Future perspectives in interstitial lung disease: state of the art

R.G. Carbone, A. Monselise, A.-M. Russell, F. Puppo, V.F. Tapson

Department of Internal Medicine, University of Genoa, Genoa, Italy. magister1@mail.com

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• Respiratory Medicine

The interstitial lung disease (ILD) field is rapidly expanding as new insights highlight novel mechanisms and procedures that influence epidemiology, diagnosis, and treatment.  The aim of this review is to report on recent advancements and future perspectives in clinical management and research in ILD, particularly in idiopathic pulmonary fibrosis (IPF), for the most common ILD. Whilst high-resolution computed tomography (HRCT) remains the gold standard for diagnosis, we focus on newer diagnostic techniques, including IPF genome analysis and epigenetics, biomarkers, bronchoscope robotic navigation, and transbronchial lung cryo biopsy for improving diagnostic accuracy.  Further, we report IPF associated with pulmonary hypertension Group 3 and scores for defining disease progression. Positron emission tomography/computed tomography, treatment with prostacyclin and antifibrotic drugs, and lung transplantation as potential treatments for end-stage IPF are discussed. Lastly, we discuss contemporary perspectives on interstitial lung abnormalities (ILA), IPF associated with lung cancer, and the use of artificial intelligence (AI) for ILD diagnosis and monitoring.

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