Rachel V Thomas

Health and Me

World Lung Day: Dry Cough, Breathlessness May Not Always Be Asthma — Could It Be ILD?

<span>Dry cough</span> and breathing difficulty aren’t always caused by <span><a href="https://www.healthandme.com/health/asthma">asthma</a></span>, COPD, or infections. They can also be signs of <span>interstitial lung disease</span> (<span>ILD</span>), a group of <span>lung</span> conditions that can cause inflammation and <span>scarring</span> and, in some cases, progressive loss of lung function.

ILD can go unnoticed in its early stages because its symptoms are often mistaken for more common respiratory conditions. By the time a patient undergoes a CT scan and reaches an ILD clinic, significant lung scarring may have already developed — and some of that damage may be irreversible.

Millions May Be Living With ILD Worldwide

A Global Burden of Disease Study 2023 analysis, published in December 2025, estimated that 4.58 million people were living with ILD and pulmonary sarcoidosis worldwide in 2023, with 112,650 deaths attributed to the conditions that year.

“The true global burden of ILD is higher than currently reported, particularly in underserved populations and low- and middle-income countries,” Prof. Marlies Wijsenbeek-Lourens, Pulmonologist and Head of the Center for Interstitial Lung Diseases and Sarcoidosis at Erasmus University Medical Center, Netherlands, told <strong><em>HealthandMe</em></strong>.

The global expert said most available epidemiological data come from Europe, North America, Japan, South Korea and Australia, where access to specialist care, multidisciplinary diagnosis and high-resolution CT imaging is generally more available.

“As a result, large parts of Africa, South America, South and Southeast Asia remain underrepresented in current estimates. In these regions, more limited access to diagnostic facilities, fewer ILD specialists and under-recognition of disease undoubtedly result in substantial underdiagnosis.”

Even in high-income countries, she added, some patients with ILD likely remain undiagnosed because symptoms such as <span>breathlessness</span> and cough are often attributed to more common conditions.

<strong>Also read: </strong><a href="https://www.healthandme.com/health-wellness/from-occasional-to-long-term-smoking-experts-explain-how-much-lung-damage-can-actually-reverse-after-quitting-article-156222554" data-type="tilCustomLink">From Occasional to Long-Term Smoking, Experts Explain How Much Lung Damage Can Actually Reverse After Quitting?</a>

<h2>What Is Interstitial Lung Disease?</h2>

ILD is not a single disease but a group of more than 200 lung conditions. The disease affects the interstitium, the tissue surrounding and supporting the lungs’ air sacs, or alveoli. In ILD, this tissue can become inflamed and/or scarred. 

As scarring progresses, the lungs can become stiffer, making it harder for them to expand and reducing the efficiency of oxygen transfer. As the disease progresses, the lung shrinks, making it difficult for the patient to breathe.

According to Prof. Marlies, there is a rise in ILD diagnoses due to several factors, such as:

<ul><li>Better awareness</li><li>More HRCT scans</li><li>Better diagnosis</li><li>Ageing populations</li><li>Autoimmune disease</li><li>Environmental and occupational exposure.</li></ul>

<h2>When Should Doctors Suspect ILD?</h2>

Some forms of ILD can be treated more effectively when identified early, before permanent lung damage occurs.

“Unfortunately, many patients still reach an ILD specialist late. Breathlessness and cough may initially be treated as asthma, infection or sometimes even tuberculosis. By the time a CT scan is done and the patient reaches an ILD clinic, significant scarring may already have developed,” Dr Asmita Mehta, Professor and Head, Department of Respiratory Medicine at Amrita Institute of Medical Sciences, Kochi, told <strong><em>HealthandMe</em></strong>.

“A dry cough and gradually progressive breathlessness lasting for more than three months, particularly breathlessness while walking or climbing stairs, should raise suspicion of ILD rather than simply being attributed to asthma, infection or ageing,” she added.

