Tables
- TABLE 1
Comorbidities in interstitial lung diseases
Acute and chronic infections Gastro-oesophageal reflux Pulmonary hypertension Cardiac disease Pulmonary embolism Lung cancer Obstructive sleep apnoea Depression - TABLE 2
Key diagnostic and management issues with regard to comorbidities in interstitial lung diseases (ILDs)
The use of immediate antibiotic treatment for acute respiratory infections The recognition of chronic infection as a cause of rapid deterioration of ILD The recognition of GORD as a possible cause of the development and acute deterioration of pulmonary fibrosis The recognition of disproportionate PH in patients with mild-to-moderate ILD The stratification of patients with ILD and lung cancer according to the risk of post-operative complications The recognition of PE and CAD as causes of shortness of breath that is disproportionate to the extent of the underlying ILD The diagnosis of OSA and the institution of management associated with good patient compliance. The referral of patients with clinically significant depression for psychiatric advice GORD: gastro-oesophageal reflux disease; PH: pulmonary hypertension; PE: pulmonary embolism; CAD: coronary artery disease; OSA: obstructive sleep apnoea.
- TABLE 3
Prevalence and treatment of key comorbidities in interstitial lung diseases (ILDs)
Comorbidity Prevalence Treatment Infections NA Broad-spectrum antibiotics
Adjust immunosuppression
Prophylactic antibiotics in case of recurrent infections
Specific therapy for chronic infectionsGastro-oesophageal reflux 0–94% in IPF Lifestyle changes
PPIs, H2-receptor antagonists, prokinetics
FundoplicationPulmonary hypertension 32–85% in IPF, 5–74% in sarcoidosis and 5–12% in SSc Treatment of contributing factors
Anti-pulmonary hypertension treatment is not recommended in IPF but combination of antifibrotic agents with targeted therapy for pulmonary hypertension may be considered
Combination of immunosuppression and anti-pulmonary hypertension agents in SSc-ILDCardiac disease 60% in IPF, 20% in sarcoidosis Immunosuppression when necessary
Specific pharmacological treatment for cardiac disease
ICD implantation (mainly in sarcoidosis)
Consider the likelihood of drug-induced ILDPulmonary embolism NA Anticoagulation (avoid vit-K antagonists in IPF) Lung cancer 4.4–10% in IPF Radiotherapy, chemotherapy, surgical removal
Careful pre-operative assessmentObstructive sleep apnoea 60–90% in IPF, 50% in SSc-ILD, 65% in sarcoidosis CPAP machine
Follow-up to check compliance/adherenceDepression >20% in ILDs, 11–50% in IPF The role of antidepressants is under debate
Pulmonary rehabilitationNA: not applicable; IPF: idiopathic pulmonary fibrosis; PPI; proton-pump inhibitor; SSc: systemic sclerosis; ICD: implantable cardioverter–defibrillator; vit-K: vitamin K; CPAP: continuous positive airway pressure.
