Table 1 Treatable traits in interstitial lung diseases according to pulmonary, aetiological, comorbidities and lifestyle domains
From: Walking the path of treatable traits in interstitial lung diseases
Treatable trait | Assessment tool | (Potential) treatment option | Expected benefits of treatment* |
|---|---|---|---|
Aetiological | |||
CTDs/Vasculitis | Clinical features Serum antibodies | Refer to rheumatologist Screening for extra-respiratory involvement Immunosuppressive drugs | Prevent or reduce lung damage Reduce mortality |
Drugs | Drug history | Assess risk–benefit of stopping potentially harmful drug | Reduce lung damage Improve lung function |
Exposure-related (organic and inorganic) | Environmental/ work/ domestic history of exposure Serum precipitins | Prevent or stop exposure | Prevent or reduce lung damage Improve outcomes Reduce mortality |
Genetic | Family history Age of onset DNA genetic testing | Refer to geneticist Family screening Targeted therapy | Improve outcomes |
Lifestyle | |||
Smoking | Patient reported Urine cotinine levels | Tobacco cessation support Nicotine replacement Antidepressant drug | Improve quality of life Improve lung function Prevent or reduce lung damage |
Adherence to treatment | Patient and relatives feedback | Education Written instructions Self-management Family and social support | Improve outcomes |
Exposure to air pollution | PM10 and NO2 concentrations | Reduce exposure | Reduce disease progression Reduce exacerbation |
Lack of exercise/ Deconditioning of skeletal muscle | Cardiopulmonary exercise testing 6MWT | Prescribed exercise programs Pulmonary rehabilitation | Improve quality of life Improve lung function Improve exercise capacity |
Diet | Patient reported | Diet instructions | Improve quality of life |
Pulmonary | |||
Progressive fibrosis | Patient reported symptoms Pulmonary function tests HRCT | Optimization of therapy Consider antifibrotics Referral to lung transplant center | Slow lung function decline Reduce mortality Prevent exacerbation |
Eosinophilic inflammation | HRCT BAL CBC | Steroid therapy Adjust immunosuppression | Prevent or reduce lung damage Improve quality of life |
Neutrophilic inflammation | HRCT BAL CBC | Azithromycin | Reduce lung damage Improve quality of life |
Acute exacerbation | HRCT BAL | Antifibrotic therapy Systemic glucocorticoids | Improve survival |
Acute infection | Patient reported symptoms Sputum cultures BAL | Airway clearance Antibiotic therapy Prophylaxis with influenza and pneumococcal vaccination Adjust immunosuppression | Prevent exacerbation Reduce mortality Reduce hospitalization |
Chronic infection or recurrent infection | Patient reported symptoms Sputum cultures BAL | Airway clearance Adjust immunosuppression Consider prophylactic antibiotics | Prevent exacerbation Improve quality of life Slow lung function decline |
Chronic respiratory failure | Patient reported symptoms ABG 6MWT Polysomnography | Long term oxygen therapy Non-invasive ventilation Referral to lung transplant center Pulmonary rehabilitation Palliative care | Improve quality of life Improve survival |
Intractable chronic cough | Patient reported symptoms Scores (LCQ, VAS, CQLQ) | Antitussive Thalidomide Gabapentin | Improve quality of life |
Emphysema / Obstructive ventilatory defects | Pulmonary function tests HRCT | Bronchodilator therapy | Improve quality of life Slow lung function decline |
Comorbidities | |||
GERD | Symptoms Oesophageal pH monitoring Manometry Upper Endoscopy | Diet instructions PPIs, H2-receptor antagonists, pro-kinetics Fundoplication | Improve outcomes Reduce lung damage |
Pulmonary hypertension | Echocardiography Consider RHC | Referral to lung transplant center Trial with PH targeted therapies in selected patients (e.g.: Treprostinil) Oxygen/Non-invasive ventilation | Improve quality of life Improve outcomes Reduce mortality |
Congestive heart failure | NT-proBNP Echocardiography | Targeted pharmacological treatment ICD implantation | Improve quality of life Reduce mortality |
OSA | Sleep study | Diet instructions CPAP treatment | Improve quality of life Reduce mortality |
Lung cancer | HRCT PET- CT Biopsy | Surgical resection Radiotherapy Chemotherapy | Reduce mortality |
Diabetes | Fasting glucose persistently above 125 mg/dl Random glucose levels above 200 mg/dl occurring in the context of high-dose glucocorticoid therapy | Diet instructions Lifestyle instructions Insulin Oral hypoglycemics | Improve quality of life Reduce systemic complication of diabetes Reduce mortality |
Osteoporosis/Osteopenia | Bone densitometry | Diet instructions Lifestyle instructions Pharmacological therapy | Improve quality of life Reduce risk of fractures Reduce mortality |
Pulmonary embolism | CT pulmonary angiogram | Anticoagulants | Reduce mortality |
Obesity | BMI | Diet instructions Pulmonary rehabilitation Bariatric surgery | Improve quality of life Improve exercise tolerance |
Cachexia/Malnutrition | BMI | Nutritional support Pulmonary rehabilitation | Improve quality of life |
Frailty | FFP binary score Frailty Index | Nutritional supportive Pulmonary rehabilitation Physical activity programs | Improve quality of life Reduce mortality |
Anxiety/Depression | Patient reported scores (K-BILD; SGRQ-IPF) | Counseling/cognitive behavioural therapy Antidepressant/Anxiolytics Pulmonary rehabilitation | Improve quality of life Improve adherence to treatment |