Craig Glazer, M.D. Answers Questions On: Interstitial Lung Diseases (ILDs)

Interstitial lung diseases such as hypersensitivity pneumonitis, asbestosis, and silicosis are often due to occupational and environmental causes.

Hypersensitivity pneumonitis is an inflammation in the lungs caused by an allergy to an antigen (a substance that causes your immune system to produce antibodies against it). This is treatable with steroids.

Silicosis is caused by breathing in bits of silica, common on construction and mining jobs. Asbestosis causes scarring in the lungs from breathing in asbestos. We can't cure those, but making the diagnosis is important because the prognosis is a lot better than with a disease like idiopathic pulmonary fibrosis (IPF).

We start with a long and detailed patient history to understand their familial background and environment. Then we perform a series of blood tests to look for autoimmune diseases, as well as a high-resolution computed tomography (CT) scan to get a look inside the body. Sometimes we also need a biopsy.

All of this information helps us reach the most accurate diagnosis, which helps us arrive at the right treatment plan. For diseases that are mainly inflammatory like hypersensitivity pneumonitis, we treat those primarily with prednisone or other immunosuppressants. But for the scarring diseases like IPF, there are no known treatments.

Probably the most important thing we learned recently is that treating IPF with drugs like prednisone and Imuran can actually make people worse. That was the standard of care for probably 30 years.

However, one of the IPFnet trials that UT Southwestern participated in showed that the treatment was actually making people worse. Those drugs may be used for other interstitial diseases but not for IPF.