New interstitial lung disease patient

Referred with interstitial lung disease.

History:
Breathlessness: [onset, rate of change, MRC 1 to 5]
Cough: [dry or productive, duration]
Best exercise tolerance in the last year, and now: []
Weight loss, fever, fatigue: []
Chest pain: []

Occupational history, every job in order:
[]
Asbestos: [trade, years, and the nature of the exposure]
Silica, coal, metal dust, welding fume: []
Wood dust, textile dust, grain: []
Personal protective equipment used: []

Environmental and antigen exposure:
Birds kept, now or in the past, including a partner's: [species, years]
Feather bedding, duvets and pillows: []
Damp, mould or water damage at home or work: []
Hot tub, humidifier or air conditioning: []
Farming, hay, compost, mushrooms: []
Any relationship between symptoms and being at home, at work, or away: []

Drugs, now and previously:
[amiodarone, methotrexate, nitrofurantoin, bleomycin, immune checkpoint
inhibitors, and any drug started within a year of symptoms]
Radiotherapy to the chest: []
Recreational drug use, including inhaled: []

Connective tissue disease review:
Joint pain, swelling or morning stiffness: []
Raynaud phenomenon: []
Dry eyes or dry mouth: []
Rash, photosensitivity, Gottron papules, mechanic's hands: []
Muscle weakness, difficulty rising from a chair or lifting arms: []
Reflux and dysphagia: []
Mouth ulcers, hair loss: []

Other:
Smoking: [pack-years, quit date]
Family history of pulmonary fibrosis or early grey hair or bone marrow
failure: []
Reflux: []
Cardiac history: []

Examination:
SpO2 []% at rest on air, [] after exertion
Height [] cm, weight [] kg
Crackles: [fine, velcro, distribution]
Clubbing: []
Joints, skin, nails and nailfold capillaries: []
Signs of pulmonary hypertension or right heart failure: []

Investigations:
High resolution CT: [pattern, distribution, honeycombing, traction
bronchiectasis, ground glass, mosaicism, air trapping on expiration]
Full lung function: FVC [] L ([]%), TLCO []%, and any previous values for
comparison
Walk test with oximetry: [distance, nadir SpO2]
Autoimmune screen: [ANA, ENA, rheumatoid factor, anti-CCP, myositis panel,
ANCA, CK]
Serum precipitins or specific IgG to relevant antigens: []
Echocardiogram: []
Bronchoscopy with lavage or biopsy, if indicated: []

Impression:
[radiological pattern] on CT, with [] % predicted FVC and [] % predicted
TLCO, most consistent with [], to be discussed at the ILD MDT.

Plan:
1. Discussed at ILD multidisciplinary meeting on []
2. Antifibrotic or immunosuppressive treatment: [considered, started, or not
indicated]
3. Antigen avoidance: [specific advice given]
4. Oxygen assessment: []
5. Pulmonary rehabilitation: []
6. Vaccination: []
7. Smoking cessation: []
8. Lung transplant discussion, or referral: [yes, no, with reason]
9. Clinical trial eligibility considered: []
10. Review in [] months with repeat lung function