Management Strategies in Interstitial Lung Disease

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Management Strategiesin Interstitial Lung Disease

• Harold R Collard MD
• Director, Interstitial Lung Disease Program
• University of California San Francisco (UCSF)

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Disclosures

• I have relationships with the following
  organizations and companies

Research Funding Association of Specialty
Professors Chest Foundation National Institute of
Health Advising Coalition for Pulmonary
Fibrosis InterMune
Scientific Consulting CV Therapeutics Genzyme Gil
ead Science InterMune Nektar Therapeutics Roche
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Overview

• This talk is about treatment strategies in
  interstitial lung disease (ILD)
• Disease modifying approaches
• Symptom modifying approaches
• I want you to understand
• Why to treat (i.e. what are the goals of
  therapy?)
• When to treat
• How to treat

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Why to treat

1. Prolong life
2. Prevent disease/prevent progression of disease
3. Improve/maintain quality of life

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Why to treat

1. Prolong life
2. Prevent disease/prevent progression of disease
3. Improve/maintain quality of life

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When to treat
BENEFIT RISK
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When to treat
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When to treat
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How to treat

• Target biology AND symptoms

Disease modifying
Illness
Improved Health
Symptom modifying
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Disease modifying treatment
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Biology of ILD

• Injury ? inflammation ?
  fibrosis

Repetitive injury leads to the development of
widespread inflammation and/or fibrosis
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Biology of ILD

• Injury ? inflammation ?
  fibrosis
• Some conditions have little fibrosis (scarring)
  and are mostly inflammation

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Biology of ILD

• Injury ? inflammation ?
  fibrosis
• Some conditions have little inflammation and are
  mostly fibrosis (scarring)

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Disease Modifying Treatments
Treating injury Treating Inflammation Treating fibrosis
Acetylcysteine (NAC) Prednisone No available therapies
Exposure avoidance Azathioprine (Imuran) -- Pirfenidone?
-- Environmental agents Mycophenolate (CellCept) -- Bosentan (Tracleer)?
-- Medications Cyclophosphamide (Cytoxan)
Vaccination Methotrexate
Reflux therapy?
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Symptom modifying treatment
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Primary Symptoms of ILD

• Shortness of breath (dyspnea)
• Cough

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Shortness of breath
Disease
Weight
Other medical conditions
Dyspnea
Functional level
Depression
Anxiety, Pain
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Cough
Sinuses
Vocal cords
Lung
Stomach Reflux
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Summary Points

• Treatment should improve or prolong
  lifeOtherwise there is only risk
• Balancing benefits and risks is not always
  easyEvery patient is different
• Treatment should target biology and symptomsA
  comprehensive approach is essential
• Take an active role in your careManage your
  disease your disease should never manage you

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Thank you!

• UCSF ILD Program
• 400 Parnassus Avenue, 5th Floor Chest Practice
• 415-353-2577 (phone)
• www.ucsfhealth.org/ild