Interstitial lung disease: treatment options and considerations - - PowerPoint PPT Presentation

This video has been developed and funded by Boehringer Ingelheim This non-promotional material is for medical-to-medical use only Date of preparation: October 2019 | SC-UK-00618

Interstitial lung disease: treatment options and considerations

Professor Joanna Porter, Consultant in Respiratory and General Medicine University College London Hospitals and Senior Lecturer in the Department of Medicine at UCL In conversation with Dr Steve Holmes, GP, Park Medical Partnership, Shepton Mallet and Evercreech Education Lead and Executive, Primary Care Respiratory Society UK

RCGP accredited until 1st April 2020 RCN accredited until 2nd July 2020 Accreditation applies only to the educational content and not to any product RCN cannot confirm competence of any practitioner

By the end of this module you should be able to:

▪ Identify treatment options for inflammatory-type ILD ▪ Understand the different treatment considerations for inflammatory and

fibrotic forms of ILD

▪ Identify non-drug treatments and other therapies for ILD

ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis

Types of interstitial lung disease (ILD)

*Desquamative interstitial pneumonia can occasionally occur in non-smokers. Figure adapted from American Thoracic Society and European Respiratory Society (2002)1 and Travis, WD. et al. (2013).2 ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis; NSIP, non-specific interstitial pneumonia

• 1. American Thoracic Society and European Respiratory Society (2002); 2. Travis, WD. et al. (2013).

Interstitial lung disease

Known cause or association:

• Connective tissue diseases
• Occupational causes
• Drug side-effects

Idiopathic interstitial pneumonias Granulomatous:

• Sarcoidosis
• Hypersensitivity pneumonitis
• Infections

Idiopathic pulmonary fibrosis Acute interstitial pneumonia Cryptogenic

• rganising

pneumonia Respiratory bronchiolitis-ILD Desquamative interstitial pneumonia* Non-specific interstitial pneumonia Idiopathic lymphoid interstitial pneumonia Major Unclassifiable Rare Idiopathic pleuroparenchymal fibroelastosis Chronic fibrosing Acute and subacute Other forms, e.g.

• Lymphangioleio-

myomatosis

• Histiocytosis X

Smoking related

Inflammatory Fibrotic IPF

Summary: treatment options and considerations ▪ Accurate diagnosis can get patients on to the appropriate treatment that will make a difference3 ▪ Treatment options depend on whether ILD is diagnosed as inflammatory or fibrotic3 ▪ Non-drug treatments should also be considered, such as: exercise, weight management and

quitting smoking, as well as pulmonary rehabilitation3,12

▪ Consider oxygen therapy where appropriate3,12 ▪ Manage co-morbidities such as gastro-oesophageal reflux, which can exacerbate ILD3,12

ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis

• 3. Meyer, K. (2014); 12. NICE clinical guideline 163. June 2013 (last updated May 2017).

References

1.

American Thoracic Society and European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. (2002). This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med, 165(2), pp. 277–304.

2.

Travis, W.D., Costabel, U., Hansell, D.M., King, T.E. Jr, Lynch, D.A., Nicholson, A.G., Ryerson, C.J., Ryu, J.H., Selman, M., Wells, A.U., Behr, J., Bouros, D., Brown, K.K., Colby, T.V., Collard, H.R., Cordeiro, C.R., Cottin, V., Crestani, B., Drent, M., Dudden, R.F., Egan, J., Flaherty, K., Hogaboam, C., Inoue, Y., Johkoh, T., Kim, D.S., Kitaichi, M., Loyd, J., Martinez, F.J., Myers, J., Protzko, S., Raghu, G., Richeldi, L., Sverzellati, N., Swigris, J. and Valeyre, D.; ATS/ERS Committee on Idiopathic Interstitial Pneumonias. (2013). An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 188(6), pp. 733–748.

3.

Meyer, K. (2014). Diagnosis and management of interstitial lung disease. Transl Respir Med, 2, pp. 4.

4.

