Interstitial lung disease

About

This service diagnoses and treat patients with interstitial lung disease (ILD). The term ILD encompasses a wide range of conditions affecting the lung tissue (as opposed to asthma and COPD which affect the airways). These conditions can sometimes result in scarring of the lungs (pulmonary fibrosis). The most common conditions we manage are idiopathic pulmonary fibrosis, sarcoidosis, and ILD associated with connective tissue disease (ILD-CTD). We offer this service at Hammersmith and St Mary’s hospitals.

Our ILD service is one of 14 nationally specialist commissioned services in England. This status reflects the standards of care that we achieve for this disease through our unique way of working. We hold regular ILD multidisciplinary team (MDT) meetings to discuss patient cases. The MDT meetings include an expert ILD radiologist, ILD physicians, pathologists, rheumatologists and if needed, pulmonary hypertension experts. We work as part of a network where respiratory physicians from district general hospitals interact with us and refer cases to us, which we discuss in our MDT meetings. We adopt a shared care approach to these patients, including interaction with transplantation centres.

Conditions and treatments

We treat all forms of ILD, including:

• Idiopathic pulmonary fibrosis (IPF)
• Sarcoidosis ILD associated with connective tissue disease or collagen vascular disease (ILD-CTD)
• Pulmonary vasculitis
• Langerhans' cell histiocytosis (LCH)
• Connective tissue-associated ILD including scleroderma and lupus-related lung disease
• Hypersensitive pneumonitis
• Drug-induced lung disease

We offer a variety of treatments for all forms of ILD, including using oral and inhaled medications, steroid treatments and intravenous (into the vein – IV) treatments as appropriate. Supportive treatments which may be advised whatever the cause include smoking cessation, high dose PPI (anti-acid reflux treatment), mucolytics (mucus-thinning agents), home oxygen, and referral for physiotherapy and/or pulmonary rehabilitation. We also provide a range of treatments for inflammatory lung disorders such as connective tissue disease associated lung fibrosis including biologics and cyclophosphamide in our various day units.

We have a specialised sarcoidosis service associated with a large sarcoid research facility. We have linked specialist cardiologists who look after our cardiac sarcoid patients, as well as linked dermatologists, rheumatologists, neurologists and HIV specialists for sarcoid, as well as ophthalmology services available 24 hours a day.

Our service is also unique in having close links with an internationally recognised renal and respiratory vasculitis service linked to the West London Renal and Transplant Centre at Hammersmith Hospital, and the national service for Langerhans' cell histiocytosis patients. In addition, our service has close links colleagues in the Trust’s haematology, pulmonary hypertension, rheumatology and kidney and transplant services, as well as with specialists in infectious diseases and cardiothoracic surgery.

Additional information

Clinical trials and research

The EME-TIPAC clinical trial is currently open for patients with IPF. Other trials may open in the near future.

As part of a busy clinical service we also participate in multicentre and multinational clinical trials in the Imperial College Clinic Trials Unit (ICCRU), and we also are involved in basic science research in ILD, and in sarcoidosis where there is an ongoing research programme headed by Professor Ajit Lalvani and Dr Trevor Hansel. You may be approached to ask if you wish to participate in these trials.

Education and elective placements

We offer these rarely, and only by personal recommendation. Please write to Dr Robina Coker in the first instance. 

The ILD Service provides excellent educational opportunities for specialist registrars in respiratory medicine, as well as nurses and physiotherapists. Dr Coker and Dr Wickremasinghe run a number of different educational events throughout the year.

Further online resources

• British Lung Foundation 
• British Thoracic Society