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CHESTGuidelines & Topic CollectionsPH-ILD: Screening, Detection, and Care Considerations

PH-ILD: Screening, Detection, and Care Considerations

This interactive pulmonary hypertension associated with interstitial lung disease (PH-ILD) resource is designed to support awareness, screening, and management considerations for patients with PH-ILD.

Through a series of interactive tools, learners can explore a structured screening pathway using the Screen-Detect-Confirm framework, review key findings from the PHINDER study and emerging evidence, and build a personalized PH-ILD care plan based on high-level management considerations. Together, these components provide a practical, evidence-informed resource to help clinicians recognize patterns of concern, understand evolving screening strategies, and navigate important considerations in the care of patients with PH-ILD.

More than fibrosis

Why Pulmonary Hypertension (PH) Screening Matters in Interstitial Lung Disease (ILD)

Not every worsening ILD patient has progressive fibrosis. Think also of complications associated with poor outcomes, such as pulmonary hypertension.

A systematic approach Screen–Detect–Confirm

Developed by the American College of Chest Physicians in collaboration with United Therapeutics

No domains selected

After confirmation

PH-ILD Management Considerations

Build a care plan by selecting treatment, supportive care, and referral considerations.

Clinical framing: Management should be individualized and guided by PH-ILD expertise. This section provides high-level considerations for use in a comprehensive treatment algorithm.
Confirm before treating

RHC confirms PH and supports appropriate classification and management decisions.

Individualize care

Consider severity, ILD subtype, oxygenation, RV function, comorbidities, and goals of care.

Use expertise

PH-ILD specialist involvement can support treatment selection, referral, and follow-up planning.

PHINDER EVIDENCE SPOTLIGHT

What Emerging Evidence Adds

Explore how PHINDER supports a systematic, multi-domain approach to PH screening in patients with ILD.

Evidence takeaway: PHINDER supports the same principle used in this interactive tool: Do not rely on a single clue. Look across multiple routine clinical domains to support timely evaluation and referral.

Future outlook: Preliminary findings from PHINDER support the composite use of PFT, lung imaging, and echocardiography to improve early detection of precapillary PH in ILD, and to guide structured screening strategies. The final data set from PHINDER will provide guidance on thresholds for continuous variables with application in diagnosing PH in ILD, facilitating the development of a validated evidence-based screening tool to aid the detection of PH in ILD.

References

References and Additional Resources

Explore source publications and supporting evidence used to inform this interactive experience, including PHINDER evidence and broader clinical guidance on PH screening, diagnosis, and management.

PHINDER evidence

The objective of PHINDER is to prospectively develop screening strategies for PH in patients with ILD.

PHINDER study design and rationale

Study protocol describing the PHINDER rationale, screening domains, enrichment criteria, RHC confirmation, and planned development of a PH-ILD screening approach.

Study protocol Screening domains RHC confirmation
View article ↗
Kulkarni T, Zisman DA, Shlobin OA, et al. Study design and rationale for the PHINDER study: pulmonary hypertension screening in patients with interstitial lung disease for earlier detection. Pulm Ther. 2025;11:491-501. doi:10.1007/s41030-025-00307-0. PMID:40711711.

PHINDER preliminary results

Preliminary PHINDER results evaluating noninvasive clinical, physiologic, imaging, and echocardiographic variables associated with RHC-confirmed precapillary PH in ILD.

Preliminary results HRCT Echocardiography
View article ↗
Zisman DA, Sahay S, Bandyopadhyay D, et al. Screening for pulmonary hypertension in interstitial lung disease: preliminary results from the PHINDER study. Adv Ther. 2026;43:2071-2089. doi:10.1007/s12325-026-03508-4.

PHINDER interim analysis

Conference abstract describing interim PHINDER findings in ILD patients with and without mPAP greater than 20 mmHg.

Interim data mPAP >20 mmHg Noninvasive measures
View abstract ↗
Shlobin OA, Zisman D, Bemiss B, et al. Interstitial lung disease with and without mean pulmonary artery pressure >20 mmHg: interim results from the PHINDER study. J Heart Lung Transplant. 2026;45(4 suppl):S728-S729. PII:S1053-2498(26)01664-5.