Symptom‐based management of the idiopathic interstitial pneumonia

Abstract

The term 'idiopathic interstitial pneumonia' (IIP) encompasses a wide variety of diseases with different and often unexplained pathophysiology as well as diverse natural histories. Unfortunately, many of these diseases are progressive and some are poorly responsive to available therapies. Despite the varied nature of IIPs, patients experience common symptoms related to their chronic lung disease. Dyspnoea, cough, fatigue and depression contribute substantially to morbidity and are often difficult to manage. The psychological stress of having a chronic and often life-limiting disease further complicates symptom control. Effective symptom-management requires a multidisciplinary approach that incorporates patient education and selfmanagement to formulate goals of care and treatment plans. In this context, palliative care is incorporated from the time of diagnosis of an IIP and is not restricted to the end stages of the disease. Pulmonary rehabilitation plays a central role in symptom-management and has beneficial effects across multiple domains. In patients who do not respond to disease-specific treatments and are not candidates for lung transplant, early referral to hospice may improve quality of life for both patients and their families near the end of life.

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

Characteristics for Quality of Life during the Clinical Course of Interstitial Lung Disease

“…However, correlations between FVC and the CAT score were not seen in subgroups. Recent findings demonstrated that quality of life was not consistent with pulmonary function tests in subjects with interstitial lung disease [5,13]. This discordance was likely because of fatigue and deconditioning due to dyspnea and cough, or subjects' reduced awareness of deterioration in actual pulmonary function.…”

“…Therefore, according to the paradigm shift, palliative care methods were addressed for all stages of chronic respiratory disease. For example, structured communication between healthcare professionals and patients was vital to ensure the best possible support and treatment [5,22].…”

“…Palliative care was recommended for managing symptoms using a multidisciplinary approach including patient education and selfmanagement [5]. For example, dyspnea is the major symptom reported by patients with interstitial lung disease, and it may be ameliorated by pulmonary rehabilitation as well as improvement in exercise capacity as assessed by the 6-min walk test (6MWT) [6][7][8].…”

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep

“…16 Olukogbon et al measured the breathing patterns in IPF patients and found that resting ventilation rate increased with worsening disease severity and declining lung function. 17 These changes were also associated with increased dyspnoea and cough severity, thus providing a quantifiable link between symptoms and disease severity.…”