Interstitial lung disease is a term to describe a large group of disorders which refers to the scarring of lung tissue and supporting of the air sacs. This scarring can contribute to lung stiffness which affects a person’s ability to breathe which limits oxygen from entering the bloodstream.
Lung scarring is irreversible but medications are available to help slow down the progression and assist in breathing. If severe a lung transplant may be advised.
Interstitial lung disease in systemic sclerosis can be treated with new promising treatment: Study
Lead investigator, Philip Clements, said, “For a sizeable fraction of people with scleroderma, scaring lung disease can be associated with a great deal of suffering and even with death. We postulated that the interstitial lung disease seen in scleroderma was caused in part by inflammation. We therefore sought to decrease the inflammation with medications that have strong anti-inflammatory properties, namely cyclophosphamide and mycophenolate mofitil.”
The researchers followed 142 patients over two years to determines if mycophenolate mofitil or cyclophosphamide would be effective in improving interstitial lung disease.
Participants were split into two groups where the first group received 2mg/kg cyclophosphamide for one year and then received placebo daily for the second year. The second group received up to 1,500mg of mycophenolate mofitil twice daily for two years.
After every three months patients underwent a physical exam where the two groups were found to have similar results in the beginning of the study.
After two years both groups showed significant improvements in the lungs and the skin. It is important to note that the cyclophosphamide group had many dropouts. Dr. Clements added, “Many of the cyclophosphamide dropouts were put on strong anti-inflammatory medications by their primary physicians after they had stopped study medications. We hypothesize that these treatments — that were started outside the study framework — could have artificially improved the outcomes in these cyclophosphamide dropouts at a time when they would have been receiving placebo if they had continued study medication in the second year.”
“The most frequent cause of death among patients with scleroderma is interstitial lung disease. Since interstitial lung disease produces permanent damage predominantly in the first five-to-seven years of scleroderma, it is important that people with scleroderma get screened with lung function tests regularly every six months in those first five-to-seven years. If a patient’s lung function declines, rheumatologists should consider treating him or her as early as possible with cyclophosphamide or mycophenolate mofitil to try to prevent further progressive lung scaring,” Dr. Clements concluded.
Systemic sclerosis-related interstitial lung disease diagnosis and tests
There are many tests available in order to properly diagnose interstitial lung disease which include:
- Chest x-ray
- Computerized tomography (CT) scan
- Echocardiogram
- Oximetry: small device is placed on a persons fingers to measure oxygen saturation in the blood while walking
- Spirometry and diffusion capacity: the test involves a person to exhale quickly and forcefully through a tube to measure how much the lugs can hold and how much air moves through the lungs
- Bronchoscopy biopsy
- Surgical biopsy
All of these tests can be utilized in order to diagnose interstitial lung disease early on so treatment can begin immediately in order to prevent severe irreversible damage from occurring.