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1.     Obstructive
Sleep Apnea (OSA)

The prevalence of OSA in IPF was
reported to be 60% to 90%, but OSA therapy reduces the clinical symptoms
associated with OSA in IPF patients. Studies shown that outcomes get worse in
IPF patients who do not comply with CPAP. 12 Oxygen
supplementation alone may alleviate the severity of desaturation in the cases
of patients with worsened PH, occurred due to failure to treat OSA.

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2.     Depression

and anxiety show high prevalence of >20% in patients with ILD. Depression
can be alone independently predicted based on the severity of dyspnea, sleep
quality, reduced FVC, and pain. Recent studies suggest that ILD patients should
be referred early in the stages to pulmonary rehabilitation based on fatigue,
functional capacity, and improvements in symptoms of depression and anxiety. 13 

Rheumatoid Arthritis (RA)

with some drug therapies or infectious precipitants, chronic immune activation
and inflammation occurs in RA that promotes aberrant fibro-proliferation, which
gives rise to RA-associated ILD (RA-ILD). 14 It has been shown
that RA-ILD significantly decreased the quality of life with high utilization
of healthcare resources and poorer mortality. 15 Treatments of RA include
methotrexate, leflunomide (LEF), and anti-tumor necrosis factor ? (anti-TNF?). 16
Immunomodulators such as mycophenolate and rituximab and newly studied
antifibrotic agents have shown promising effects. Prevalence of RA-ILD has been
reported from 3.6% to 60%.



Comorbidities in ILD have shown to
significantly impair the quality of life and to reduce life expectancy. Due to
different nature of each comorbidity or the adverse effects on each other, the
treatments for each of them can be further complicated. For example,
antifibrotic therapy is less likely to prolong life in IPF patients with
advanced lung cancer or severe PH. In some cases, immunosuppression may help to
alleviate the symptoms itself, however, it may further cause the worsening of
pre-existing or triggers the development of ILD. It is essential to study the comorbidities
in ILD because an early detection and its accurate management may have the potential
benefits in reducing morbidity and mortality in the future.

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