Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand.

Nov 26, 2020

Contributor: Adelle S Jee,Robert Sheehy,Peter Hopkins,Tamera J Corte,Christopher Grainge,Lauren K Troy,Karen Symons,Lissa M Spencer,Paul N Reynolds,Sally Chapman,Sally de Boer,Taryn Reddy,Anne E Holland,Daniel C Chambers,Ian N Glaspole,Helen E Jo,Jane F Bleasel,Jeremy P Wrobel,Leona Dowman,Matthew J S Parker,Margaret L Wilsher,Nicole S L Goh,Yuben Moodley,Gregory J Keir

Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand.

Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmune-mediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, disease-specific approaches to treatment have been provided.
© 2020 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Author

admin

View all posts

About The Expert

Adelle S Jee

Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Robert Sheehy

Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.

School of Medicine, University of Queensland, Brisbane, QLD, Australia.

Peter Hopkins

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

School of Medicine, University of Queensland, Brisbane, QLD, Australia.

Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia.

Tamera J Corte

Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Christopher Grainge

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.

Lauren K Troy

Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

Karen Symons

Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.

Lissa M Spencer

Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Paul N Reynolds

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.

Lung Research Laboratory, University of Adelaide, Adelaide, SA, Australia.

Sally Chapman

Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.

Sally de Boer

Respiratory Services, Auckland District Health Board, Auckland, New Zealand.

Taryn Reddy

Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia.

Anne E Holland

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.

Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.

Institute for Breathing and Sleep, Melbourne, VIC, Australia.

Daniel C Chambers

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

School of Medicine, University of Queensland, Brisbane, QLD, Australia.

Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia.

Ian N Glaspole

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.

Central Clinical School, Monash University, Melbourne, VIC, Australia.

Helen E Jo

Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Jane F Bleasel

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Jeremy P Wrobel

Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia.

Department of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.

Leona Dowman

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.

Physiotherapy Department, Austin Health, Melbourne, VIC, Australia.

Matthew J S Parker

Central Clinical School, University of Sydney, Sydney, NSW, Australia.

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Margaret L Wilsher

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

Respiratory Services, Auckland District Health Board, Auckland, New Zealand.

Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.

Nicole S L Goh

Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.

Institute for Breathing and Sleep, Melbourne, VIC, Australia.

Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia.

Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.

Yuben Moodley

NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.

University of Western Australia, Institute for Respiratory Health, Perth, WA, Australia.

Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.

Gregory J Keir

Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.

School of Medicine, University of Queensland, Brisbane, QLD, Australia.

References

PubMed