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Types Of Interstitial Lung Disease (ILD)
Interstitial lung disease (ILD) is a broad group of lung diseases comprising of more than a hundred distinct disorders. All of these involve scarring or inflammation of the interstitial lung tissue and affect the volume of oxygen that can reach the bloodstream via the respiratory system.
They can be classified into different types, according to the cause of the disease, as described in more detail below.
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Although there are many known causes of interstitial lung disease, the most common of all types is idiopathic pulmonary fibrosis, which occurs without a known cause. Specific conditions that are classed as idiopathic may include:
Idiopathic lung disease involves damage to the lung tissue resulting from scarring or inflammation without a clearly identifiable cause. There are likely to be several factors that play a role in the pathology, such as genetic and environmental factors, but these are not always clear.
Interstitial Lung Disease at the University of MichiganPlay
EnvironmentalIn some cases, environmental or occupational factors may be responsible for the onset of interstitial lung disease, usually due to the inhalation of irritants.
For example, extrinsic allergic alveolitis, also known as Farmer's lung, can lead to IPF as a result of the inhalation of dust in the farm environment. Similarly, black lung disease can affect coal miners that inhale coal dust in the occupational setting.
Pneumoconiosis is a condition that is a type of interstitial lung disease resulting from exposure to chemicals, such as silicon, asbestos or iron. Specifically, inhalation of asbestos can cause asbestosis, iron can cause siderosis and silicon can cause silicosis. When these irritants are inhaled that can cause damage to the lung tissue and symptoms of ILD.
Individuals that smoke cigarettes are also at an elevated risk for ILD, as a result of the inhaled toxins.
MultisystemThere are also several systemic diseases that can result in interstitial lung disease, in addition to other effects around the body. Diseases of the connective tissues are the classic example of this type. Multisystem disease leading to IPF may include:
Sarcoidosis is a notable systemic condition that involves the formation of granulomas anywhere around the body, but commonly in the lungs to cause interstitial pulmonary disease.
Medication-InducedAdverse drug reactions can also induce interstitial lung disease in some patients. The may include reactions from:
The damage to the lung tissue caused by these medications is highly variable, depending on the length and dose of the treatment.
InfectionSevere infections of the lungs can cause permanent damage to the respiratory system, leading to ILD. These infections may include:
Familial pulmonary fibrosis, also known as familial interstitial pneumonia, accounts for a small percentage of patients that have idiopathic pulmonary fibrosis. This occurs when a particular gene mutation is associated with increased susceptibility to scarring and damage to the lungs.
MalignancyMalignancy has been associated with ILD, due to the pathology of the condition and the treatments to manage it.
Lymphangitic carcinomatosis involves malignant growth in the lung tissue that can lead to the scarring and ILD. Chemotherapy and radiation therapy can both cause damage to the lungs and cause symptoms of ILD.
References Further ReadingExercise Rehabilitation Found To Help Alleviate Symptoms Of Several Chronic Respiratory Diseases
Researchers discovered that exercise helps to alleviate various symptoms for patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.
Training-based pulmonary exercise rehabilitation is effective in alleviating the symptoms of chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.
Researchers conducted a review examining the positive rehabilitative effects of exercise on COPD, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer. Along with alleviating symptoms, they found that exercise improved patients' quality of life, cardiovascular function, tolerance to physical activity, and muscle function.
"Moderate-intensity aerobic exercise, resistance training, and [high-intensity interval training] are the most common forms of pulmonary rehabilitation exercises," the authors wrote.
For those with COPD, the authors hypothesized that exercise would improve their immune response, leading to the activation of their adaptive immune response. They said they came to this conclusion due to similar studies done on mice.
"In animal studies, aerobic exercise was found to prevent the increase in macrophage and neutrophil count in mice with COPD; a similar trend was found in population trials, with a significant reduction in eosinophil count in vivo after 6 weeks of endurance and strength training," the authors wrote.
Additionally, a study in patients with COPD found that a 12-week exercise training regimen was associated with an increase in CD4+ T cells, better immune response, and fewer COPD exacerbations and hospitalizations.
Because of these results, the authors concluded that exercise is an effective strategy for COPD patients to reduce pulmonary and systemic inflammation, alleviate symptoms, and prevent disease progression.
Patients with asthma, who are more prone to fatigue and breathing difficulties during exercise, are often encouraged to reduce or eliminate physical activity to avoid symptom deterioration or exercise-induced bronchoconstriction; this could lead to decreased fitness and exercise tolerance, ultimately leading to exercise avoidance.
The authors instead claimed that patients with asthma are capable of physical activity and could improve their health status with it as aerobic exercise helps them manage airway inflammation.
