Interstitial Lung Disease (ILD) and Lung Fibrosis Care

A diagnosis many people have never heard of

Most patients with interstitial lung disease have never heard the term before the day it appears on their CT report. Often the road to that report has been long: a dry cough for a year, breathlessness that was blamed on age or weight, a course of TB medicines that didn't help, and finally an HRCT that shows "fibrosis" or "ILD pattern".

It's understandable to feel frightened at that point. ILD covers a large group of conditions, some mild and very treatable, some more serious. Getting the exact type right is what decides the treatment and the outlook.

What ILD is

The lungs are made of millions of tiny air sacs. The walls between them, called the interstitium, are normally thin and delicate, letting oxygen pass easily into the blood. In ILD, these walls become inflamed, thickened or scarred (fibrosis). The lungs become stiff, it takes more effort to breathe, and less oxygen gets through.

Common types

• Idiopathic pulmonary fibrosis (IPF): scarring with no clear cause, usually in people over 60
• Hypersensitivity pneumonitis: a reaction to something breathed in repeatedly, such as bird droppings and feathers (pigeons on balconies and window ACs are a very common source in the Tricity), mould, or certain dusts
• ILD linked to connective tissue disease: rheumatoid arthritis, scleroderma, Sjögren's, myositis and others
• Sarcoidosis: an inflammatory condition that often affects lungs and lymph nodes
• Occupational ILD: from silica, asbestos and other workplace dusts
• Drug-related ILD: from some heart, cancer, arthritis or antibiotic medicines
• Post-infection scarring, such as after severe COVID or TB

Symptoms

• Dry, persistent cough
• Breathlessness on exertion that slowly gets worse over months
• Fatigue and weight loss
• Rounded, swollen fingertips (clubbing) in some people
• Crackling sounds in the lungs, which the doctor hears with a stethoscope, often described as "velcro" crackles

How ILD is diagnosed

This is a careful, step-by-step process.

1. History, in detail. Dr. Bedi will ask about birds and pigeons at home or nearby, mould and damp, your job and hobbies, every medicine you have taken in recent years, joint pain, skin changes, dry eyes or mouth, and family history.
2. HRCT chest. The high-resolution CT scan is the key test. The pattern of changes often points to the type of ILD.
3. Lung function tests including spirometry and DLCO, which measures how well oxygen passes into the blood. See PFT test.
4. Six-minute walk test to see how oxygen levels hold up on walking.
5. Blood tests for autoimmune and connective tissue diseases.
6. Bronchoscopy with lavage or biopsy in selected cases. See bronchoscopy.
7. Discussion with radiology, rheumatology and pathology colleagues for difficult cases.

If you already have an HRCT, bring the CD or films, not only the written report. Seeing the images directly makes a real difference. You can also start with our report review service.

Treatment

Treatment depends on the type of ILD.

• Remove the trigger. In hypersensitivity pneumonitis, getting away from the cause (birds, mould, a workplace exposure) is the single most important step. Sometimes this alone brings big improvement.
• Anti-inflammatory and immune-modulating medicines for inflammatory types, such as steroids and steroid-sparing drugs, with careful monitoring.
• Antifibrotic medicines (such as pirfenidone or nintedanib) for IPF and other progressive fibrosing ILDs. These don't reverse scarring but slow its progression.
• Treating the linked disease when ILD is part of a connective tissue disorder, often together with a rheumatologist.
• Oxygen therapy if oxygen levels fall at rest or on walking.
• Pulmonary rehabilitation to improve stamina and breathing control.
• Vaccines for flu and pneumonia to prevent infections.

Living with ILD

• Keep active within your limits; regular walking helps
• Stop smoking completely
• Check your oxygen with a pulse oximeter if advised, and know what numbers should prompt a call
• Treat acid reflux if present
• Keep follow-up appointments, usually every three to six months with lung function tests, so progression is picked up early

ILD care in Panchkula for the Tricity

Dr. Manan Bedi (MD, Pulmonary Medicine) evaluates and follows ILD patients from Panchkula, Chandigarh, Mohali and surrounding areas at Booth 194, Sector 20, Panchkula. OPD runs Monday to Saturday, 5–7 PM, and Sunday, 11 AM–2 PM. Call +91-99280 14284 or book online.