emDOCs.net Emergency Medicine (EM) Podcast Episode 130: Interstitial Lung Disease Part 2
Dec 1, 2025
Explore the management strategies for acute exacerbations of interstitial lung disease. Discover the importance of early involvement from pulmonology and critical care. Learn about the nuanced use of steroids and adjunct immunosuppressants. The podcast highlights antibiotic recommendations and fluid management strategies for optimal care. Understand the benefits of high-flow nasal cannula and non-invasive ventilation. Gain insights on intubation considerations and advanced rescue options like ECMO and lung transplant. Key takeaways ensure effective evaluation and management.
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Prioritize Resuscitation And Specialist Transfer
- Resuscitate and exclude other causes of respiratory distress in AE-ILD patients before definitive therapy.
- Consult pulmonology or critical care early and transfer severe cases to centers with ECMO and transplant if possible.
Use Steroids And Halt Offending Drugs
- Stop any offending medication and consider corticosteroids for acute exacerbations, acknowledging weak guideline support.
- A common regimen is IV methylprednisolone 125 mg daily for 3 days then oral taper over 2–4 weeks.
Variable Steroid Benefit By ILD Subtype
- Steroids show limited benefit in IPF exacerbations but more benefit in other ILD subtypes.
- Immunosuppressants are recommended by guidelines despite low-quality evidence.