Prevalence and treatment of key comorbidities in interstitial lung diseases (ILDs)

InfectionsNABroad-spectrum antibiotics
Adjust immunosuppression
Prophylactic antibiotics in case of recurrent infections
Specific therapy for chronic infections
Gastro-oesophageal reflux0–94% in IPFLifestyle changes
PPIs, H2-receptor antagonists, prokinetics
Pulmonary hypertension32–85% in IPF, 5–74% in sarcoidosis and 5–12% in SScTreatment 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-ILD
Cardiac disease60% in IPF, 20% in sarcoidosisImmunosuppression when necessary
Specific pharmacological treatment for cardiac disease
ICD implantation (mainly in sarcoidosis)
Consider the likelihood of drug-induced ILD
Pulmonary embolismNAAnticoagulation (avoid vit-K antagonists in IPF)
Lung cancer4.4–10% in IPFRadiotherapy, chemotherapy, surgical removal
Careful pre-operative assessment
Obstructive sleep apnoea60–90% in IPF, 50% in SSc-ILD, 65% in sarcoidosisCPAP machine
Follow-up to check compliance/adherence
Depression>20% in ILDs, 11–50% in IPFThe role of antidepressants is under debate
Pulmonary rehabilitation
  • NA: 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.