Diagnosing complications and co-morbidities of fibrotic interstitial lung disease

ABSTRACT

Introduction: Interstitial lung diseases (ILDs) represent a heterogeneous group of rare disorders that include more than 200 entities, mostly associated with high mortality. In recent years, the progress regarding the understanding of the pathogenesis of these diseases led to the approval of specific treatments. In ILDs, the presence of comorbidities has a significant impact on the quality of life and the survival of patients and, therefore, their diagnosis and treatment has a pivotal role in management and could improve overall outcome.

Areas covered: We discuss key diagnostic issues with regard to the most frequent comorbidities in ILDs. Treatment options are also discussed as the decision to investigate more definitively in order to identify specific comorbidities (including lung cancer, pulmonary hypertension, GE reflux, and obstructive sleep apnoea) is critically dependent upon whether comorbidity-specific treatments are likely to be helpful in individual patients, judged on a case by case basis.

Expert opinion: The extent to which clinicians proactively pursue the identification of comorbidities depends on realistic treatment goals in individual patients.

KEYWORDS:

• Interstitial ling diseases
• idiopathic pulmonary fibrosis
• infections
• gastroesophageal reflux
• pulmonary hypertension
• pulmonary embolism
• cardiac disease
• sleep disorders
• depression

Article highlights

•There is a high prevalence of comorbidities in ILDs, due to common risk factors (e.g smoking) and the fact that ILDs predispose to the development of comorbidities such as pulmonary hypertension and gastroesophageal reflux. The presence of comorbidities has a significant impact on the quality of life and survival of ILD patients and, therefore, their diagnosis and treatment has a pivotal role in management.

• The diagnosis of comorbidities represents a real challenge for clinicians.

• The decision to perform diagnostic tests for a confident diagnosis of an individual comorbidity depends on the existence of treatment approaches which can influence the outcome.

• Combination treatment with ILD and comorbidity-specific medications is an area of great interest which is likely to gather momentum in the next few years.

Declaration of interest

A.U. Wells reports receiving the following, outside the submitted work: personal fees for speaking and for acting on advisory boards from Boehringer Ingelheim, Roche and Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.