Interstitial Lung Disease: Guidelines for Therapy

Gary L. Johnson, MD, MBA: The ATS Guidelines are basically just that, guidelines. They talk about drugs and treatment approaches that we, from a managed care standpoint, really do not get involved with. We do not pro, um, prescribe to the providers that a certain stepwise fashion treatment should occur.

Alicia M. Hinze, MD: So there’s different groups kind of or categories of interstitial lung disease. So the ATS has guidelines on treating idiopathic pulmonary fibrosis, for example. But regarding treating interstitial lung disease, for example, in the context of rheumatic diseases, we don’t have necessarily formal guidelines, but we do have some major studies that we reference with regards to medication management and success potentially of those therapies.

Gary L. Johnson, MD, MBA: From the standpoint of the managed care organization, we do not require steps in terms of treatment. That may vary, however, with various health plans, but I can only speak for the ones that I’ve been associated with.

Prior authorization for the anti-fibrotic medications is relatively straightforward. It basically requires that the diagnosis be confirmed by high resolution CT scan, or a lung biopsy, and that the person does not have a disease, or symptoms, that are caused by some other identifiable cause that this truly is a ILD as opposed to sarcoidosis or radiation fibrosis or something like that.

Lisa H. Lancaster, MD: Therapeutic goals for patients with idiopathic pulmonary fibrosis have to take into consideration multiple modalities, including the patient’s own personal goals for their care and well being. So this is a discussion that’s ongoing not just from the point of diagnosis but at every single visit down the road. We want to make sure we discuss the two FDA approved therapies, side effects, and expectations. The patients won’t necessarily feel better with the therapies, but they do slow disease progression, and there’s some evolving data about improved survival as well too. So we want to discuss that. We want to manage any comorbidities that patients have, such as reflux, sleep apnea, pulmonary hypertension, coronary artery disease to name a few. We want to make sure that patients are fully vaccinated, not just for the flu but with the two new, with the two pneumococcal vaccinations that are available and we may think about proteus when there’s a flare in the community as well.

We want to make sure patients are aware of and enrolled where possible in pulmonary rehab. We also want to discuss early palliative care and Hospice, because we want patients to be empowered with as much education about not just the disease state but its course, and ultimate plans for the goals of care at the end of life.