Although there are more than 100 types of ILD with different etiologies, the usual trigger is most commonly smoking for prolonged years. Pollution in the environment, whether a trigger or just an aggravator, is a grey area, but either way can aggravate the problem.
Interstitial lung disease is a disease characterised by basic pathology of inflammation and fibrosis. Any kind of trigger most common being smoke, dust, organic& inorganic dust exposure, mold can initiate an inflammatory process which leads to remodelling and self-attack on the lungs and destroying it's spongy texture and replacing it with thickened, fibroses tissue leading to inability of oxygen flowing through blood vessels to diffuse into the lungs for adequate oxygenation of the body leading to reduced blood oxygen.
This usually presents as a chronic dry cough that lasts 1-2 years, more at night, due to friction from thickened lung tissue, which is why it does not improve with usual cough medicines. Exertional breathlessness, more than usual, with inability to do regular work, are the most characteristic symptoms.
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Although there are more than 100 types of ILD with different etiologies, the usual trigger is most commonly smoking for prolonged years. Pollution in the environment, whether a trigger or just an aggravator, is a grey area, but either way can aggravate the problem. This was classically seen in the example of the World Trade Centre attacks, where the huge amount of dust storms as a result showed increased incidence of ILD, specifically idiopathic pulmonary fibrosis type.
The other point to consider is that polluted air has all kinds of nitrous oxide, sulphur, carbon particulates along with this construction dust may have silica and asbestos which when chronically exposed can lead to ILD, it also worsens the AQI leading to reduced oxygen in the environment adding on to the hypoxic insult, which is already faced by ILD patients. These pollutants also have an effect on the weather and resultant climate changes can lead to fluctuations in the temperature further trapping the gases and particulate matter making it a vicious cycle.
Temperature fluctuations and resultant unpredictable weather leads to increase in humidity and mold, different types of mold as a part of organic dust exposure, which can lead to hypersensitivity pneumonitis, which is a type of ILD.
Exposure to birds, cattle, pigeon droppings, and feathers is another cause of hypersensitivity pneumonitis. Notably, one of the best ways to manage hypersensitivity pneumonitis is to avoid the known trigger, the sooner the better. Given these reasons, controlling pollution and such exposures plays an important role in the management of ILD.
All these changes also result in a rise in infections in society, which is one of the main; reason such patients land up in the hospital with an acute worsening. It was widely noted that during COVID and social distancing, people with chronic lung disease, like ILD, had fewer hospital visits and were stable. This can be attributed to less exposure to infections, as we were restricted to our homes, the use of masks, and fewer vehicles on the road, improving the air quality as well.
So sometimes calamities teach us a good lesson. Although ILD is a disease with less treatment options for complete cure, prevention measures capable in our hands is always helpful and advocated.
-Dr. Udaya Sureshkumar, Consultant Pulmonologist, KMC Hospital, Mangalore
