109. A Drop in the Bucket - An Approach to ILD

Interstitial lung disease (ILD) involves a heterogeneous group of disorders characterized by inflammation and subsequent scarring of the pulmonary interstitium, leading to reduced lung compliance and impaired gas exchange. Diagnosis requires a systematic approach, beginning with the identification of insidious symptoms like exertional dyspnea and "Velcro" crackles, followed by a detailed history of occupational exposures, medications such as amiodarone, and potential connective tissue disease triggers. While high-resolution CT scans showing patterns like usual interstitial pneumonia (UIP) are critical diagnostic tools, surgical lung biopsy remains the gold standard for uncertain cases. Management varies significantly by etiology; while systemic corticosteroids are mainstay treatments for sarcoidosis and hypersensitivity pneumonitis, the PANTHER-IPF trial demonstrated that prednisone is actually harmful in idiopathic pulmonary fibrosis (IPF). Ultimately, treatment focuses on suppressing inflammation, avoiding triggers, and evaluating candidates for lung transplantation in progressive cases.