Doctors should think of ILD especially when these symptoms do not improve with usual treatment, when fine crackling sounds are heard in the lungs, or when oxygen levels fall during walking.

It is also important to ask about joint pain, skin changes, dry eyes or mouth, and exposure to birds, mould, biomass smoke or occupational dust. Sometimes the clue to ILD is outside the lungs, the expert said.

Pre-existing ILD was associated with worse outcomes during COVID-19. Now, six years later, some patients who had severe COVID-19 also continue to show persistent lung abnormalities.

“The reassuring part is that not every abnormal CT after COVID means progressive lung fibrosis. In many patients, the lung changes gradually improve or remain stable. Some patients who had very severe COVID, prolonged ICU admission, or required ventilation may be left with persistent scarring and may need longer follow-up,” Dr Asmita said.

<h2>What Does ILD Look Like In India?</h2>

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Common ILD diagnoses seen in India include connective tissue disease-associated ILD (CTD-ILD), hypersensitivity pneumonitis (HP), idiopathic pulmonary fibrosis (IPF), sarcoidosis and idiopathic nonspecific interstitial pneumonia (NSIP).

Dr Asmita said that, apart from idiopathic pulmonary fibrosis, ILD related to autoimmune diseases and environmental exposures is also commonly seen in India. These exposures can include birds, mould, biomass smoke and certain occupations.

Epidemiological reviews estimate the overall prevalence of ILD in India to range between 49.0 and 98.1 per 100,000 people, with an annual crude incidence rate of 10.1 to 20.2 per 100,000 population.

India is also building a larger national evidence base through the ICMR-led Indian Network of Pulmonary Fibrosis (INPF) registry.

<h2>Biggest Challenges For ILD Patients In India</h2>

<ul><li>Delayed diagnosis: Symptoms can be mistaken for asthma, infections, or tuberculosis.</li><li>Limited specialist access: ILD specialists and advanced diagnostic facilities are concentrated in larger centres.</li><li>High treatment costs: Medicines, investigations, oxygen, and pulmonary rehabilitation can be expensive.</li><li>Limited transplant access: Lung transplantation remains available only to a limited number of eligible patients.</li><li>Low awareness: Many patients and families are unfamiliar with ILD and its long-term nature.</li></ul>

“We therefore need not only earlier diagnosis, but better awareness, affordable treatment, wider access to ILD specialists and stronger advanced-care and transplant programs,” Dr Asmita said.

