Background:Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD has been managed in tertiary referral centres.Objectives:We set up a combined service incorporating both rheumatology and respiratory domains in a district general hospital (DGH) to help patients avoid long journeys and improve their experience whilst focusing on an integrated care pathway. We evaluated the outcomes of the first set of patients managed in this proof-of-concept service model.Methods:Referrals were accepted from any hospital specialist involved in the management r-ILD. They were triaged by lead ILD pulmonologist to monthly ILD MDT comprising a rheumatologist, respiratory physician, a radiologist and ILD specialist nurse. Appropriate patients were booked into combined clinic, run by the respective rheumatology and chest specialists with ILD interest, attracting a multi-speciality tariff. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management.Results:89 patients were included in this proof-of-concept. Mean age was 66.1 yrs (19-90 yrs) and 44% (n=39) were male. 35 (40%) had RA, 34 (39%) had CTD, eight (10%) had sarcoidosis, five had IPAF and seven others. Most predominant HRCT pattern was NSIP (n=53,60%) followed by UIP (n=23, 21%), sarcoid (n=10, 12%) and miscellaneous (LIP and mixed). Mean FVC was 2.64 L/min (1.93-4.13) with DLCOc of 52.7% (28.9-90.1%) predicted. Only two patients had all antibodies negative whilst 87 had at least one antibody positive with ANA being the most common (n=28).Most (83%) patients were treated with immunomodulators including nine with rituximab. 39 (44.3%) patients had significant improvement in clinical, imaging and pulmonary parameters with DLCOc improving to 56.57% and FVC to 2.70 L/min. There were similar improvements in six minute walk test. 17 patients died and 20 patients required long term oxygen therapy.Conclusion:This proof-of-concept real world study confirms the utility of a combined specialist service in a district general hospital. Nearly half of this complex and resource intensive patient cohort had good clinical outcomes and derived benefit from the expertise in one room. Feedback from both patients and referrers was unanimously positive. No patient required tertiary centre referral and all could be managed adequately in the clinical setting.Our report confirms that r-ILD can be managed in a DGH setting with a stream-lined service offering clear benefits to patients. We would argue that r-ILD service, congruent to satellite pulmonary hypertension clinics in secondary care with hub-and-spoke model liaison with tertiary centre, can be established on similar principles and could help over-stretched tertiary care with repatriation of services whilst helping develop local expertise in the management of chronic ILD.Disclosure of Interests:Karim Salama: None declared, Natasha Ramsundar: None declared, Vijay Joshi: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB

Background: Coexistence of bronchial asthma and allergic nasal polyposis make both disorders more difficult to control with more exacerbation and more eosinophilic inflammation. Aim: to assess the coexistence of subclinical bronchial asthma in patients with allergic nasal polyp refractory to medical therapy and to identify those at risk of developing asthma. Subjects and methods: A case-control study was conducted on 60 allergic nasal polyp patients and 60 healthy subjects. All of them were assessed by peripheral eosinophils%, allergic rhinitis score (SFAR), NOSE-score, endoscopic-sinus examination, sinus computed tomography using Lund and Mackey scoring-system, asthma screening questionnaire (ASQ), spirometric-indices, and histopathological examination of endoscopically removed polyps. Results: Patients with allergic nasal polyps had significantly lower spirometric-indices than controls. Subclinical asthma was significantly more common in-patient group than controls (61.7% vs. 10%), it was of mild and moderate severity (83.8% and 16.2%). Allergic nasal polyp patients with coexistence of asthma had significantly higher peripheral eosinophils %, SFAR-score, NOSE-score, Lund and Mackey CT-score, and ASQ score (10, 39.7, 40.5, 40, and 40.1) than patients without asthma (15.2, 15.7, 15.2 and14.1). Moreover, they had significantly common eosinophilic-predominate pathological subtypes (81.1%).

Background Subclinical or overt cardiovascular affection in patients with interstitial lung diseases (ILD) may expect to have increased mortality and/or reduced exercise capacity. Objective Echocardiographic (echo) assessment of right ventricular (RV) and left ventricular (LV) functions in patients with ILD. Patients and methods Conventional echo, tissue Doppler imaging (TDI) and two-dimensional speckle tracking echo (2D STE), spirometry [forced vital capacity (FVC%), forced expiratory volume in 1 s% and forced expiratory volume in 1 s/FVC], and functional exercise capacity (6 min walking test) were performed on 60 patients with ILD and 60 age-matched and sex-matched controls. Pulmonary involvement was identified in high-resolution computed tomography (HRCT) and scored according to a semiquantitative Warrick score. Results Using conventional echo-Doppler, TDI, and 2D STE, there are statistically significant impairments in both RV systolic and diastolic functions, as well as LV diastolic functions in ILD patients compared with controls (P<0.05). LV systolic dysfunction was detected by TDI and STE only; however, ejection fraction was normal by standard echo. In the ILD group, the tricuspid annular plane systolic excursion was positively correlated with PaO2 and FVC%, while it was negatively correlated with the HRCT score. RV global longitudinal strain% was positively correlated with both 6 min walking distance and FVC%. Moreover, LV global longitudinal strain% was positively correlated with both 6 min walking distance and PaO2, while it was negatively correlated with HRCT score. Conclusion Both RV and LV systolic and diastolic dysfunctions were detected by echo in ILD patients. Ventricular dysfunctions were related to hypoxemia, radiological score, and vital capacity of the lungs. Ventricular dysfunction has a negative impact on function exercise capacity of patients with ILD.