The 2023 ACR Guideline for the Detection and Monitoring of Interstitial Lung Disease (ILD) provides evidence-based recommendations to support early identification and structured follow-up of ILD in patients with systemic autoimmune rheumatic diseases (SARDs).
This summary highlights the key screening and monitoring recommendations relevant to clinical practice, particularly for patients at increased risk of SARD-associated ILD, including:
- Rheumatoid Arthritis (RA)
- Systemic Sclerosis (SSc)
- Idiopathic Inflammatory Myositis (IIM), including polymyositis, dermatomyositis, antisynthetase syndrome, and immune-mediated necrotizing myopathy
- Mixed Connective Tissue Disease (MCTD)
- Sjögren’s Disease (SjD)
The guideline also outlines recommendations for monitoring disease progression, helping clinicians standardize evaluation intervals and diagnostic testing strategies in high-risk populations.
By América Torres
ACR Recommendations for ILD Screening in Systemic Autoimmune Rheumatic Diseases
Pulmonary Function Tests (PFTs) for ILD Screening
- For patients with SARDs at increased risk of developing Interstitial Lung Disease (ILD), the Guide conditionally recommends screening with PFTs (Pulmonary Function Tests).
High-Resolution CT (HRCT) for Early ILD Detection
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends screening with High-resolution computed tomography (HRCT) of the chest.
- The Guide conditionally recommends screening with HRCT chest and PFTs over PFTs alone.
Tests Not Recommended for Routine ILD Screening
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with 6-minute walking distance (6 MWD).
- The Guide conditionally recommends against screening with chest radiography.
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with ambulatory desaturation testing.
- It conditionally recommends against screening with bronchoscopy.
- The Guide strongly recommends against screening with surgical lung biopsy.
ACR Recommendations for Monitoring ILD Progression
Monitoring with Pulmonary Function Tests (PFTs)
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with PFTs.
- It conditionally recommends monitoring with HRCT chest.
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with PFTs and HRCT chest over PFTs alone.
- It conditionally recommends monitoring with ambulatory desaturation testing.
Tests Not Recommended for ILD Monitoring
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with chest radiography.
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with 6MWD.
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with bronchoscopy.
Monitoring Frequency by Disease Type
- For patients with IIM-ILD and SSc-ILD, the Guide suggest PFTs for monitoring every 3-6 months rather than either shorter or longer intervals, for the first year, then less frequently once stable.
- For patients with RA-ILD, SjD-ILD, and MCTD-ILD, the Guide suggest PFTs for monitoring every 3-12 months rather than shorter or longer intervals, for the first year, then less frequently once stable.
- For patients with SARDs-ILD, the Guide does not provide guidance about frequency of routine HRCT chest for monitoring ILD but suggest HRCT when clinically indicated.
- For patients with SARDs-ILD, it suggests assessment for ambulatory desaturation every 3-12 months rather than at shorter or longer intervals.
Key Takeaways from the 2023 ACR ILD Guideline
In summary, the 2023 American College of Rheumatology Guidelines for the Detection and Monitoring of Interstitial Lung Disease in individuals with systemic autoimmune disease and rheumatic disease conditionally recommends the following screening tests:
- Pulmonary Function Tests: spirometry, lung volume, and diffusion capacity.
- High-resolution computed tomography of the chest.
It conditionally recommends these Pulmonary Function Tests: spirometry, lung volumes, and diffusion capacity in the following cases:
- For idiopathic inflammatory myopathy (IIM): every 3-6 months in the first year. Then less frequently, once the patient is stable.
- For systemic sclerosis: every 3-6 months in the first year. Then less frequently once the patient is stable.
- For rheumatoid arthritis, Sjögren’s syndrome, mixed connective tissue disease: every 3-12 months in the first year. Then less frequently once the patient is stable.
It also conditionally recommends ambulatory desaturation testing every 3-12 months. This test can be performed during routine visits or as part of the 6-minute walking distance test). Chest computed tomography is conditionally recommended as needed.
Diagnostic Solutions for ILD Screening and Monitoring
At SCHILLER-GANSHORN, we provide cutting-edge solutions for diagnosing and monitoring respiratory conditions, such as asthma, COPD, and interstitial lung disease. In addition, we design each solution with precision, efficiency, and patient comfort in mind. Our signature SharpFlow ultrasonic technology powers every system and integrates seamlessly with LFX software.
