Interstitial lung disease (ILD) refers to a group of disorders that cause progressive scarring (fibrosis) of lung tissue. This can affect oxygenation.

Causes

Long-term exposure to hazardous materials such as asbestos, silica dust, and coal dust.
Autoimmune diseases like rheumatoid arthritis, lupus, and scleroderma.
Medications, including certain chemotherapy drugs, antibiotics, and heart medications.
Radiation therapy to the chest.
Infections such as hepatitis C and HIV.
Idiopathic pulmonary fibrosis, where the cause is unknown.

Diagnosis

Blood tests: To check for infections, autoimmune diseases, and other conditions.
Imaging tests: High-resolution CT scans provide detailed images of the lungs to assess the extent of fibrosis.
Pulmonary function tests: Measure lung capacity and the ability to transfer oxygen into the blood.
Bronchoscopy: A flexible tube is inserted into the lungs to collect tissue samples.
Lung biopsy: A small sample of lung tissue is examined under a microscope.

Treatment

Medications:
- Anti-fibrotic drugs like pirfenidone and nintedanib to slow the progression of fibrosis.
- Corticosteroids to reduce inflammation.
- Immunosuppressants for autoimmune-related ILD.
Oxygen therapy: To maintain adequate oxygen levels in the blood.
Pulmonary rehabilitation: Exercise and education programs to improve lung function and quality of life.
Lung transplant: For severe cases where other treatments are ineffective.

Causes and Management of Interstitial Lung Disease

Cause	Clinical Diagnosis	Investigations	Management
Idiopathic Pulmonary Fibrosis (IPF)	Gradual onset of dry cough and dyspnoea, fine inspiratory crackles, clubbing	High-resolution CT (HRCT) scan showing honeycombing and reticular patterns, pulmonary function tests (PFTs)	Antifibrotic agents (e.g., Pirfenidone, Nintedanib), pulmonary rehabilitation, oxygen therapy, lung transplantation in advanced cases
Hypersensitivity Pneumonitis (HP)	Recurrent exposure to organic dust, birds, or mold; symptoms worsen after exposure	HRCT showing ground-glass opacities, poorly defined centrilobular nodules; bronchoalveolar lavage (BAL) showing lymphocytosis	Avoidance of antigen, corticosteroids for acute management, immunosuppressants for chronic cases
Sarcoidosis	Systemic symptoms (fatigue, weight loss), erythema nodosum, bilateral hilar lymphadenopathy	HRCT showing perilymphatic nodules, non-caseating granulomas on biopsy, elevated serum ACE levels	Corticosteroids (first-line), immunosuppressants (e.g. methotrexate) for refractory cases, monitoring for organ involvement
Connective Tissue Disease-Associated ILD (e.g., Scleroderma, Rheumatoid Arthritis)	Symptoms of underlying CTD (joint pain, skin thickening), dyspnoea on exertion	HRCT showing ground-glass opacities, reticulations; autoantibody testing (ANA, RF); PFTs showing restrictive pattern	Management of underlying CTD, immunosuppressants (e.g., cyclophosphamide, mycophenolate mofetil), antifibrotic therapy in progressive cases
Occupational Lung Disease (e.g., Asbestosis, Silicosis)	History of exposure to asbestos, silica, or other industrial dusts; progressive dyspnoea, cough	HRCT showing pleural plaques (asbestosis), nodular opacities (silicosis), lung biopsy if diagnosis is unclear	Removal from exposure, supportive care (oxygen therapy), corticosteroids for symptomatic relief, monitoring for complications like lung cancer
Drug-Induced ILD	History of use of drugs known to cause ILD (e.g., amiodarone, methotrexate); non-productive cough, dyspnoea	HRCT showing diffuse alveolar damage, eosinophilia in blood or BAL, lung biopsy if diagnosis is unclear	Discontinuation of the offending drug, corticosteroids in severe cases, supportive care, monitoring for resolution or progression
Radiation-Induced ILD	History of chest radiation therapy, progressive dyspnoea, non-productive cough	HRCT showing fibrosis confined to the radiation field, PFTs showing restrictive pattern	Supportive care, corticosteroids in severe cases, monitoring for progression or resolution

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Interstitial Lung Disease

Causes

Diagnosis

Treatment

Causes and Management of Interstitial Lung Disease

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