Impact of Lifestyle Changes on Interstitial Lung Disease Progression

Introduction:

There are many types of interstitial lung diseases, and most of them cause irreversible lung damage. In patients with interstitial lung diseases, the parts of the lungs that help oxygen enter the blood and out into the tissues are damaged. Even though altered body composition and malnutrition are well-documented in chronic pulmonary diseases, investigations on the impact of lifestyle changes and nutritional changes in interstitial lung disease are very limited.

What Is Interstitial Lung Disease (ILD)?

Interstitial lung disease includes a group of over 200 disorders that can cause lung inflammation and scarring. Interstitial lung disease can damage the tissues located between the alveoli (small air sacs in the lungs) and the blood vessels around them. This leads to difficulty in moving oxygen out of the lungs and into the body. Interstitial lung disease is often known as diffuse parenchymal lung disease (DPLD).

What Are the Causes of Interstitial Lung Disease (ILD)?

Interstitial lung disease can occur due to both known and unknown causes. They are as follows:

• Known Causes: The known causes of interstitial lung disease are as follows:

  • Granulomatous diseases like sarcoidosis.

  • Connective tissue diseases like scleroderma, rheumatoid arthritis (RA), and systemic lupus erythematosus.

  • Allergic reactions on inhaling substances like bacteria, fungi, molds, and bits of bird feathers or droppings.

  • Treatments like radiation therapy.

  • Medications like Nitrofurantoin, Amiodarone, or Methotrexate.

  • Inhaling substances like tobacco, silica, asbestos, and beryllium.

• Unknown Causes: A person having interstitial lung disease in the absence of any underlying condition or without any exposure to harmful substances is thought to be of unknown origin.

What Are the Symptoms of Interstitial Lung Disease (ILD)?

The common symptoms associated with interstitial lung disease are as follows:

• Chest discomfort.

• Fatigue and weakness.

• Dyspnea (shortness of breath), especially while climbing stairs or exercising.

• Dry cough.

• Clubbing of toes or fingers.

• Unusual sounds while breathing.

• Loss of appetite.

• Weight loss.

How Does Lifestyle Impact Interstitial Lung Disease Progression?

• Having heavy meals can often create a feeling of fullness which restricts the lungs from inflating fully, thereby causing difficulty in breathing.

• Physical inactivity and a sedentary lifestyle can give rise to excess weight, which can increase shortness of breath and strain the heart. This can lead to the progression of interstitial lung disease.

• Less intake of food and malnourishment also results in the worsening of interstitial lung disease, as being underweight can reduce the energy level, thereby making the person more susceptible to infections.

• Excess sodium intake can result in fluid retention, which interferes with breathing. Excess sodium intake is even more dangerous in persons who take Prednisone or have heart problems or high blood pressure.

• In persons with interstitial lung disease, smoking can damage the lungs even more.

• Being careless and not taking treatment for infections like flu, whooping cough, and COVID-19 can worsen interstitial lung disease.

• Exposure to silica dust, coal dust, molds, asbestos fibers, grain dust, and other irritants tends to damage the lungs over time. Hence people associated with jobs like mining and construction are at increased risk of developing interstitial lung disease.

• Exposure to animal proteins from raising birds or farming can cause lung scarring and increase the risk of interstitial lung disease.

• People who take drugs like NSAIDs, antibiotics (Nitrofurantoin, Daptomycin), heart medications like Amiodarone, and certain chemotherapy drugs like Methotrexate for prolonged periods are prone to lung damage.

How to Diagnose Interstitial Lung Disease?

The methods to diagnose interstitial lung disease are as follows:

• Medical history, which includes collecting details about the current medications, family history of lung diseases, workplace, and habits like smoking.

• A physical examination that includes looking for the signs of interstitial lung disease, like clubbing of fingers and rales (sounds heard with a stethoscope).

• Pulmonary Function Tests.

  • Oximetry.

  • Spirometry and diffusion capacity.

• Blood tests to detect antibodies or proteins of autoimmune diseases or inflammatory responses to exposures caused by bird proteins or molds.

• X-ray and CT (computed tomography) of the chest.

• Lung tissue analysis by bronchoscopy or bronchoalveolar lavage.

• Echocardiogram.

• Lung biopsy.

How Is Interstitial Lung Disease Treated?

There is no definitive cure for interstitial lung disease, and the lung scarring that has occurred cannot be reversed. But various treatment options can stop the progression of the disease and improve the symptoms. They are as follows:

• Medications:

  • Corticosteroids like Prednisone can help in reducing lung inflammation.

  • Anti-fibrotic drugs like Pirfenidone and Nintedanib help in preventing interstitial lung disease progression by blocking the scarring of lung tissues.

  • People with GERD (gastroesophageal reflux disease) can have worsening symptoms of interstitial lung disease. Proton pump inhibitors like Pantoprazole or Omeprazole are given to people with symptoms of acid reflux.

  • Medicines like Rituximab are given to treat specific causes of interstitial lung disease, like autoimmune diseases.

  • Bronchodilators are given to open up the airways and make breathing easier.

• Pulmonary Rehabilitation: This therapy focuses on strengthening the lungs and improvement in breathing. This therapy includes the following:

  • Breathing exercises.

  • Physical therapy.

  • Nutritional counseling.

• Oxygen Therapy: This involves delivering extra oxygen through a tube or mask in the nose to reduce the complications of low oxygen levels in the blood. It helps the patient to breathe easily.

• Lung Transplantation: This is the last treatment option for patients who have severe interstitial lung disease and do not respond to any other treatment methods. It is a surgical method that involves the removal of a diseased lung and replacing it with a healthier one.

How Can Lifestyle Changes Prevent Interstitial Lung Disease Progression?

The various lifestyle changes that can prevent the progression of interstitial lung disease are as follows:

• Quit smoking. People who find it difficult can indulge in smoking cessation programs. Staying away from secondhand smoke is also important.

• Exercise regularly to burn calories and strengthen the muscles used for breathing. A BMI (body mass index) of 20 to 30 should be maintained.

• A nutritionally rich diet filled with proteins, fresh fruits, and vegetables should be taken. Healthy eating is important for people with ILD as they often require extra energy to breathe and have difficulty eating.

• Getting vaccinated for pneumonia and taking an annual flu shot can reduce the worsening of respiratory symptoms in people with ILD.

• Avoid fatty and fried food items that elevate cholesterol levels.

• Wear a respirator (a mask that removes contaminants from the air) while working in harmful environments filled with metal dust, asbestos, or other chemicals.

• Stay away from things like bird droppings, hay, feathers, or grains that can cause severe allergic reactions.

• Limit caffeinated drinks and alcohol consumption.

• As ILD can affect a person emotionally due to its interference with daily life activities, it is good to join support groups where people can share the challenges they face with each other.

Conclusion:

Interstitial lung disease can cause symptoms that can range from mild to severe. Prompt treatment can help in slowing down the progression of interstitial lung disease. Taking the symptoms lightly and not consulting a doctor in the early stages can often lead to serious life-threatening complications. With timely and right treatment combined with a healthy lifestyle, people with ILD can lead a normal life.