Holistic management of symptom burden in fibrosing interstitial lung diseases (F-ILDs)

BACKGROUND: Disease modifying therapies for progressive fibrotic interstitial lung diseases (F-ILDs) slow physiological decline but have not consistently shown to improve patient-reported symptoms or health-related quality of life. Patients with F-ILD experience a substantial symptom burden that necessitates comprehensive supportive care alongside antifibrotic treatment. This review summarises the current evidence for management strategies for F-ILD to be considered in conjunction with disease-modifying therapies. SYMPTOM MANAGEMENT: Dyspnoea, chronic cough, fatigue, anxiety and depression are highly prevalent in F-ILD and significantly impair daily functioning. Dyspnoea management includes non-pharmacological interventions, personalised self-management strategies and selective use of low dose opioids in advanced disease though overall benefit may be modest. Chronic cough may be addressed through behavioural and speech therapy, treatment of contributing comorbidities such as gastro-oesophageal reflux disease and antitussive therapies, including neuromodulators and low dose opioids for refractory symptoms. Fatigue and psychological distress require routine screening, evaluation of modifiable factors and targeted interventions. OXYGEN THERAPY: Oxygen therapy remains a standard of care for patients with resting or exertional hypoxaemia. While it improves oxygenation, its effect on dyspnoea and symptoms is variable, underscoring the importance of individualised assessment and patient-centred decision making. PULMONARY REHABILITATION: Pulmonary rehabilitation provides evidence-based improvements in exercise capacity, symptom burden and health-related quality of life. It also offers important psychological benefits and should be integrated early and maintained as feasible throughout the disease course. PALLIATIVE CARE: Given the unpredictable trajectory of F-ILD, early integration of palliative care is essential. Discussions regarding prognosis, advance care planning and end of life preferences, supported by a multidisciplinary care model, enable holistic, goal concordant care across the progressive disease trajectory. A multidisciplinary care model is beneficial for providing individualised, holistic care throughout the patient's progressive disease trajectory.