Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic

Wong, Alyson W.; Fidler, Lee; Marcoux, Veronica; Johannson, Kerri A.; Assayag, Deborah; Fisher, Jolene H.; Hambly, Nathan; Kolb, Martin; Morisset, Julie; Shapera, Shane; Ryerson, Christopher J.

Abstract The 2019 coronavirus disease (COVID-19) pandemic caused by the SARS-CoV-2 virus has affected virtually all aspects of patient care. Healthcare systems around the world are trying to simultaneously treat patients with COVID-19 infection, prepare for its long-term impacts, and manage patients with other acute and chronic diseases. There are multiple ways that the COVID-19 pandemic will directly affect patients with fibrotic interstitial lung disease (ILD), particularly given their common risk factors for poor outcomes. Major issues for patients with ILD will include restricted access to key components of the diagnostic process, new uncertainties in the use of common ILD pharmacotherapies, limited ability to monitor both disease severity and the presence of medication adverse effects, and significantly curtailed research activities. The purpose of this review is to summarize how COVID-19 has impacted key components of the diagnosis and management of fibrotic ILD as well as to provide strategies to mitigate these challenges. We further review major obstacles for researchers and identify priority areas for future ILD research related to COVID-19. Our goals are to provide practical considerations to support the care of patients with ILD during the COVID-19 pandemic and to provide a road map for clinicians caring for these patients during future infectious disease outbreaks.