When most people think about lung disease, especially in the current climate, they think of acute infections like COVID-19, asthma, or even COPD. But there is another little-known category of conditions that can have a devastating impact on our ability to breathe called interstitial lung disease (ILD). Characterized by shortness of breath, chronic cough, fatigue, and exercise intolerance, ILD causes inflammation and scarring of the lung tissue, making it difficult to breathe and get oxygen into the bloodstream.
“Interstitial lung disease is not just one disease,” explains Grace Peloquin, MD, a pulmonologist at Summit Health. “It is a family of hundreds of different lung diseases that have inflammation and/or scarring in the lungs, and these diseases can look very much alike. It is important to have a team with expertise in the care of patients with this group of diseases to receive an accurate diagnosis and the most up-to-date treatment recommendations.”
What is Interstitial Lung Disease and Pulmonary Fibrosis?
Pulmonary fibrosis (PF) is the most common type of ILD. Every year, PF affects somewhere between 10 and 60 in every 100,000 people. Striking primarily individuals in their fifties or older, some cases have no known cause, while others are linked to underlying autoimmune diseases or exposure to toxins either at work or during previous medical treatments.
Historically, the outlook for ILD has been bleak; however, with new therapies and careful management, physicians can slow the progression of disease and, in severe cases, bridge the gap until patients are eligible for lung transplant.
“Even though it is not a common condition, it is important to raise awareness about pulmonary fibrosis. If you are experiencing shortness of breath or a prolonged cough for more than 6 months, speak to your physician,” advises Jessie Wilt, MD, a pulmonologist at Summit Health. “With any ILD diagnosis, access to the right care is critical. Since the condition is rare and quite serious, evaluation and management need to be with a provider that has a very high level of training and expertise in the field.”
Managing ILD During the Time of COVID-19
Caring for patients with ILD has become even more complex throughout the pandemic. As Dr. Wilt explains, any viral illness will be more serious in a patient with lung disease. For example, when someone with advanced lung disease develops pneumonia or even a simple cold, they often need hospitalization and potentially even intubation. Dr. Wilt encourages all her patients to get common immunizations against pneumococcal, influenza, whooping cough, and COVID-19.
She also counsels them about safe respiratory health practices. “Even before COVID, my patients needed to be extremely cautious about gathering with family during high times of community viral illness like a bad flu season. Many of my patients have grandchildren who are in school or daycare, where respiratory illnesses are rampant.”
A Multidisciplinary Treatment Approach
Managing ILD requires a team approach to care—and it starts with diagnosis. Approximately half of the patients who are diagnosed with ILD experience symptoms, while the remaining cases are found accidentally on a scan for another medical problem.
“At Summit Health, we have a built-in team of radiologists, pathologists, rheumatologists, thoracic surgeons, and other specialists to provide seamless multidisciplinary comprehensive care,” says Dr. Peloquin. “We have the expertise to diagnose and treat the various forms of ILD and address the complications of these disorders that can greatly compromise quality of life. At Summit Health, patients have the convenience of receiving top-quality care in one medical system with a well-integrated team.”
Summit Health has several highly trained radiologists who specialize in interpreting CT scans. Some 80 percent of patients can be diagnosed from imaging alone and do not need a biopsy.
The only way to cure ILD is with lung transplantation; this takes time, however, and many patients are not candidates. With the right care and new medications, life expectancy has improved dramatically for patients with ILD over the last decade. Anti-fibrotic therapies, which have become available over the last few years, are medications that can help slow the progression of disease, while supportive services like pulmonary rehabilitation are improving the quality of life.
“The key is to diagnose early, keep up with lung function monitoring, and start treatment when indicated. The treatments currently approved do not reverse fibrosis, but rather slow its progression,” says Aditi Mathur, MD, a pulmonologist at Summit Health.
A team approach to care is particularly critical for patients with ILD caused by underlying autoimmune diseases like rheumatoid arthritis or scleroderma. These patients are often affected in numerous ways including inflammatory arthritis and esophageal dysmotility, a swallowing disorder that can lead to malnutrition. At Summit Health, rheumatologists, gastroenterologists, and pulmonologists all work together to come up with an optimal treatment plan.
“Patients are very happy to have all their care from their internist to their specialists and tests inside the Summit Health family. It is a huge relief not to have this fractured care across multiple institutions,” describes Dr. Wilt. “My team and I are thrilled to be able to provide this type of comprehensive care for them in their backyard.”
Neighborhood Care for Interstitial Lung Disease
Until recently, individuals with ILD had to travel to major academic medical centers for care. Summit Health is one of the few community-based practices that has three leading pulmonologists—Drs. Jessie Wilt, Aditi Mathur, and Grace Peloquin—who specialize in a range of lung conditions including ILD, pulmonary hypertension, and COPD, as well as the long-term follow-up of lung transplant recipients.
Dr. Wilt says local care is not only comforting and convenient, it also improves outcomes. “Patients need to know that their doctor is in their backyard—not across a bridge—and that they have easy access to services whether it be a physician appointment, imaging, or labs. When patients have problems and we are able to intervene early, it prevents hospitalization.”