Interstitial Lung Diseases treatment prescription practices among pulmonologists in India: A prospective multicentre observational study (India-ILD care study)

Abstract

Background and objectives There is limited data on prescription behaviour and compliance with interstitial lung disease (ILD) guidelines among pulmonologists. This study aimed to evaluate ILDs treatment prescription behaviour in India. Methods Prescriptions of treatment-naive ILD patients from 13 tertiary care hospitals were reviewed and classified as guideline compliant (GCP) or non-compliant (GNCP) for pharmacological and non-pharmacological components. Change in forced vital capacity (FVC), diffusing capacity (DLCO), and six-minute walk distance (6-MWD) at 6 and 12 months were compared between GCP and GNCP. Results After screening 720 participants, 425 treatment-naïve ILD patients (56.7% female; mean age 51.7 years) were included. Connective tissue associated-ILD (CTD-ILD) was the most common diagnosis (36.2%), followed by hypersensitivity pneumonitis (17.4%), idiopathic pulmonary fibrosis (IPF, 13.9%), interstitial pneumonia with autoimmune features (13.9%), and sarcoidosis (8.2%). GCP rates for ILD specific pharmacotherapy were 83%, 74.7%, and 93.5% for IPF, CTD-ILD, and sarcoidosis, respectively. In IPF, patients with GCP had significantly lower FVC decline at 12 months compared to the GNCP (0.06 L vs. 0.25 L; p = 0.02). There was huge care-gap in non-pharmacological advice with 13.2%, 7.1%, 10.2% and 4.2% of eligible cases were advised vaccination, pulmonary rehabilitation, antigen avoidance, and lung transplantation counselling, respectively. Interpretation and conclusions India-ILD care study revealed a huge care gap with significantly under-prescription of non-pharmacological components. These results highlight the urgent need for organized implementation strategies including dissemination of guidelines, and a greater emphasis on a structured management protocol that includes both pharmacological and non-pharmacological treatment to optimize outcomes for ILD in India.