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Management Strategies in Interstitial Lung Disease

Management Strategies in Interstitial Lung Disease

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Management Strategies in Interstitial Lung Disease

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  1. Management Strategiesin Interstitial Lung Disease Harold R Collard MD Director, Interstitial Lung Disease Program University of California San Francisco (UCSF)

  2. 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 Gilead Science InterMune Nektar Therapeutics Roche

  3. 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

  4. Why to treat Prolong life Prevent disease/prevent progression of disease Improve/maintain quality of life

  5. Why to treat Prolong life Prevent disease/prevent progression of disease Improve/maintain quality of life

  6. When to treat Side effects Adverse reactions Cost BENEFIT RISK

  7. When to treat Prolong life Improve/maintain quality of life Side effects Adverse reactions Cost BENEFIT RISK

  8. When to treat Side effects Adverse reactions Cost Prolong life Improve/maintain quality of life BENEFIT RISK

  9. How to treat • Target biology AND symptoms Disease modifying Illness Improved Health Symptom modifying

  10. Disease modifying treatment

  11. Biology of ILD • Injury → inflammation → fibrosis Repetitive injury leads to the development of widespread inflammation and/or fibrosis

  12. Biology of ILD • Injury → inflammation → fibrosis • Some conditions have little fibrosis (scarring) and are mostly inflammation

  13. Biology of ILD • Injury → inflammation → fibrosis • Some conditions have little inflammation and are mostly fibrosis (scarring)

  14. Disease Modifying Treatments

  15. Symptom modifying treatment

  16. Primary Symptoms of ILD • Shortness of breath (dyspnea) • Cough

  17. Shortness of breath • Pulmonary hypertension • Reflux disease • Sleep apnea • “Neuro-mechanics” • Disease modifying therapies Disease Other medical conditions Weight • Nutrition • Exercise • (Prednisone) Dyspnea Depression Functional level Anxiety, Pain • Support groups • Advocacy • Professional Counseling • Medication • Pulmonary rehabilitation • Self-management techniques

  18. Cough • Saline nasal washes • Nasal steroid spray • Decongestant • Surgery • Disease modifying therapies • OTC suppressants • Prednisone • Thalidomide Sinuses Vocal cords Lung • Treat cause of irritation • Speech therapy Stomach Reflux • Lifestyle modification • Antacid therapy • Surgery

  19. 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

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