Furthermore, our devices perform the tests recommended by the 2023 ACR guideline for ILD detection and monitoring. They help clinicians detect disease early, track progression, and evaluate treatment response with confidence.
Spirometry and Diffusion Capacity Testing for ILD
Spirometry. To begin with, we offer the ultrasonic spirometer, SpiroScout, which requires no calibration and avoids cross-contamination thanks to its single-use disposable ScoutTube mouthpieces. Moreover, it features LFX software, which allows for quick report generation and comparison of patient tests for reliable monitoring.
Lung Volumes and Diffusion Capacity Testing. In addition, for comprehensive pulmonary function assessment, we offer advanced solutions for measuring lung volumes and diffusion capacity (DLCO)—key parameters recommended in the 2023 ACR guideline for the evaluation and monitoring of interstitial lung disease (ILD).
Specifically, the PowerCube Body+ body plethysmography enables precise measurement of total lung volumes, including total lung capacity (TLC), providing reliable data for detecting restrictive lung patterns commonly associated with ILD.
Likewise, for diffusion capacity testing, the PowerCube Diffusion+ System delivers accurate DLCO measurements using modern calibration-free ultrasonic sensors combined with high-speed proprietary technology. As a result, this ensures reproducible, efficient testing while supporting early detection and longitudinal monitoring of interstitial lung disease.
6-Minute Walk Test and Vital Sign Monitoring
Our solution, the Diagnostic Station DS-20, not only monitors vital signs with high precision. It also performs electrocardiograms and supports the 6-minute walk test as part of comprehensive patient assessment. In fact, the DS-20 is a unique device on the market that combines key vital signs and physical assessment tools in a single system—such as NIBP, TEMP, SpOâ‚‚, and 3-lead ECG. Furthermore, this innovative, high-performance device was designed to streamline and optimize clinical workflows. As a result, it supports physicians and nurses in hospitals, emergency departments, triage settings, and medical offices by integrating multiple assessment tools into a single platform.Â
SCHILLER Trial Program
The SCHILLER Trial Program allows you to try the SpiroScout or Diagnostic Station DS-20 free of charge for 15 business days. There is no risk and no fine print. At the end of the trial period, if the device meets your expectations, simply complete the purchase and keep it. If it does not fit your needs, return it—no obligation. Contact us today to request your trial and evaluate the system directly in your clinical workflow.
Frequently Asked Questions About PFT Devices for ILD Monitoring
What pulmonary function tests are recommended for interstitial lung disease (ILD)?
The 2023 ACR guideline recommends pulmonary function tests (PFTs) for both screening and monitoring interstitial lung disease in patients with systemic autoimmune rheumatic diseases. These tests include:
Spirometry
Lung volume measurement
Diffusion capacity (DLCO)
These parameters help detect restrictive patterns and impaired gas exchange, which are common in ILD.
What features should a pulmonary function testing device have for ILD monitoring?
When selecting a PFT device for ILD evaluation and follow-up, clinicians typically look for:
Accurate spirometry and DLCO measurement
Reliable total lung volume assessment (e.g., whole body plethysmography)
Calibration-free or low-maintenance sensors
Longitudinal comparison tools for monitoring progression
Integration with reporting software for efficient workflow
Consistency and reproducibility are especially important for detecting subtle functional decline.
Is DLCO measurement essential in autoimmune-related ILD?
Yes. Diffusion capacity (DLCO) is a critical parameter in the early detection and monitoring of interstitial lung disease. Reduced DLCO may precede spirometric changes and can signal worsening gas exchange before significant symptoms appear.
When is HRCT preferred over pulmonary function tests?
High-resolution computed tomography (HRCT) is essential for confirming ILD diagnosis and evaluating structural changes. However, for routine monitoring, PFTs are often preferred because they are non-invasive, repeatable, and suitable for longitudinal follow-up. HRCT is typically performed when clinically indicated.
Can pulmonary function testing be integrated into routine rheumatology or pulmonology practice?
Yes. Modern PFT systems are designed to integrate into outpatient clinics, hospitals, and specialty practices. Compact spirometry systems and fully equipped plethysmography cabins allow clinicians to implement guideline-recommended ILD screening and monitoring directly within their workflow.
What should clinicians consider when implementing PFT testing in their practice?
Key considerations include:
Ease of use for staff
Infection control measures (e.g., disposable mouthpieces)
Software compatibility with EMR systems
Service and maintenance requirements
Trial or evaluation programs to test performance in real-world conditions
Many providers choose to evaluate devices through structured trial programs before making a long-term investment.