Approach to the Evaluation and Management of Interstitial Lung Abnormalities: An Official American Thoracic Society Clinical Statement.

Podolanczuk AJ, Hunninghake GM, Wilson KC, Khor YH, Kheir F, Pang B, Adegunsoye A, Cararie G, Corte TJ, Flanagan J, Gudmundsson G, Hariri LP, Hatabu H, Humphries SM, Kaul B, Kim JS, Konigshoff M, Kropski JA, Lee JS, Luo F, Lynch DA, Martinez FJ, Montesi SB, Moodley Y, Oldham JM, Piciucchi S, Putman RK, Richeldi L, Rosas IO, Salisbury ML, Salvatore MM, Selman M, Seo JB, Song JW, Thomson CC, Vivero M, Wain LV, Wijsenbeek M, Schwartz DA, Ryerson CJ. Approach to the Evaluation and Management of Interstitial Lung Abnormalities: An Official American Thoracic Society Clinical Statement. American journal of respiratory and critical care medicine. 2025 Jul 1; 211(7):1132-1155, DOI: 10.1164/rccm.202505-1054ST.

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Abstract:

There is growing interest in identifying early stages of interstitial lung disease (ILD) to improve patient outcomes. This document reviews updated evidence on interstitial lung abnormalities (ILAs); provides suggestions for screening, evaluation, and management; proposes criteria for distinguishing ILAs from ILD; and identifies research priorities. A committee of clinical and methodology experts met by video conference to define ILAs and ILD by consensus and voted on 11 prespecified questions after reviewing synthesized evidence from a systematic literature search. Agreement of 70% was required to approve each suggestion. ILA is defined as nondependent bilateral parenchymal abnormalities on computed tomography, including ground-glass opacities or reticulations, lung distortion, traction bronchiectasis, and/or honeycombing involving 5% of a lung zone. The updated definition removes the prior exclusion of high-risk populations. ILD is distinguished from ILAs by symptoms (dyspnea/cough) attributable to an interstitial process, abnormal or declining lung function, fibrotic (honeycombing and/or reticulation with traction bronchiectasis involving 5% of total lung volume) or progressive imaging abnormalities, and/or specific fibrotic ILD patterns on imaging or pathology. Suggestions include ILA/ILD assessment on imaging acquired for lung cancer screening, screening adults with connective tissue disease and first-degree relatives of patients with familial pulmonary fibrosis, assessing baseline symptoms and pulmonary function among those with ILAs, and monitoring ILAs with chest computed tomography every 2-3 years. This document presents a comprehensive literature review of ILAs with updates to the Fleischner Society ILA definition, establishes a working ILD definition, and provides evidence-based suggestions for ILA evaluation and management.