Steroid Regimen for Interstitial Lung Disease (ILD) in Inpatient Setting

Initial Steroid Approach Based on ILD Type and Severity

The American Thoracic Society recommends pulse dose IV methylprednisolone (1000 mg daily for 3 days) followed by moderate-dose oral prednisone (up to 60 mg daily) for non-SSc SARD-ILD patients, with a slow taper over weeks to months 1, 2
For rapidly progressive ILD or acute respiratory failure, the American College of Chest Physicians recommends pulse dose IV methylprednisolone (1000 mg daily for 3 days) followed by high-dose oral prednisone (up to 60 mg daily) 1, 2, 4
The American College of Rheumatology strongly recommends against daily glucocorticoids as first-line treatment for SSc-ILD due to risk of scleroderma renal crisis 5, 3, 6
The European Respiratory Society does not recommend corticosteroid therapy for idiopathic pulmonary fibrosis (IPF) except in the context of acute exacerbation 7

The American College of Rheumatology recommends mycophenolate mofetil as a first-line steroid-sparing agent for all SARD-ILD types 5, 3, 6, 8
Azathioprine is also recommended as a first-line steroid-sparing agent for SARD-ILD patients 5, 3
Rituximab is recommended for patients with inflammatory arthritis or myositis 5, 3
Cyclophosphamide is recommended for severe, rapidly progressive cases 5, 3, 4

The American Thoracic Society recommends daily assessment of respiratory status and oxygen requirements, as well as pulse oximetry at rest and with activity 1, 2
Serial pulmonary function tests are recommended as clinically indicated 1
Monitoring for steroid-related complications, such as hyperglycemia and hypertension, is recommended 10

The American College of Chest Physicians recommends tapering steroids to the lowest effective dose or off, and continuing steroid-sparing agents as maintenance therapy 1, 2, 5, 3
Close monitoring of pulmonary function tests every 3-6 months is recommended, especially in the first 1-2 years 1, 2
Antifibrotic therapy, such as nintedanib, may be considered for progressive fibrotic ILD phenotype 1, 2