Progressive fibrotic interstitial lung diseases in India: national challenges and implications for global health policies.

BACKGROUND: Interstitial lung diseases (ILDs) constitute a heterogeneous group of diffuse parenchymal lung disorders characterized by varying degrees of inflammation and fibrosis. Global estimates indicate that the incidence of ILDs has risen by over 50% in the recent years. In India, epidemiological data remain limited and inconsistent due to heterogeneity in diagnostic criteria and regional disparities, impeding accurate burden estimation and policy prioritization.

MAIN TEXT: Among ILDs, progressive fibrotic forms, idiopathic pulmonary fibrosis (IPF) in particular, cause substantial morbidity and mortality. Many ILDs progress to irreversible fibrosis, leading to declining lung function, impaired quality of life and shortened survival. Timely and precise diagnosis of progressive fibrotic (PF)-ILDs is imperative to facilitate early therapeutic intervention and potentially slow down fibrotic progression. Diagnostic evaluation necessitates high-resolution computed tomography, histopathological examination and multidisciplinary team consensus, all of which are often unavailable or prohibitively expensive outside tertiary care centres in India. Therapeutic options are confined primarily to two antifibrotic agents approved for IPF, which modestly attenuate disease progression but do not significantly improve survival in patients. Access to these therapies is limited by cost, lack of proper insurance coverage and non-uniform healthcare infrastructure. Clinical presentation is often delayed owing to low disease awareness and referral gaps. Although, pulmonary fibrosis following novel coronavirus disease 2019 has attracted recent attention, it constitutes a minor fraction of the PF-ILD burden. Despite the high morbidity and mortality associated with PF-ILDs, these conditions are inadequately represented in India's health policy instruments, research agendas and funding priorities.

CONCLUSIONS: The burden of PF-ILDs in India demands an urgent policy response, which involves integrating ILDs into national non-communicable disease frameworks, expanding diagnostic capacity in secondary care, improving affordability and access to antifibrotic drugs and supporting multicentre registries for surveillance and research. Addressing these gaps could reduce disease impact domestically and provide a model for other low- and middle-income countries confronting similar challenges in tackling fibrotic lung diseases.