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

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.