• NHS. Treatment: Idiopathic pulmonary fibrosis. May 2019.

Available at: www.nhs.uk/conditions/idiopathic-pulmonary-fibrosis/treatment/ (accessed October 2019).

5.

Wells, A.U. and Hirani, N. (2008). Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax, 63(suppl V), pp. 1–58.

6.

British Lung Foundation. Hypersensitivity pneumonitis formerly called extrinsic allergic alveolitis. August 2016. Available at: www.blf.org.uk/sites/default/files/5.%20Hypersensitivity%20pneumonitis.pdf (accessed October 2019).

7.

van den Hombergh, W.M.T., Simons, S.O., Teeselink, E., Knaapen-Hans, H.K.A., van den Hoogen, F.H.J., Fransen, J. and Vonk, M.C. (2018). Intravenous cyclophosphamide pulse therapy in interstitial lung disease associated with systemic sclerosis in a retrospective open-label study: influence of the extent of inflammation on pulmonary function. Clin Rheumatol, 37(10), pp. 2715–2722.

References

8.

Robles-Perez, A. and Molina-Molina, M. (2015). Treatment considerations of lung involvement in rheumatologic disease. Respiration, 90, pp. 265–274.

9.

Berezne, A., Ranque, B., Valeyre, D., Brauner, M., Allanore, Y., Launay, D., Le Guern, V., Kahn, JE., Couderc, L.J., Constans, J., Cohen, P., Mahr, A., Pagnoux, C., Hachulla, E., Kahan, A., Cabane, J., Guillevin, L. and Mouthon, L. (2008). Therapeutic strategy combining intravenous cyclophosphamide followed by oral azathioprine to treat worsening interstitial lung disease associated with systemic sclerosis: a retrospective multicenter open-label study. J Rheumatol, 35(6), pp. 1064–1072.

• 10. Coker, R.K. (2009). Management strategies for pulmonary sarcoidosis. Ther Clin Risk Manag, 5, pp. 575–584.
• 11. Margaritopoulos, G.A., Antoniou, K.M. and Wells, A.U. (2017). Comorbidities in interstitial lung diseases. Eur Respir Rev, 26(143), pp. 160027.
• 12. National Institute for Health and Care Excellence. Clinical guideline 163. June 2013 (last updated May 2017). Idiopathic pulmonary fibrosis in

adults: diagnosis and management. Available at: www.nice.org.uk/guidance/cg163 (accessed October 2019).

• 13. Raghu, G., Collard, H.R., Egan, J.J., Martinez, F.J., Behr, J., Brown, K.K., Colby, T.V., Cordier, J.F., Flaherty, K.R., Lasky, J.A., Lynch, D.A., Ryu,

J.H., Swigris, J.J., Wells, A.U., Ancochea, J., Bouros, D., Carvalho, C., Costabel, U., Ebina, M., Hansell, D.M., Johkoh, T., Kim, D.S., King, T.E. Jr, Kondoh, Y., Myers, J., Müller, N.L., Nicholson, A.G., Richeldi, L., Selman, M., Dudden, R.F., Griss, BS., Protzko, S.L. and Schünemann, H.J.; ATS/ERS/JRS/ALAT Committee on Idiopathic Pulmonary Fibrosis. (2011). An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med, 183(6), pp. 788–824

• 14. Raghu, G., Rochwerg, B., Zhang, Y., Garcia, C.A., Azuma, A., Behr, J., Brozek, J.L., Collard, H.R., Cunningham, W., Homma, S., Johkoh, T.,

Martinez, F.J., Myers, J., Protzko, S.L., Richeldi, L., Rind, D., Selman, M., Theodore, A., Wells, A.U., Hoogsteden, H. and Schünemann, H.J.; American Thoracic Society; European Respiratory society; Japanese Respiratory Society; Latin American Thoracic Association. (2015). An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis. An update of the 2011 clinical practice guideline. Am J Respir Crit Care Med, 192(2), pp. e3–19.