"…Aerobic exercise has been found to effectively reduce airway eosinophilic expression, which in turn reduces the inflammation, inhaled glucocorticoid (ICS) dosage, and acute exacerbations, under the premise of standardizing and optimizing ICS medication," the authors wrote. "Aerobic training can also positively modulate airway inflammation and remodeling mediators."
Consequently, aerobic training and medication together can help patients with asthma.
Patients with lung cancer can also benefit from exercise. Lung cancer, the leading cause of cancer-related deaths, is broken down into 2 subtypes: non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Pneumonectomy is currently the most effective treatment for stages I, II, and IIIA of NSCLC, offering the best chance for long-term survival.
Exercise can benefit patients both preoperatively and postoperatively, as population-based trials have showed that resistance training improved participants' muscle mass, strength, and sleep quality. Also, for those who previously could not undergo surgery due to poor preoperative evaluations, 4 weeks of aerobic exercise and respiratory training improved both their lung function and chances of undergoing surgery.
"Aerobic exercise improves exercise tolerance and cardiorespiratory fitness and reduces postoperative respiratory morbidity, length of hospital stay, cancer fatigue, anxiety, and depression," the authors wrote.
Because of its positive effects, the authors considered exercise an effective adjunct to existing anticancer therapies.
Patients with bronchiectasis benefit from exercise as resistance training and aerobic exercises of the upper and lower extremities can improve their exercise capacity, endurance, lung function, and peripheral and respiratory muscle strength. It can also reduce dyspnea and raise patients' quality of life.
The authors noted that it is challenging for patients with bronchiectasis to maintain these benefits as it becomes difficult for them to adhere to the regimen as the exercise cycles increase; as they exercise less, the positive cumulative effect decreases accordingly.
Patients with interstitial lung disease (ILD) are affected by dyspnea, exercise-induced hypoxemia, and exercise intolerance. It is difficult for patients to achieve adequate exercise intensity, the researchers wrote, but the standard COPD exercise program of aerobic exercise training appears to be effective.
The authors advised patients with ILD to start exercise training as soon as possible as exercise becomes more difficult in the late stages of symptoms. Exercise reduces patients' lung inflammation and glucocorticoid-induced damage to the immune system.
Overall, additional high-quality randomized controlled trials are required to further evaluate the effect of exercise on patients with CRD.
"More in-depth studies are needed to investigate the pathophysiological mechanisms by which different forms of exercise improve CRD and determine alternatives to pulmonary rehabilitation in patients with exercise limitations," the authors concluded.
Reference
Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, Shi Y. Exercise rehabilitation and chronic respiratory diseases: effects, mechanisms, and therapeutic benefits. Int J Chron Obstruct Pulmon Dis. 2023;18:1251-1266. Doi:10.2147/COPD.S408325
Breathing Difficulties After Covid-19: A Guide For Primary Care
Breathing difficulties can present in several ways, including breathlessness or pressure, tightness, soreness, and pain or burning in the chest. These symptoms can be associated with considerable distress. The general multisystem approach and investigation of breathlessness tends to be similar despite the interval between healthcare presentation and infection. Although there is some natural recovery in persisting symptoms between four to 12 weeks, it is difficult to predict at an individual level, and early support is often needed.7Box 1 describes a typical patient narrative.
Box 1 Breathing difficulties after covid-19—a patient's storyI had covid-19 early in 2020. At the time of my initial illness, my breathlessness was not too bad, but about four weeks after and throughout the following months it became awful. I would be gasping for air and unable to speak, and my oxygen level would drop significantly. Over two and a half years later, I still experience breathlessness daily.
Initially, I didn't know what was wrong. It was frightening, but I couldn't get any investigations on the NHS. Many of us who were ill in the first wave were told to stay away from hospital unless having a heart attack or "turning blue." I can feel very breathless even whilst sitting down; it feels like I am breathing in through a straw that collapses and stops me from getting air in. I also feel breathless when speaking, even for a short time, and my chest can feel very sore, as if the air is grating on my windpipe.
It took over a year before I had a video appointment with a long covid clinic. Eventually I had a chest x ray (which was normal) and an echocardiogram. Although the echo showed the tachycardia I was also experiencing and revealed some other issues, I was told that these did not explain the severe ongoing breathlessness that was significantly impacting my whole life. I wasn't given any specific treatment, but I was referred to a respiratory physiotherapist. I had already been doing some breathing exercises so was sceptical, but it actually proved quite helpful and made me realise just how bad the way I was breathing had been.
I now use what I learnt from the physio every day and, although I still suffer from breathlessness, it helps me to control how I am breathing, to pace my breathing, and also helps my tachycardia. I underwent lung function testing in February 2023—nearly three years since I had covid-19.
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