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Dry cough and breathing difficulty aren’t always caused by asthma, COPD, or infections. They can also be signs of interstitial lung disease (ILD), a group of lung conditions that can cause inflammation and scarring and, in some cases, progressive loss of lung function.ILD can go unnoticed in its early stages because its symptoms are often mistaken for more common respiratory conditions. By the time a patient undergoes a CT scan and reaches an ILD clinic, significant lung scarring may have already developed — and some of that damage may be irreversible.Millions May Be Living With ILD WorldwideA Global Burden of Disease Study 2023 analysis, published in December 2025, estimated that 4.58 million people were living with ILD and pulmonary sarcoidosis worldwide in 2023, with 112,650 deaths attributed to the conditions that year.“The true global burden of ILD is higher than currently reported, particularly in underserved populations and low- and middle-income countries,” Prof. Marlies Wijsenbeek-Lourens, Pulmonologist and Head of the Center for Interstitial Lung Diseases and Sarcoidosis at Erasmus University Medical Center, Netherlands, told HealthandMe.The global expert said most available epidemiological data come from Europe, North America, Japan, South Korea and Australia, where access to specialist care, multidisciplinary diagnosis and high-resolution CT imaging is generally more available.“As a result, large parts of Africa, South America, South and Southeast Asia remain underrepresented in current estimates. In these regions, more limited access to diagnostic facilities, fewer ILD specialists and under-recognition of disease undoubtedly result in substantial underdiagnosis.”Even in high-income countries, she added, some patients with ILD likely remain undiagnosed because symptoms such as breathlessness and cough are often attributed to more common conditions.Also read: From Occasional to Long-Term Smoking, Experts Explain How Much Lung Damage Can Actually Reverse After Quitting?What Is Interstitial Lung Disease?ILD is not a single disease but a group of more than 200 lung conditions. The disease affects the interstitium, the tissue surrounding and supporting the lungs’ air sacs, or alveoli. In ILD, this tissue can become inflamed and/or scarred. As scarring progresses, the lungs can become stiffer, making it harder for them to expand and reducing the efficiency of oxygen transfer. As the disease progresses, the lung shrinks, making it difficult for the patient to breathe.According to Prof. Marlies, there is a rise in ILD diagnoses due to several factors, such as:Better awarenessMore HRCT scansBetter diagnosisAgeing populationsAutoimmune diseaseEnvironmental and occupational exposure.When Should Doctors Suspect ILD?Some forms of ILD can be treated more effectively when identified early, before permanent lung damage occurs.“Unfortunately, many patients still reach an ILD specialist late. Breathlessness and cough may initially be treated as asthma, infection or sometimes even tuberculosis. By the time a CT scan is done and the patient reaches an ILD clinic, significant scarring may already have developed,” Dr Asmita Mehta, Professor and Head, Department of Respiratory Medicine at Amrita Institute of Medical Sciences, Kochi, told HealthandMe.“A dry cough and gradually progressive breathlessness lasting for more than three months, particularly breathlessness while walking or climbing stairs, should raise suspicion of ILD rather than simply being attributed to asthma, infection or ageing,” she added. Doctors should think of ILD especially when these symptoms do not improve with usual treatment, when fine crackling sounds are heard in the lungs, or when oxygen levels fall during walking.It is also important to ask about joint pain, skin changes, dry eyes or mouth, and exposure to birds, mould, biomass smoke or occupational dust. Sometimes the clue to ILD is outside the lungs, the expert said. ILD And COVID-19Pre-existing ILD was associated with worse outcomes during COVID-19. Now, six years later, some patients who had severe COVID-19 also continue to show persistent lung abnormalities.“The reassuring part is that not every abnormal CT after COVID means progressive lung fibrosis. In many patients, the lung changes gradually improve or remain stable. Some patients who had very severe COVID, prolonged ICU admission, or required ventilation may be left with persistent scarring and may need longer follow-up,” Dr Asmita said.What Does ILD Look Like In India?   Common ILD diagnoses seen in India include connective tissue disease-associated ILD (CTD-ILD), hypersensitivity pneumonitis (HP), idiopathic pulmonary fibrosis (IPF), sarcoidosis and idiopathic nonspecific interstitial pneumonia (NSIP).Dr Asmita said that, apart from idiopathic pulmonary fibrosis, ILD related to autoimmune diseases and environmental exposures is also commonly seen in India. These exposures can include birds, mould, biomass smoke and certain occupations.Epidemiological reviews estimate the overall prevalence of ILD in India to range between 49.0 and 98.1 per 100,000 people, with an annual crude incidence rate of 10.1 to 20.2 per 100,000 population.India is also building a larger national evidence base through the ICMR-led Indian Network of Pulmonary Fibrosis (INPF) registry.Biggest Challenges For ILD Patients In IndiaDelayed diagnosis: Symptoms can be mistaken for asthma, infections, or tuberculosis.Limited specialist access: ILD specialists and advanced diagnostic facilities are concentrated in larger centres.High treatment costs: Medicines, investigations, oxygen, and pulmonary rehabilitation can be expensive.Limited transplant access: Lung transplantation remains available only to a limited number of eligible patients.Low awareness: Many patients and families are unfamiliar with ILD and its long-term nature.“We therefore need not only earlier diagnosis, but better awareness, affordable treatment, wider access to ILD specialists and stronger advanced-care and transplant programs,” Dr Asmita said.

world lung day: dry cough, breathlessness may not always be asthma — could it be ild?

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