Thank you to everyone who joined us for our recent ILD Day webinar, Personalizing ILD Medicine: The Right Treatment for the Right Patient. During the live question and answer session, the conversation sparked so many great questions from attendees that we couldn't address them all before time ran out. To keep the conversation going, we've answered five of the most common questions we received and hope these additional insights help you better understand how personalized treatment approaches may apply to your own care.

1. What genetic factors or changes could lead to medication changes?

As of now, there is no consensus of how to incorporate genetic testing to guiding treatment plans for patients with pulmonary fibrosis. There is some research that suggests patients with pulmonary fibrosis who have shorter telomere lengths should not receive immunosuppression therapies like mycophenolate and azathioprine. A major caveat is that there has yet to be a rigorous clinical trial that tests the effect of immunosuppression drugs in patients with shorter and longer telomere lengths, so there remains a lot of uncertainty. Nevertheless, this is an active area of research, and we look forward to receiving guidance on how to incorporate genetic testing to treatment plans. We have seen this approach work in cancer and other chronic lung diseases like cystic fibrosis, so I am very hopeful. 

2. Is a blood test the only way to identify biomarkers?

Blood tests are one of the most common and easiest ways to identify biomarkers that have the potential to help with diagnosis, prognosis, and treatment choices. However, other methods can also be considered to develop biomarkers. These include lung imaging (computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound), lung tissue sampling, and oral and fecal swabs that can convey information about the microbiome. These biomarker types are largely still in the research and development phase, but some are being investigated as clinical trial endpoints or to help with clinical trial enrichment.

3. Are home spirometry and monitoring via an app currently accessible to ILD patients now? If so, how can someone access these options?

Yes. There are several vendors which have developed home spirometry devices, several are FDA-approved, and monitoring apps. They are being used by some medical centers in the U.S. Keep in mind, the standard of care remains on-site clinic visits to do spirometry, and home spirometry does not replace this. If interested, patients can inquire with their providers and see if their ILD program is participating in home spirometry. With further research that proves the utility of home spirometry and that it is beneficial for patients, home spirometry may become more prevalent.  

4) How could AI be used in precision medicine?

Determining whether AI can help accelerate progress in areas we need to improve for our patients is a major priority in our ILD community. There has been published research showing the use of AI to develop and test drug therapies in pulmonary fibrosis. Another example is using AI to process and analyze lung images from CT scan to quantify the amount of damage and fibrosis that may have prognostic implications and identify features that are distinct to a patient. Notably, the National Institute of Health has prioritized this and is funding efforts to understand and implement AI for chronic illnesses. One of the major disease focuses is pulmonary fibrosis (https://nhlbi-ai.org/). I am hopeful that AI can incorporate a lot of different data (lung images, blood tests, exposure history, family history, genetics, nutrition) to help clinicians and patients identify the optimal treatment plans.  

Also, there’s an excellent PFF Disease Education Webinar by Dr. Manoj MaddalI, who discusses this in more detail. That webinar can be found here.

5) What research papers do you recommend for patients to learn more on this topic?

In addition to the research papers below, the Pulmonary Fibrosis Foundation has a wealth of resources, reading materials, and webinars that touch on many of these topics related to personalized medicine.

• Artificial intelligence in idiopathic pulmonary fibrosis: advances, challenges and future directions
• Home monitoring in interstitial lung diseases
• Online home spirometry in national pulmonary fibrosis care: insights from daily practice
• Telomere length and immunosuppression in non-idiopathic pulmonary fibrosis interstitial lung disease

Have a question that wasn't answered here? Explore the Pulmonary Fibrosis Foundation's educational resources, browse our past webinars, or contact the PFF Help Center at 844-825-5733 for additional support and information. We're here to help you stay informed every step of the way.