Lessons from the interstitial lung disease-India registry: A proposed practical scheme of classification of diffuse parenchymal lung diseases in the Indian subcontinent

Abstract

The revelation of interstitial lung disease India registry leads one to consider a revisit into the classification of diffuse parenchymal lung disease that would be clinically relevant for the Indian subcontinent. The author ponders that a simple clinical classification based on steroid sensitivity may be worthwhile.

Epidemiology and Clinico-radiological features of Interstitial Lung Diseases

“…There are more than 200 various manifestations of this condition based on clinical, radiological and histopathological findings. 1 Epidemiologic studies and archive reports on diagnoses of ILD have often been dependent on International Classification of Diseases (ICD) 9th edition codes, chronological databases, or diagnosis by a single physician that exhibited variable accuracy. [2][3][4] Consequently, the accurate diagnosis of ILD requires a wide multidisciplinary approach based on assessment by a pulmonologist, a radiologist and sometimes a histopathologist with comprehensive expertise in handling the cases of ILD.…”

Pragmatic Real-world Approach to Treat Diffuse Parenchymal Lung Disease in Logistically Constraint Situations: A Proposition

“…The property of steroid-responsiveness can classify DPLD as "treatable" and "not well-treatable" categories with a third group as "unknown steroid responsiveness." 7 Incidentally, the common etiologies of DPLD in India [hypersensitivity pneumonitis (HP), sarcoidosis, connective tissue disease-related DPLDs] along with some members of idiopathic DPLD [lymphocytic interstitial…”

“…8 On the other hand, idiopathic progressive fibrosis (IPF), fibrotic-NSIP, asbestosis, and silicosis-like etiologies form the steroid non-responsive category. 7 This identification of the steroid-sensitive entities can be largely accomplished through a critical algorithmic evaluation of HRCTchest as presented in Flowchart 1. The flowchart outlines the rationality and feasibility of such an approach based on common and often some specific features of different entities on the HRCTchest.…”