Treatment for Lung Involvement in Systemic Sclerosis

There are several treatments available for ILD, and the best option will depend on your individual situation. Treatments will usually aim to stabilise your condition, reduce your symptoms and prevent the fibrosis from worsening. In some cases of early diagnosis there may even be an improvement if the disease has not yet had a chance to progress.

All drug treatments have some side effects, and these will vary from person-to-person, according to several factors including the type of treatment and the dosage prescribed. Side effects can include an increased appetite, mood changes and difficulty sleeping; and occur most commonly with steroid tablets. Your doctor or respiratory nurse specialist will see you regularly and help you to manage the impact of any side effects.
Once a treatment plan is established, this will usually continue for as long as there is evidence of ongoing inflammation. For many people, it may be possible to reduce and eventually stop the medication once the disease is no longer active, although this process may take several years. 

Current treatments for ILD include:

• Immunosupressants are the most commonly-prescribed drugs for interstitial lung disease. They work by reducing the overactivity of the immune system, slowing the development of irreversible lung scarring. Immunosuppressants come in tablet form, and include Mycophenolate and Azathioprine. In some cases, an intravenous treatment (by drip infusion) may be considered.

• Low-dose steroids (usually 10 mg once daily) may be prescribed together with an immunosuppressant drug. Newer treatments such Nintedanib, Tocilizumab or Rituximab that target the immune system or may directly inhibit fibrosis are being tested and evaluated in clinical trials, to assess their effectiveness.

• Antibiotics may be given to treat and prevent infections, which is especially important when taking immunosuppressants. 

• Antacids to treat indigestion and heartburn (e.g. lansoprazole), are often prescribed, since the acid can irritate the lungs and may worsen fibrosis.

• Pulmonary rehabilitation (PR) is a programme of exercise and education for people affected by a chronic lung condition. It combines tailored exercises with the sharing of information, to enable people to better understand their conditions, the associated breathlessness and other symptoms. PR has been found to enable people to walk further and carry out day-to-day tasks more easily.  A PR course will usually last for up to eight weeks. Sessions are designed to provide information along with suitable  programme of exercise, and are delivered by a team of health professionals who have undergone training in PR. including physiotherapists, occupational therapists and nurses. For more information or to ask for a referral, talk to your doctor.