has pretty mild symptoms (“dyspnea on exertion” just means someone can’t catch their breath when doing activities), she may not need treatment.

I am very uncomfortable with not telling a patient about her own diagnosis. I have had a handful of cases where a person has specifically asked not to be told of their condition. I have also had many cases where a person is unable to understand their diagnosis completely (such as a person with dementia). But I would be very concerned that you are doing your mother a disservice by not being completely forthright about the X-ray findings.

In my experience, the vast majority of older people want to know their diagnosis and prognosis, and also want to be involved in their own care. It may be as simple as getting a CT scan and deciding not to do anything for some months while monitoring her symptoms. Getting a CT scan is a low-risk step that will give you a much better idea about what condition she might have.

Finally, let me point out that she might already have some anxiety due to her symptoms and the chest X-ray, the results of which haven’t seemed to been explained to her.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu