Table 4.

Diagnosis and Management of Comorbid Conditions in Fibrotic Interstitial Lung Disease

Comorbidity	Diagnostic and Screening Tests	Management Considerations
Combined pulmonary fibrosis and emphysema	Disproportionate reduction in Dlco compared with FVC	Smoking cessation, supplemental oxygen, pulmonary rehabilitation trial of bronchodilator therapy
Lung cancer	May be incidental finding on chest radiography	Increased risk of pulmonary toxicity or ILD exacerbation in setting of surgical resection, chemotherapy, or radiotherapy
Venous thromboembolism	Consider venous Doppler scan and/or PE protocol CT scans for acute respiratory decompensation	Unchanged from non-ILD except consider drug interactions (nintedanib) PE may exclude patient from lung transplantation
Depression, deconditioning, and sedentariness	Screening and regular assessment in clinic	Cognitive behavioral therapy and antidepressant therapy Pulmonary rehabilitation
Coronary artery disease	Cardiac evaluation ± catheterization	Caution with drug-eluting stents and long-term antiplatelet therapy if candidate for lung transplant Assess for bleeding risk in patients taking nintedanib
Gastroesophageal reflux disease	Esophageal pH evaluation ± manometry	Lifestyle modification Histamine2-blocker, PPI
Hypoxemia	Pulse oximetry at rest and during exercise	Supplemental oxygen if oxygen saturation < 89%
Sleep-disordered breathing	Overnight oximetry Polysomnography	CPAP
Pulmonary Hypertension	Echocardiography, BNP Right-heart catheterization	Exclude other potential treatable causes of pulmonary hypertension Avoid endothelin receptor antagonists in IPF

BNP = B-type natriuretic peptide; ILD = interstitial lung disease; PE = pulmonary embolism. See Table 2, 3, and 4 legends for expansion of other abbreviations.