Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs’ anatomic structure.
The interstitium is a lace-like network of tissue that extends throughout both lungs. The interstitium provides support to the lungs’ microscopic air sacs (alveoli). Tiny blood vessels travel through the interstitium, allowing gas exchange between blood and the air in the lungs. Normally, the interstitium is so thin it can’t be seen on chest X-rays or CT scans.
Causes of Interstitial Lung Disease
Bacteria, viruses, and fungi are known to cause interstitial pneumonias. Regular exposures to inhaled irritants at work or during hobbies can also cause some interstitial lung disease. These irritants include:
- Asbestos
- Silica dust
- Talc
- Coal dust, or various other metal dusts from working in mining
- Grain dust from farming
- Bird proteins (such as from exotic birds, chickens, or pigeons)
Symptoms of Interstitial Lung Disease
The most common symptom of all forms of interstitial lung disease is shortness of breath. Nearly all people with interstitial lung disease will experience breathlessness, which may get worse over time.
Other symptoms of interstitial lung disease include:
- Cough, which is usually dry and nonproductive.
- Weight loss, most often in people with COP or BOOP.
Diagnosis of Interstitial Lung Disease
People with interstitial lung disease usually come to see a doctor due to concern about shortness of breath or cough. Imaging tests of the lungs are usually done to identify the problem.
Chest X-ray: A simple chest X-ray is the first test in the evaluation of most people with a breathing problem. Chest X-ray films in people with interstitial lung disease may show fine lines in the lungs.
Computed tomography (CT scan): A CT scanner takes multiple X-rays of the chest and a computer creates detailed images of the lungs and surrounding structures. Interstitial lung disease can usually be seen on a CT scan.
High-resolution CT scan: If interstitial lung disease is suspected, using certain CT scanner settings can improve the images of the interstitium. This increases the CT scan’s ability to detect interstitial lung disease.
Pulmonary function testing: A person sits in a sealed plastic booth and breathes through a tube. People with interstitial lung disease may have a reduced total lung capacity. They may also have a decreased ability to transfer oxygen from their lungs into their blood.
Treatments for Interstitial Lung Disease
Treatments for interstitial lung disease vary according to the type of interstitial lung disease and its cause.
Antibiotics . These are effective treatments for most interstitial pneumonias. Azithromycin (Zithromax) and levofloxacin (Levaquin) eliminate the bacteria that cause most interstitial pneumonias. Viral pneumonias usually resolve on their own. Fungal pneumonias are rare, but can be treated with antifungal drugs.
Corticosteroids: In some forms of interstitial lung disease, ongoing inflammation in the lungs causes damage and scarring. Corticosteroids like prednisone and methylprednisolone reduce the activity of the immune system. This reduces the amount of inflammation in the lungs and the rest of the body.
Inhaled oxygen: In people with low oxygen blood levels due to interstitial lung disease, inhaled oxygen may improve symptoms. Regular use of oxygen might also protect the heart from damage caused by low oxygen levels.
Lung transplant : In advanced interstitial lung disease causing severe impairment, a lung transplant may be the best option. Most people undergoing lung transplant for interstitial lung disease make large gains in quality of life and their ability to exercise.
Azathioprine (Imuran): This drug also suppresses the immune system. It has never been proven to improve interstitial lung disease, but some studies suggest it might help.
N-acetylcysteine (Mucomyst): This potent antioxidant may slow the decline of lung function in some forms of interstitial lung disease. It should not be used alone.
Other treatments considered controversial for the treatment of interstitial lung disease include:
- Cyclophosphamide (Cytoxan)
- Methotrexate
- Cyclosporine
- Pirfenidone (Exbriet)
- Nintedanib (OFEV)
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