Current best clinical practices for monitoring of interstitial lung disease

ABSTRACT

Introduction

Interstitial lung diseases (ILDs) are a heterogeneous group of inflammatory and/or fibrotic conditions with variable outcome and often a dismal prognosis. Since many ILDs are progressive in nature, monitoring of signs and symptoms of progression is essential to inform treatment decisions and patient counseling. Monitoring of ILDs is a multimodality process and includes all aspects of the disease, e.g. measurement of pulmonary function and exercise capacity, symptom registration and quality of life (QoL), imaging, comorbidities and/or involvement of other organs to assess disease activity, symptom burden, treatment effects, adverse events, the need for supportive and palliative care, and lung transplantation.

Areas covered

For this narrative review, we searched the PUBMED database to identify articles relevant for monitoring ILDs, including pulmonary function tests, exercise capacity, imaging, telemedicine, symptoms, and QoL.

Expert opinion

Due to the high heterogeneity of the ILDs and their disease course, an individualized multimodality approach must be applied. Future strategies include use of telemedicine for home monitoring of lung function and symptoms, use of artificial intelligence to support automatized guidance of patients, computerized evaluation of ILD changes on imaging, and new imaging tools with less radiation dosage.

KEYWORDS:

• Interstitial lung disease
• monitoring
• HRCT
• pulmonary function tests
• home spirometry
• patient-related outcome measures

Article highlights

• Monitoring of ILD requires a multimodality approach

• Monitoring is crucial for treatment decisions of any kind

• Common tools used are PROMs, lung function, exercise capacity, and imaging

• Low dose CT and thoracic ultrasonography to monitor ILD progression might become the future imaging tool

• Home monitoring and artificial intelligence are future monitoring options

Declaration of Interest

E Bendstrup reports research fees paid to her institution regarding a study on interstitial lung diseases from Boehringer Ingelheim, Hoffman la Roche and Galapagos, not related to this study. E Bendstrup also reports lecture fees from Boehringer Ingelheim, Roche, Galapagos, Astra Zeneca, Novartis and Bristol Myer Squibb; travel and congress fees from Boehringer Ingelheim and Roche; Advisory Board membership by Boehringer Ingelheim and Roche.

TS Prior reports an unrestricted grant from Boehringer Ingelheim outside this study, and lecture fees from Boehringer Ingelheim and consultancy fee from Galapagos.

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 apart from those disclosed.

Reviewer Disclosures

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

Additional information

Funding

This paper was not funded.