Here's What Constitutes The Treatment For Interstitial Lung Disease

Interstitial lung disease (ILD) is a group of lung disorders characterised by inflammation and/or scarring of lung tissue. Such damage can affect the ability to breathe and to get adequate oxygen into the blood stream.

There are many factors that cause ILD. Auto-immune diseases like rheumatoid arthritis and sarcoidosis to exposure to environmental trigger factors like dust and smoke. However, mostly the disease has a genetic component that largely remains elusive. The most common symptoms of ILD are shortness of breath that worsens over time and dry cough.

Once the diagnosis is made, the doctor will discuss the treatment options. As Dr Anand Jaiswal, Director and HOD, Department of Respiratory Medicine, Medanta Hospital, Gurugram says "Regardless of the cause, the goal is to improve the overall quality of your life by resolving inflammation and reversing or slowing the rate of progression of scarring. Importantly, the idea is to improve the quality of life in such patients. There are a handful of drugs that are useful in such situations namely corticosteroids and other steroid-sparing drugs like Mycophenolate and Azathioprine"

Dr Anand Jaiswal continues "Corticosteroids (ex: prednisolone) is the treatment of choice in many categories of ILD. However, there are many side effects associated with steroids like abnormal weight gain, high blood pressure, depression. There is also a tendency to develop diabetes, peptic ulcer, infections and osteoporosis (weakening of bones). The side effects of steroids have led to usage of steroid-sparing drugs. They suppress immune system to reduce the further damage that can be caused by ILD".

Dr Jagadish Chandra Suri, Director and HOD, Pulmonology, Fortis Flt.Lt.Rajan Dhall Hospital, Vasant Kunj, Delhi claims "However, there are newer drugs on the horizon now. There is a class of drugs called anti-fibrotics which are approved for Idiopathic Pulmonary Fibrosis (IPF)- Pirfenidone and Nintedanib. Pirfenidone is an oral medication while the mechanism of action is unknown, but it seems to have both anti-fibrotic and anti-inflammatory properties. Pirfenidone slows the progression of disease for some people with IPF. Nintedanib is also an orally taken medication with a specific mechanism triple kinase inhibitor that blocks several pathways that lead to the development of scars. Like pirfenidone, nintedanib also slows the progression of disease in IPF patients"

"Response to therapy varies among patients. Some types of ILD may respond quickly, and others may not respond at all. Treatment is considered successful if symptoms, physiologic findings and X-ray findings are stabilized. Even with treatment, many types of ILD progress naturally with a worsening of symptoms, X-ray findings and physiologic findings. Sometimes worsening is due to a complication of the disease or therapy. This may include conditions such as pulmonary hypertension or right heart failure" Dr Jagadish Chandra Suri concludes.

Dr Nevin Kishore, Head of Bronchology and Sr Consultant, Respiratory Dept, Max Hospital, Saket chimes "The major problem with lungs being affected in ILD is less oxygen in the bloodstream. Therefore, oxygen is required for some people with ILD because of low level of oxygen in the blood. Some may need oxygen therapy all of the time while others may need it only during sleep or exercise. Improving the level of oxygen in the blood by supplemental oxygen relieves strain on the heart and lungs and improve symptoms of shortness of breath and fatigue.

However, ILD may progress despite intensive and continuous therapy. If this happens, lung transplantation is the last option. Lung transplant surgery replaces one or two diseased lungs with healthy lungs from a non-living donor. With improved surgical techniques and post-transplant care, this offers an improved quality of life and thereby longer survival. Importantly, ILD doesn't recur in transplanted lungs" Dr Nevin Kishore concludes.

Pulmonary rehabilitation program is recommended for all patients with ILD. This includes education, exercise conditioning, breathing techniques, nutritional counseling and psychosocial support. To conclude, the goal of treatment in ILD is to decrease symptoms and increase the quality of life leading to prolonged survival.