Subclinical Interstitial Lung Disease

Abstract

The widespread use of high-resolution computed tomography in clinical and research settings has increased the detection of interstitial lung abnormalities (ILA) in asymptomatic and undiagnosed individuals. We reported that in smokers, ILA were present in about 1 of every 12 high-resolution computed tomographic scans; however, the long-term significance of these subclinical changes remains unclear. Studies in families affected with pulmonary fibrosis, smokers with chronic obstructive pulmonary disease, and patients with inflammatory lung disease have shown that asymptomatic and undiagnosed individuals with ILA have reductions in lung volume, functional limitations, increased pulmonary symptoms, histopathologic changes, and molecular profiles similar to those observed in patients with clinically significant interstitial lung disease (ILD). These findings suggest that, in select at-risk populations, ILA may represent early stages of pulmonary fibrosis or subclinical ILD. The growing interest surrounding this topic is motivated by our poor understanding of the inciting events and natural history of ILD, coupled with a lack of effective therapies. In this perspective, we outline past and current research focused on validating radiologic, physiological, and molecular methods to detect subclinical ILD. We discuss the limitations of the available cross-sectional studies and the need for future longitudinal studies to determine the prognostic and therapeutic implications of subclinical ILD in populations at risk of developing clinically significant ILD.

Interstitial Lung Abnormalities in a CT Lung Cancer Screening Population: Prevalence and Progression Rate

“…This is consistent with the finding in our study that the CT finding of fibrotic abnormality was associated with higher mean age. However, in at-risk populations, such as families affected with pulmonary fibrosis, smokers with chronic obstructive pulmonary disease, and patients with inflammatory lung disease, this CT finding of fibrotic abnormality might be associated with reductions in lung volume, functional limitations, and increased pulmonary symptoms (31). The fact that 37% (seven of 19) of individuals with this pattern showed progression over 2-year follow-up in our study suggested that this should not necessarily be dismissed as an incidental abnormality.…”

Management of idiopathic pulmonary fibrosis: selected case reports

“…Pulmonary function tests (PFTs) showed only mild impairment of vital capacity (VC) but a severely reduced diffusing capacity of the lung for carbon monoxide (DLCO). In accordance with the diagnostic algorithm for patients with suspected ILD [8], a chest multi-slice high-resolution computed tomography (HRCT) scan was performed ( fig. 1 and table 1).…”

The Aging Lung: Clinical and Imaging Findings and the Fringe of Physiological State

“…The majority of subjects exhibited unremarkable, i. e. ageappropriate, results in the pulmonary function test. The differentiation of the described septum thickening from early forms of IPF and other forms of interstitial lung disease (ILD) is both elementary -and highly challenging [34] ( • " Fig. 5).…”