Interstitial Lung Disease: Risk Factors and Comorbidities

Lisa H. Lancaster, MD: The causes of ILD are very varied. We are looking for autoimmune causes. We’re looking for occupational or environmental exposures as well as family history in genetics that may play into this.

Alicia M. Hinze, MD: Within autoimmune diseases, we can see interstitial lung disease in actually several of our autoimmune diseases. So the one that we associate interstitial lung disease with the most would be systemic sclerosis, also called scleroderma. But there are other conditions or other autoimmune diseases that we often will see interstitial lung diseases in which would include rheumatoid arthritis, for example. We have seen it in cases of Sjögren’s syndrome. We’ve also seen it in cases, rarely but in lupus. And then there are some patients that have some more overlapping phenotypes where they don’t fit into a specific category but may have overlapping features that can also develop interstitial lung disease.

In regards to age, we do see most of our autoimmune diseases often occurring early in life. And so patients can present with autoimmune disease, scleroderma or even rheumatoid arthritis in their 20s, 30s, 40s. But in patients, for example, with idiopathic pulmonary fibrosis, these are often presenting after the age of 50.

Lisa H. Lancaster, MD: There are multiple comorbidities associated with interstitial lung disease. and as we assess patients for interstitial lung disease, and more specifically, idiopathic pulmonary fibrosis, we want to identify those comorbidities with key ones being pulmonary hypertension, uh, coronary artery disease, as well as gastroesophageal reflux disease, and obstructive sleep apnea.

Reflux disease has been linked with acute exacerbations and perhaps has been suggested to be a recurrent form of injury that may augment the disease process. Sleep apnea is just a floppy airway with desaturations occurring at nighttime that has been linked as well with both idiopathic pulmonary fibrosis and reflux disease. Assessing sleep in patients with idiopathic pulmonary fibrosis is important because what we’re doing is assessing their breathing during one-third of their day, which is their sleep.