Table 4.
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 |