Can you design an interstitial lung disease (ILD) education workshop that includes stations on basic disease concepts, pulmonary function testing, high‑resolution computed tomography (HRCT) interpretation, medication management (antifibrotic agents and prednisone), supplemental oxygen, pulmonary rehabilitation, environmental exposure avoidance, and psychosocial support?

Designing an ILD Education Workshop: Evidence-Based Structure

Yes, a comprehensive ILD education workshop should include all the proposed stations—basic disease concepts, pulmonary function testing, HRCT interpretation, medication management (antifibrotic agents and prednisone), supplemental oxygen, pulmonary rehabilitation, environmental exposure avoidance, and psychosocial support—as these align with current multidisciplinary guidelines for ILD diagnosis and management. 1, 2, 3

Workshop Structure and Core Components

Station 1: Basic Disease Concepts

This station must cover:

• ILD classification and subtypes: Focus on idiopathic pulmonary fibrosis (IPF) as the prototype of progressive fibrosis, plus connective tissue disease-associated ILD (CTD-ILD) including systemic sclerosis-ILD (SSc-ILD), rheumatoid arthritis-ILD (RA-ILD), idiopathic inflammatory myopathy-ILD (IIM-ILD), Sjögren's disease, and mixed connective tissue disease 2
• Progressive pulmonary fibrosis (PPF) criteria: Defined as occurrence over the past year of at least two of: worsening respiratory symptoms, physiological disease progression, or radiologic disease progression 4, 5
• Risk stratification: Disease-specific risk factors vary by subtype—for example, anti-Scl-70 antibodies in SSc, rheumatoid factor in RA, anti-synthetase antibodies in myositis 1, 2

Station 2: Pulmonary Function Testing (PFT)

PFTs are the cornerstone of ILD screening and monitoring 3, 1:

• Required tests: Spirometry, lung volumes, and diffusing capacity for carbon monoxide (DLCO) 3
• Screening thresholds: Decreased DLCO is the most sensitive early marker for ILD detection 1
• Monitoring frequency by disease type 3:
  • SSc-ILD and IIM-ILD: Every 3–6 months for the first year, then less frequently once stable
  • RA-ILD, Sjögren's disease-ILD, and MCTD-ILD: Every 3–12 months for the first year, then less frequently once stable
• Progression markers: ≥5% absolute or 10% relative decrease in FVC over 6 months, or ≥15% decrease in DLCO over 6 months indicates significant progression 6

Station 3: HRCT Interpretation

HRCT is the primary imaging tool for ILD detection and the most sensitive screening modality 1, 3:

Technical specifications 4:

• Slice thickness ≤1.5 mm
• Volumetric acquisition on full inspiration
• Additional ventral decubitus and expiratory acquisitions at baseline
• No contrast medium required

Pattern recognition 5:

• UIP pattern: Honeycombing with/without traction bronchiectasis, subpleural and basal predominant, heterogeneous distribution
• Probable UIP pattern: Reticular pattern with traction bronchiectasis but no honeycombing
• NSIP pattern: Most common in SSc-ILD, IIM-ILD, and Sjögren's disease—ground-glass opacities with volume loss 1
• Features suggesting alternative diagnosis: Peribronchovascular predominance with subpleural sparing, perilymphatic distribution, profuse centrilobular micronodules 5

Monitoring strategy 3:

• HRCT frequency should be clinically indicated rather than routine
• Perform HRCT when symptoms worsen or PFTs show abnormalities
• Visual scoring of fibrosis extent is essential for detecting PPF 4

Station 4: Medication Management

Antifibrotic Agents

Nintedanib is indicated for PPF when relevant lung fibrosis is present 4:

• Eligibility requires radiologic evidence of disease progression on HRCT
• Early initiation is critical as progression causes irreversible lung damage 2
• Used primarily in IPF and progressive fibrosing ILD

Prednisone Management 7

Critical warnings for prednisone use in ILD:

• Triple therapy with prednisone, azathioprine, and N-acetylcysteine is NOT recommended in definite IPF 6
• Prednisone is primarily used for CTD-ILD with inflammatory components, not fibrotic IPF
• Major risks to emphasize:
  • Immunosuppression increases infection risk (bacterial, fungal, viral, including tuberculosis reactivation)
  • Screen for latent tuberculosis and hepatitis B before initiating
  • Avoid in patients with active infections, strongyloides, or cerebral malaria
  • Osteoporosis risk: Initiate calcium, vitamin D, and bisphosphonates for therapy ≥3 months at ≥5 mg daily equivalent
  • Adrenal insufficiency with abrupt withdrawal—taper gradually
  • Monitor intraocular pressure if used >6 weeks
  • Contraindicated with live vaccines during immunosuppressive dosing

Dosing principles 7:

• Use lowest effective dose for shortest duration
• Gradual dose reduction to minimize secondary adrenocortical insufficiency
• May require up to 12 months for HPA axis recovery after prolonged high-dose therapy

Station 5: Supplemental Oxygen

Ambulatory desaturation testing is conditionally recommended 3:

• Assess every 3–12 months rather than shorter or longer intervals
• Oxygen saturation <88% during 6-minute walk test at room air indicates poor prognosis 6
• Supplemental oxygen improves quality of life in advanced ILD 8

Station 6: Pulmonary Rehabilitation

Non-pharmacologic management is essential 8:

• Pulmonary rehabilitation tailored to clinical status
• Weight-bearing exercise 30–60 minutes daily reduces osteoporosis risk in patients on corticosteroids 7
• Addresses dyspnea, exercise tolerance, and quality of life

Station 7: Environmental Exposure Avoidance

Key exposures to assess 1, 2:

• Occupational exposures (asbestos, silica, metal dusts)
• Hypersensitivity pneumonitis triggers (birds, mold, hot tubs)
• Cigarette smoking cessation is mandatory 7
• Gastroesophageal reflux disease management (risk factor for SLE-ILD) 1

Station 8: Psychosocial Support

Address the patient's illness journey 2:

• Palliative care integration for advanced ILD 8
• Early lung transplant referral discussion—advanced ILD can be rapidly fatal 8
• Psychiatric effects of corticosteroids: euphoria, insomnia, mood swings, depression, frank psychosis 7
• Support for lifestyle modifications and medication adherence

Multidisciplinary Approach

The workshop must emphasize that ILD diagnosis and management require multidisciplinary discussion (MDD) involving pulmonologists, radiologists, and pathologists 1, 6. Complex cases should be referred to expert centers 6. Recent evidence shows videoconferencing MDD platforms are feasible for physician education and remote ILD management 9.

Educational Strategy

Effective ILD education requires 10, 11:

• Combination of didactic lectures with supervised hands-on training
• Case-based learning and imaging interpretation practice
• Structured protocols to overcome barriers of lack of experience and time constraints 10
• Focus on skills for diagnosis and management at appropriate independence levels—trainees show higher confidence in diagnosis than management after training 11

Common Pitfalls to Avoid

1. Do not use prednisone triple therapy in definite IPF—this is explicitly not recommended 6
2. Do not rely on chest radiography for monitoring—conditionally recommended against 3
3. Do not use 6-minute walk distance alone for monitoring—conditionally recommended against 3
4. Do not delay HRCT when PFTs are abnormal or symptoms worsen 1
5. Do not miss screening for latent infections before immunosuppression 7
6. Do not forget that early, asymptomatic lung function loss can occur—maintain high suspicion 2