Interstitial Lung
Diseases
Dr Revati Amin Ph.D.
Dept. of Physiotherapy
KMC Mangalore
Definition
• Interstitial lung diseases (ILD) represent a large
group of heterogenous disorders that involve the
parenchyma of the lung, the alveoli, the alveolar
epithelium, capillary epithelium, and the space
between the structures.
ILD’s include more than 200 chronic lung disorders.
The lung is affected in 3 stages:
→The lung is damaged in a known or an unknown way
→The walls of the air sacs in the lung become inflamed
→Scaring/ fibrosis begins in the interstitium (or tissues
between the air sacs) and the lung becomes stiff.
• When the interstitium becomes
scarred and thickened, it is much
more difficult for oxygen to
travel from the airways into the
bloodstream.
• ILD patients then develop
symptoms which are a result of
lung malfunction (dyspnoea and
cough)
• Exposure to hazardous materials such as
asbestos/ coal/ cotton/ grain/ silica dust etc
• Autoimmune disorder such as RA
• Occupational and environmental factors
• Radiation treatment
Etiology • Use of certain medications such as
• Chemotherapy drugs: methotrexate etc
• Cardiac medications: amiodarone, propranolol,
cyclophosphamide etc
• Antibiotics: nitrofurantoin, ethambutol etc
• Anti-inflammatory drugs: sulfasalazine, rituximab
etc
Risk factors
• Age: more likely to occur in adults (infants and children may
sometimes develop this disease)
• Exposure to occupational and environmental toxins: exposure
to hazardous substances in the mining, farming or exposure to
pollutants
• Smoking
• Radiation and chemotherapy
• GERD: uncontrolled acid reflux or indigestion may cause
increased risk of ILD
Clinical manifestations
Shortness of breath at rest/ aggravated by exertion
Dry cough, usually non-productive
Fatigue
Tachypnoea
Clubbing of fingers
Basal bilateral crackles/ Velcro crepts
Reduced muscle strength and endurance
Balance impairment in later stages
Diagnostic evaluation
History: occupational, medical, smoking, medication use
Physical examination
Blood tests: to rule out proteins, antibodies and other markers
High-resolution computed tomography (HRCT) scan: fibrosis
Electrocardiogram (ECG): Pulmonary Artery Hypertension (PAH)
Pulmonary Function Test (PFT): FVC, DLCO – determining disease severity
6 Minute Walk Test (6 MWT): predictor of mortality
Bronchoscopy: persistent cough, infection or something unusual seen on X-ray
Surgical biopsy: To provide a specific diagnosis.
HRCT findings
Sub-pleural reticular opacities, smooth
Ground Glass Opacities (GGO) interlobular septal thickening with
honeycombing (UIP)/ fibrosis (IPF)
X-Ray findings
Reticular Pattern Nodular Pattern Reticulonodular Pattern
Reticular- patterns of linear opacification in the lung
Nodular- A linear pattern is seen when there is thickening of the interlobular septa, producing Kerley
lines.
Reticulonodular- produced by either overlap of reticular shadows or by the presence of reticular
shadowing and pulmonary nodules.
Complications
Pulmonary Right sided
Artery heart failure Respiratory
Hypertension failure
(PAH) (Cor Pulmonale)
Medical management
Corticosteroids: eg: Prednisone
Anti-fibrotics: eg: Rituximab
Proton pump inhibitors: eg: Omeprazole, pantoprazole
Oxygen therapy
Pulmonary Rehabilitation
Patient education
Based on the
Dyspnea relieving positions
functional and
Energy conservation techniques
strength assessments:
Breathing exercises
Strength training
Endurance training
Balance training (if affected)
Emotional support
Nutritional counseling (high protein, high fiber diet, hydration)
Educational components
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UL strength training
LL strength training
Balance training
Surgical intervention
Lung transplantation
Prophylactic measures
Limiting exposure to irritants
Monitoring symptoms
Maintain regular follow-ups with Pulmonologist and
Physiotherapist
Continue medications
Thank you
